Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study.

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

Implementation of an on-demand app-based heart rate and rhythm monitoring infrastructure for the management of atrial fibrillation through teleconsultation: TeleCheck-AF.

During the coronavirus 2019 (COVID-19) pandemic, outpatient visits in the atrial fibrillation (AF) clinic of the Maastricht University Medical Centre (MUMC+) were transferred into teleconsultations. The aim was to develop anon-demand app-based heart rate and rhythm monitoring infrastructure to allow appropriatmanagement of AF through teleconsultation. In line with the fundamental aspects of integrated care, including actively involving patients in the care process and providing comprehensive care by a multidisciplinary team, we implemented a mobile health (mHealth) intervention to support teleconsultations with AF patients: TeleCheck-AF. The TeleCheck-AF approach guarantees the continuity of comprehensