[Education interventions in heart failure using m-Health: Systematic review]. / Educación terapéutica en insuficiencia cardiaca mediante e-Salud: revisión sistemática.

OBJECTIVE: To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure. DESIGN: Systematic review of randomized clinical trials. DATA SOURCES: Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science. SELECTION OF STUDIES: In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included. DATA EXTRACTION: The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias. RESULTS: All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application. CONCLUSION: This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.

[Opinion of doctors and users on e-health advances in primary care]. / Opinión de los facultativos y usuarios sobre avances de la e-salud en atención primaria.

OBJECTIVE: To find out the opinions of users and primary care doctors on the progress of e-health in primary care. DESIGN: Focus groups set up between 1st May and 25th September 2018. LOCATION: Primary care level in regional online health services. PARTICIPANTS: A total of 29 users and 33 primary care doctors linked to primary care that were contacted, through user associations and regional public health services, respectively. METHOD: Inductive analysis of transcripts from focus groups about the following issues: accessibility and security; efficiency; information and technical problems; potentialities. RESULTS: Online health services are positively valued in terms of cost savings both by users and doctors of primary care. Nevertheless, face-to-face interaction is still considered a key factor in the quality of service. When it comes to the access and provision of e-health services, there is shared concern for the security of the data and for the training deficiencies of users and doctors. An adequate design of the applications becomes a condition for the acceptance and diffusion of technologies that support online health. CONCLUSIONS: Health authorities should intensify the use of new technologies oriented towards easing the work of doctors, simplifying bureaucratic tasks, providing diagnostic and prescription security, and protecting data. As long as systems generate failures and mistrust, new technologies will remain to be perceived as a complement, but not as an alternative to the traditional care model.

Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India.

OBJECTIVE: To raise the quality of counselling by community health volunteers resulting in improved uptake of maternal, neonatal and child health services (MNCH), an m-health application was introduced under a project named 'Reducing Maternal and Newborn Deaths (ReMiND)' in district Kaushambi in India. We report the impact of this project on coverage of key MNCH services. METHODS: A pre- and post-quasi-experimental design was undertaken to assess the impact of intervention. This project was introduced in two community development blocks in Kaushambi district in 2012. Two other blocks from the same district were selected as controls after matching for coverage of two indicators at baseline - antenatal care and institutional deliveries. The Annual Health Survey conducted by the Ministry of Health and Family Welfare in 2011 served as pre-intervention data, whereas a household survey in four blocks of Kaushambi district in 2015 provided post-intervention coverage of key services. Propensity score matched samples from intervention and control areas in pre-intervention and post-intervention periods were analysed using difference-in-difference method to estimate the impact of ReMiND project. RESULTS: We found a statistically significant increase in coverage of iron-folic acid supplementation (12.58%), self-reporting of complication during pregnancy (13.11%) and after delivery (19.6%) in the intervention area. The coverage of three or more antenatal care visits, tetanus toxoid vaccination, full antenatal care and ambulance usage increased in intervention area by 10.3%, 4.28%, 1.1% and 2.06%, respectively; however, the changes were statistically insignificant. CONCLUSION: Three of eight services which were targeted for improvement under ReMiND project registered a significant improvement as result of m-health intervention.

Telemedicine in the treatment of patients with inflammatory bowel disease. / Telemedicina en el manejo de pacientes con enfermedad inflamatoria intestinal.

Inflammatory bowel disease (IBD) is a chronic and relapsing disorder with significant medical, social and financial impacts. IBD patients require continuous follow-up, and healthcare resource use in this context increases over time. In the last decade, telemedicine has influenced the treatment of chronic diseases like IBD via the application of information and communication technologies to provide healthcare services remotely. Telemedicine and its various applications (telemanagement, teleconsulting and tele-education) enable closer follow-up and provide education resources that promote patient empowerment, encouraging treatment optimisation over the entire course of the disease. We describe the impact of using telemedicine on IBD health outcomes and discuss the limitations of implementing these systems in the real-life management of IBD patients.

Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review.

INTRODUCTION: Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. METHODS: We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. RESULTS: A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. CONCLUSIONS: Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.

Digital health to promote adherence to antiretroviral treatment in patients with HIV/AIDS: Meta review. / Salud digital para promover la adherencia al tratamiento antirretroviral en pacientes con VIH/sida: metarevisión.

INTRODUCTION: Digital health or "e-Health" is a set of applications based on Information and Communication Technologies that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-Health interventions to promote adherence to antiretroviral therapy in people living with HIV/AIDS. METHOD: A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-Health components to promote adherence to antirretroviral therapy, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables. RESULTS: A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 randomized controlled therapies with different e-Health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-Learning. CONCLUSIONS: Evidence was found that supports that some e-Health interventions are effective in promoting adherence to antirretroviral therapy and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.

The diabetes education material on diabetes for website: Results of a validation process.

OBJECTIVE: To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS: An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS: Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION: The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care.

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.

Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours.The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Providers and adolescents rated Teen Well Check as usable and acceptable, and providers indicated that they would recommend it to their adolescent patients.

Is only one cognitive technique also effective? Results from a randomized controlled trial of two different versions of an internet-based cognitive behavioural intervention for post-traumatic stress disorder in Arabic-speaking countries.

Background: Internet-based cognitive-behavioural interventions seem to be effective for the treatment of posttraumatic stress disorder (PTSD) in Arabic-speaking countries in the MENA region. However, due to high prevalence rates of trauma-related mental disorders in this region, it is important to scale up existing Internet-based interventions in order to increase the number of clients. Objective: The aim of the study was to examine whether a brief Internet-based intervention with one cognitive technique (TF-short, 6 assignments) results in the same PTSD symptom change and lower dropouts compared to a longer intervention with two cognitive techniques (TF-reg, 10 assignments). Method: A total of 224 Arab participants (67.4% female; M = 25.3 years old) with PTSD were randomly assigned to Internet-based CBT with either a TF-reg protocol (n = 110) or a TF-short protocol (n = 114). Symptoms of PTSD and secondary outcomes (anxiety, depression, somatic complaints, quality of life) were self-assessed online at baseline and post-treatment. Treatment-associated changes were estimated using multigroup latent difference score models. Results: The overall PTSD score assessed with the PDS decreased by about 15 points in both conditions. The between-group differences (TF-reg vs. TF-short) at post-assessment were non-significant, Δ = 0.29, p = .896, d = 0.02, 95% CI [-0.30, 0.34]. Like the primary outcome, all within-group changes for the secondary outcomes throughout the intervention were statistically significant and all between-group effects were non-significant. Overall, the dropout rates did not differ between the two conditions, χ2 (1/N = 175) = 0.83, p = .364. Conclusions: The findings suggest that the shorter condition results in the same symptom change and dropout rate as the longer condition. This highlights the potential of shorter, more scalable Internet-based interventions in socially restricted and (post-)conflict societies. ClinicalTrialsgov ID: NCT01508377.

Antecedentes: Las intervenciones cognitivo-conductuales basadas en Internet parecen ser efectivas para el tratamiento del trastorno de estrés postraumático (TEPT) en los países de habla árabe de la región MENA. Sin embargo, debido a las altas tasas de prevalencia de trastornos mentales relacionados con el trauma en esta región, es importante escalar las intervenciones existentes basadas en Internet para aumentar el número de clientes.Objetivo: El propósito del estudio fue examinar si una intervención breve basada en Internet con una técnica cognitiva (TF-corta, 6 asignaciones) da como resultado el mismo cambio sintomático del TEPT y menos abandonos en comparación con una intervención más prolongada con dos técnicas cognitivas (TF -reg, 10 asignaciones).Método: Un total de 224 participantes árabes (67,4% mujeres; M = 25,3 años) con TEPT fueron asignados aleatoriamente a TCC basada en Internet con un protocolo TF-reg (n = 110) o un protocolo TF-corta (n = 114). Los síntomas del TEPT y los resultados secundarios (ansiedad, depresión, quejas somáticas, calidad de vida) fueron autoevaluadas en línea al inicio y al finalizar el tratamiento. Los cambios asociados al tratamiento se estimaron utilizando modelos de puntuación de diferencia latente multigrupo.Resultados: El puntaje general de TEPT evaluado con la PDS disminuyó aproximadamente 15 puntos en ambas condiciones. Las diferencias entre grupos (TF-reg vs. TF-corta) en la evaluación posterior no fueron significativas, Δ = 0,29, p = .896, d = 0,02, IC del 95% [-0,30, 0,34]. Al igual que el resultado primario, todos los cambios dentro del grupo para los resultados secundarios a lo largo de la intervención fueron estadísticamente significativos y todos los efectos entre los grupos no fueron significativos. En general, las tasas de abandono no difirieron entre las dos condiciones, χ2 (1/N = 175) = 0.83, p = .364.Conclusiones: Los hallazgos sugieren que la condición más corta da como resultado el mismo cambio de síntomas y la misma tasa de abandono que la condición más larga. Esto resalta el potencial de intervenciones más breves y escalables basadas en Internet en sociedades socialmente restringidas y (post) conflicto.

Technological development in telemedicine: bibliometric analysis, research gaps, and literature trends / Desenvolvimento tecnológico na telemedicina: análise bibliométrica, lacunas de pesquisa e tendências na literatura / Desarrollo tecnológico en telemedicina: análisis bibliométrico, lagunas en la investigación y tendencias en la literatura

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19.

O objetivo deste artigo foi analisar a literatura acerca do desenvolvimento tecnológico na telemedicina, por meio da bibliometria, ao identificar o estado da arte, lacunas de pesquisa e tendências na literatura. Analisou-se 67 artigos relacionados ao campo de estudo, publicados entre 2010-2020 nas bases de dados Springer Link, Science Direct, Wiley Online Library, Web of Science e Scopus. O tratamento dos dados se deu por meio dos softwares StArt, Excel, IBM SPSS Statistics e Iramuteq. Os resultados apresentaram a análise bibliométrica dos artigos, classificados nas áreas de Gestão (52,2%), TI (25,4%) e Medicina (22,4%), e uma tabela com 34 sugestões para pesquisas futuras. As tendências da literatura envolveram seis classes de estudo (saúde, estudo, serviço, tecnologia, paciente e telemedicina), que se subdividiram em nove temas de pesquisa (plataforma digital, gestão do serviço de telemedicina, operação do serviço de telemedicina, percepção do usuário final, oportunidades de negócios, percepção de profissionais de saúde, covid-19, regulamentação e robótica). Observou-se aumento significativo no número de publicações na área devido à covid-19.

El objetivo de este artículo fue analizar la literatura sobre el desarrollo tecnológico en la telemedicina me-diante bibliometría, identificando el estado del arte, las lagunas de investigación y las tendencias en la literatura. Se analizaron un total de 67 artículos relacionados con el campo de estudio, publicados entre 2010-2020 en las bases de datos de Springer Link, Science Direct, Wiley Online Library, Web of Science y Scopus. Los datos fueron procesados utilizando los programas StArt, Excel, IBM SPSS Statistics e Iramuteq. Los resultados presentaron un análisis bibliométrico de los artículos, clasificados en las áreas de Gestión (52,2%), TI (25,4%) y Medicina (22,4%), junto con una tabla de 34 sugerencias para futuras investiga-ciones. Las tendencias en la literatura abarcaron seis clases de estudio (salud, estudio, servicio, tecnología, paciente y telemedicina), que se subdividieron en nueve temas de investigación (plataforma digital, gestión del servicio de telemedicina, operación del servicio de telemedicina, percepción del usuario final, oportuni-dades de negocio, percepción de los profesionales de la salud, covid-19, regulación y robótica). Un resultado observado fue un aumento significativo en el número de publicaciones en el área debido al covid-19.

Educación terapéutica en insuficiencia cardiaca mediante e-Salud: revisión sistemática / Education interventions in heart failure using m-Health: Systematic review

Objetivo: Aportar la mejor evidencia científica disponible sobre la efectividad de los programas de educación terapéutica mediante salud digital en pacientes con insuficiencia cardiaca. Diseño: Revisión sistemática de ensayos clínicos aleatorizados. Bases de datos: Se incluyeron 6 bases de datos por su relevancia en Ciencias de la Salud: PubMed, EMBASE, Scielo, Cochraine, CINAHL y Web of Science. Selección de los estudios: Se seleccionaron estudios realizados entre el año 2018 y 2023, en idioma inglés y español, tras evaluar la calidad metodológica de los estudios; se utilizó la herramienta Jadad para discriminar aquellos que no cumplían con dicha calidad. En total se incluyeron 8 artículos de 6 países diferentes. Extracción de datos: La revisión y análisis de los documentos se realizó por pares de manera independiente. Para evaluar el riesgo de sesgo se utilizó la herramienta Cochrane para ensayos clínicos aleatorizados RoB 2. Resultados: Todas las aplicaciones contaban con educación terapéutica; también se valoró que contasen con monitorización, evaluación de signos y síntomas, titulación de fármacos y seguimiento de profesionales a través de la aplicación. Conclusión: Esta revisión revela el impacto significativo de la educación terapéutica en el aumento de conocimiento del paciente, la reducción de reingresos hospitalarios y la mejora del estado funcional y el autocuidado. Esto convierte a la salud digital en una herramienta válida para complementar la atención enfermera en pacientes con insuficiencia cardiaca.(AU)

Objective: To provide the best scientific evidence available on the effectiveness of therapeutic education programs through digital health in patients with heart failure. Design: Systematic review of randomized clinical trials. Data sources: Six databases were included due to their relevance in Health Sciences: PubMed, EMBASE, Scielo, Cochrane, CINAHL, and Web of Science. Selection of studies: In English and Spanish, studies carried out between 2018 and 2023 were selected. After evaluating the methodological quality of the studies, the Jadad tool was used to discriminate those that did not meet said quality. In total, 8 articles from 6 different countries were included. Data extraction: The review and analysis of the documents were carried out by independent pairs. The Cochrane tool for RoB 2 randomized clinical trials was used to assess the risk of bias. Results: All the applications had therapeutic education, it was also assessed that they had monitoring, evaluation of signs and symptoms, drug titration, and professional follow-up through the application. Conclusion: This review reveals the significant impact of therapeutic education in increasing patient knowledge, reducing hospital readmissions, and improving functional status and self-care. This makes digital health a valuable tool to complement nursing care in patients with heart failure.(AU)

Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

Telemedicina para seguimiento de pacientes renales trasplantados durante la pandemia por COVID-19

Contexto: la pandemia por COVID-19 generó la reestructuración de los servicios de salud en el mundo. La teleconsulta ofrece el acceso a la atención en salud a distancia como estrategia de mitigación a la propagación del virus y como una forma flexible de telemedicina. Objetivo: describir los resultados de atención en salud por modalidad de teleconsulta en pacientes trasplantados durante el inicio de la pandemia por COVID-19. Metodología: estudio descriptivo de corte transversal que describe la experiencia del uso de la teleconsulta en el inicio de la pandemia por COVID-19 en un centro de trasplante de órganos en Colombia. La información fue obtenida mediante la recolección directa de la atención en el mes de abril de 2020 y a través del envío de un cuestionario electrónico, estructurado para los pacientes atendidos por teleconsulta. Resultados: un total de 1139 pacientes con trasplante renal fueron valorados en la modalidad de teleconsulta. Alrededor del 50 % de los pacientes atendidos vivían fuera de áreas metropolitanas (n = 564) y un total de 292 (de 800 contactados) respondieron la encuesta enviada con una media de edad de 48 años. Los pacientes presentaron altos porcentajes de satisfacción con el modelo de teleconsulta (n = 278, lo que equivale al 94 %). Se presentaron dos casos sospechosos de COVID-19, los cuales fueron negativos al realizar la prueba de PCR-RT. Conclusiones: la teleconsulta es una herramienta útil en la mitigación de la emergencia sanitaria, con un alto potencial que genera mayor acceso y oportunidad de atención en salud, presentando altos índices de aceptación.

Introduction: The COVID-19 pandemic led to the restructuring of health services around the world. Teleconsultation offers access to remote health care and a mitigation strategy. Purpose: Describe the results of a teleconsultation program in a transplant center at the beginning of the COVID-19 pandemic. Methodology: Descriptive cross-sectional study describing the experience of the use of teleconsultation during the beginning of the COVID-19 pandemic at an organ transplant center in Colombia. The information was obtained by directly collecting the total number of patients treated during April 2020 and by sending a structured electronic questionnaire to the patients involved in the care. Results: A total of 1139 renal transplant patients were assessed by teleconsultation. The geographical distribution of patients in metropolitan areas and outside the metropolitan area were similar (n=575 and n=564, respectively). Of the total, 292 patients responded to the survey sent with an average age of 48 years. The patients had high satisfaction with the teleconsultation model (n=278, 94%). There were 2 suspected cases of COVID-19, which were negative when performing the PCR-RT test. Conclusions: Teleconsultation is a useful tool in the mitigation of the health emergency, with a high potential, which generates greater access and health care opportunity, presenting high acceptance rates.

Posicionamiento de la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria sobre telefarmacia: teleatención farmacéutica (TAF) / Position of the Spanish Society of Clinical, Family and Community Pharmacy on telepharmacy: telepharmaceutical telecare (TAF)

Las nuevas tecnologías de la información y comunicación (TIC) están desarrollándose desde hace bastantes años, pero la pandemia de COVID-19 ha acelerado la transformación digital de la sociedad. En el campo de la salud han surgido nuevas actividades y de esta forma términos como telemedicina, teleasistencia o teleconsulta empiezan a ser habituales. Indudablemente suponen un avance, pero tienen el riesgo de deshumanizar el contacto de sanitarios y pacientes.En el campo de la farmacia ha surgido la telefarma cia con unas innegables connotaciones logísticas y comerciales. Desde la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria se prefiere utilizar el término teleatención farmacéutica (TAF), definiéndolo como la práctica farmacéutica asistencial a distancia que utiliza las TIC para complementar la atención farmacéutica presencial que precise el paciente. La TAF incluye la prestación a distancia de algunos servicios profesionales farmacéuticos asistenciales (SPFA). La TAF debe ayudar al farmacéutico comunitario a prestar algunos SPFA, mejorando así la practica farmacéutica clínica sin caer en la deshumanización que la aplicación indiscriminada de las TIC puede producir. (AU)

Estudio piloto de un programa basado en Internet para la prevención e intervención temprana de la depresión en adolescentes / Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet "Cuida tu Ánimo", mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto).

Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

Authentic leadership in nurses' professional practice: an integrative review / El liderazgo auténtico en el ejercicio profesional del enfermero: una revisión integradora / A liderança autêntica no exercício profissional do enfermeiro: uma revisão integrativa

ABSTRACT Objectives: to identify the primary constructs concerning authentic leadership and its relevance for nurses' professional practice. Methods: integrative literature review conducted between 2015 and 2020 in LILACS, SciELO, and PubMed databases. Results: the United States published most of the 31 studies analyzed, with eight studies (25.8%), followed by Canada with seven studies (22.6%), and Brasil with five (16.1%). Most studies adopted a quantitative approach (77.41%), and 96.8% presented weak evidence. Three categories emerged: Work Engagement/Job Satisfaction and Organizational Commitment; Healthy Work Environment; and Intention to Quit the Job and Mental Exhaustion. Final Considerations: authentic leadership positively contributes to management and nursing care practice, promoting healthy work environments, structural empowerment, greater work engagement, and organizational commitment, decreasing absenteeism and mental exhaustion.

RESUMEN Objetivos: identificar los principales constructos adoptados sobre el liderazgo auténtico y su relevancia para la práctica profesional del enfermero. Métodos: revisión integradora de la literatura en el período de 2015 a 2020, en las bases de datos: LILACS, SciELO y PubMed. Resultados: de los 31 estudios analizados, los países que más publicaron fueron Estados Unidos, con 08 estudios (25,8%), Canadá con 07 (22,6 %) y Brasil con 05 (16,1%); hubo predominio de estudios de abordaje cuantitativo (77,41%) y 96,8% presentaron nivel de evidencia débil. Surgieron tres categorías para discusión: Compromiso/Satisfacción en el Trabajo y Comprometimiento organizacional; Ambiente de Trabajo Saludable; Intención de Salir del Empleo y Desgaste Mental. Consideraciones Finales: el liderazgo auténtico contribuye positivamente en la gestión y práctica del cuidado del enfermero, proporcionando ambientes de trabajo más saludables, empoderamiento estructural, mayor compromiso con el trabajo y comprometimiento organizacional, además de contribuir para la disminución de las tasas de ausentismo y desgaste mental.

RESUMO Objetivos: identificar os principais construtos adotados sobre a liderança autêntica e sua relevância para a prática profissional do enfermeiro. Métodos: revisão integrativa da literatura no período de 2015 a 2020, nas bases de dados: LILACS, SciELO e PubMed. Resultados: dos 31 estudos analisados, os países que mais publicaram foram Estados Unidos, com 8 estudos (25,8%), Canadá com 7 (22,6 %) e Brasil com 5 (16,1%); houve predomínio de estudos de abordagem quantitativa (77,41%), e 96,8% apresentaram nível de evidência fraca. Emergiram três categorias para discussão: Engajamento/Satisfação no trabalho e comprometimento organizacional; Ambiente de trabalho saudável; Intenção de sair do emprego e desgaste mental. Considerações Finais: a liderança autêntica contribui positivamente na gestão e na prática do cuidado do enfermeiro, proporcionando ambientes de trabalho mais saudáveis, empoderamento estrutural, maior engajamento no trabalho e comprometimento organizacional, além de contribuir para diminuição das taxas de absenteísmo e desgaste mental.

Atención del paciente con EPOC mediante un programa de e-salud / E-health for copd patients

La e-salud, apoyada en el uso de las nuevas tecnologías, nos da las herramientas necesarias para innovar en la asistencia a nuestros pacientes y ha permitido evolucionar el concepto de la relación profesional sanitario-paciente. Sus aplicaciones son prácticamente ilimitadas y los estudios avalan su eficacia, si bien, existen una serie de cuestiones que limitan su implementación real (dificultad para la comparación metodológica, factores asociados al profesional o al paciente, aspectos éticos y legales, etc.). Una de las aplicaciones más interesantes desde el punto de vista clínico es la tele-consulta, especialmente en la actual situación de pandemia por la COVID-19. En este trabajo revisamos las posibilidades de implementación de un programa de tele-consultas en pacientes con EPOC, la selección de candidatos, las posibles herramientas tecnológicas y las limitaciones de este tipo de programas (AU)

E-health using new technologies is a new way to attend our patients and creates a new scenario in the relation between patients and their health carers. Their applications are uncontable and many articles support their efficacy, although some questions still make difficult its implementation. One of the most interesting applications for clinicians is teleconsultation, specially nowadays with COVID pandemic. We review the possible implementation of a tele-consultation program for COPD patients, the right selection of patients, technological tools and its limitations (AU)

Monitorización clínica del paciente con esclerosis múltiple a través de la tecnología digital, un campo en plena revolución / Clinical monitoring of multiple sclerosis patients by means of digital technology, a field in the midst of a revolution

Introducción: A pesar de los grandes avances acontecidos en el área del diagnóstico y el tratamiento de la esclerosis múltiple (EM), pocos cambios se han gestado respecto al seguimiento clínico. La escasez de tiempo y espacio en la práctica clínica dificulta la valoración de síntomas invisibles y ciertos síntomas motores, como la destreza manual y la capacidad de marcha, que presentan un claro impacto en la situación funcional del paciente. Objetivo: Revisar el papel potencial de las herramientas tecnológicas en la monitorización clínica del paciente con EM. Desarrollo: Se realizó una búsqueda bibliográfica a través de PubMed, seleccionando los estudios centrados en biosensores y herramientas digitales destinadas a la evaluación de la situación funcional general, y de aspectos concretos de la enfermedad o de determinados sistemas funcionales. Resultados: Diferentes herramientas digitales en formato de biosensores, aplicaciones móviles o web, tanto de uso remoto como hospitalario, autocumplimentadas o administradas por el personal sanitario, parecen ofrecer una visión más ‘completa y real’ de la situación funcional de los pacientes. Algunos estudios han demostrado que la tecnología digital es capaz de detectar la progresión subclínica de la discapacidad, que las pruebas tradicionales, incluyendo la Escala expandida del estado de discapacidad, no consiguen reflejar, lo que favorece la adopción de medidas y acciones terapéuticas apropiadas de forma temprana y personalizada. Conclusiones: Las herramientas digitales, capaces de brindar información clínica amplia y detallada, podrían ocupar un papel importante en la toma de decisiones y el seguimiento clínico del paciente afecto de EM.(AU)

Introduction: Despite the great advances that have occurred in the diagnosis and treatment of ​ multiple sclerosis (MS), few changes have taken place in terms of clinical monitoring. The lack of time and space in clinical practice limits the assessment of invisible symptoms and certain motor symptoms as manual dexterity and walking ability, which have a clear impact on the patient functional situation.Objective: To review the potential role of technological tools in the clinical monitoring of MS patients. Development: A bibliographic search was carried out through PubMed, selecting those studies focused on biosensors and digital tools aimed at evaluating the general functional situation, and specific aspects of the disease or certain functional systems. Results: Different digital tools such as biosensors, mobile or web applications, both for remote and hospital use, self-completed or administered by healthcare personnel, seem to offer a more ‘complete and real’ picture of the functional situation of patients. Some studies have shown that digital technology could detect subclinical disability progression, which traditional tests, including the EDSS, fail to reflect, favouring the adoption of appropriate therapeutic measures and actions in an early and personalized manner. Conclusions: Digital tools, capable of collecting detailed and extensive clinical information, could play an important role in decision-making and clinical monitoring of patients with MS.(AU)

Descripción de la implantación y grado de desarrollo de tecnología de comunicación e informática de los equipos de Atención Primaria en los servicios autonómicos de salud en España / Description of the implementation and degree of development of primary care telecommunication and information technology in regional health services in Spain

Objetivo: Describir la situación, percepciones y opiniones de los profesionales sanitarios de Atención Primaria (AP) respecto a los sistemas de telecomunicación y telemedicina de este ámbito, así como determinar su grado de satisfacción. Método: Estudio descriptivo observacional transversal realizado en profesionales sanitarios de Atención Primaria mediante un cuestionario autocumplimentado con variables sociodemográficas, características laborales, opiniones y percepciones sobre desarrollo informático, sistemas de información, accesibilidad telemática, seguridad para pacientes y el grado de satisfacción de los profesionales respecto al desarrollo informático. Resultados: Los resultados muestran que se puede acceder a informes de alta hospitalaria y urgencias en el 89,2% (intervalo de confianza [IC] 95%: 86,4-92,0) y 87,2% (IC 95%: 84,2-90,2) de casos, respectivamente. Existe opción de teleconsulta con hospitalaria según un 95,1% de encuestados. Un 38,9% indicó disponer de alertas de recepción de informes de hospital, y el 73,3%, tener accesibilidad telemática para sus pacientes. El 34,8% señaló que no había ninguna mejora en general en las vías de comunicación, y el 51,7% y tampoco veía mejoras en los recursos tecnológicos en general tras la pandemia. Un 13,0% manifestó estar muy insatisfecho y el 27,3% dijo estar insatisfecho con el nivel de desarrollo informático en sistemas de telemedicina y telecomunicación en la AP de su área sanitaria. Conclusiones: La mayoría de los equipos de Atención Primaria de los Servicios Autonómicos disponen de historia clínica compartida con el hospital, mientras que solo una parte cuenta con sistemas de alertas de recepción de informar del ámbito hospitalario. El obligado cambio de la asistencia sanitaria no ha mejorado sustancialmente los recursos tecnológicos tras la pandemia y existe un considerable grado de insatisfacción de los profesionales.(AU)

Objective: To report Primary Care healthcare professionals’ circumstances, insight and points of view in regard to telecommunication systems and telemedicine as well as determine their degree of satisfaction. Method: Descriptive, observational, transversal study performed on primary healthcare professionals by means of a self-completion questionnaire with socio-demographic variables, job characteristics, views and perceptions in regard to IT development, information systems, online accessibility, patient safety and the degree of satisfaction of healthcare professionals with IT development. Results: The results showed that it is possible to access discharge reports from hospitalized patients and from the accident and emergency department in 89.2% (95%CI: 86.4-92.0) and 87.2% (95%CI: 84.2-90.2) of cases, respectively. According to 95.1% of people polled, there is an option for remote consultation with hospital care. A total of 38.9% of survey respondents pointed out that they receive e-notifications of hospital reports and 73.3% claimed to have online access to their patients’ information. A total of 34.8% and 51.7% of clinicians stated that, in general, there was no improvement in communication channels or technological resources after the pandemic, respectively. A total of 13.0% of respondents expressed that they are very unsatisfied and 27.3% unsatisfied with IT development in primary healthcare telemedicine systems and telecommunication in their health area. Conclusion: Most Primary Care healthcare teams in regional health services have access to medical histories shared with hospitals. However, just some of them have electronic notification systems for hospital reports. The mandatory change in healthcare has not substantially improved technological resources after the pandemic and there is a considerable level of dissatisfaction among professionals.(AU)

Módulo Programas Médicos para el Sistema de Información Hospitalaria XAVIA HIS / Module Medical Programs for the XAVIA HIS Hospital Information System

La prestación personalizada de los servicios de salud resulta cada vez más atractiva y eficiente. El empleo de las herramientas informáticas para facilitar este propósito es una necesidad de las instituciones de salud. El Sistema de Información Hospitalaria XAVIA HIS es un ejemplo de la relación entre las necesidades de las instituciones de salud y la evolución funcional del mismo. Sin embargo, en el sistema no se ha concebido la posibilidad de planificar un protocolo que especifique los cuidados y procedimientos que deben realizarse en función del estado de salud del paciente. El trabajo presenta el desarrollo del módulo Programas Médicos para el sistema XAVIA HIS, que permite mejorar la gestión de la información generada durante el procesamiento de los programas médicos en las instituciones hospitalarias. Se realizó el análisis de los procesos de negocio asociados a la gestión de los programas médicos, se empleó como metodología de desarrollo AUP-UCI, JBoss Developer Studio, Java, JBoss como servidor de aplicaciones, PostgreSQL como sistema gestor de bases de datos y Visual Paradigm como herramienta CASE. Como resultado se obtuvo el módulo Programas médicos para el sistema XAVIA HIS, que permite la configuración de un programa médico a un paciente con una determinada enfermedad agrupando varios servicios, procedimientos, investigaciones clínicas por cada área del hospital(AU).

The health services personalized provision is becoming increasingly attractive and efficient. The computer tools used to facilitate this purpose is a necessity for health institutions. The Hospital Information System XAVIA HIS is an example of the relationship between the health institutions needs and its functional evolution. However, the system has not conceived the possibility of planning a protocol that specifies the care and procedures that must be performed depending on patient health condition. The paper presents the development of the Medical Programs module for the XAVIA HIS system, which allows to improve the management of information generated during the medical programs processing in hospital institutions. For this work development, an analysis of the business processes associated with the medical programs management was carried out; AUP-UCI was used as development methodology, JBoss Developer Studio, Java, JBoss as an application server, PostgreSQL as database management system and Visual Paradigm as a CASE tool. As a result, the Medical Programs module for the XAVIA HIS system was obtained, which allows the medical program configuration for a patient who has a certain disease, grouping several services, procedures, clinical investigations for each hospital area(AU)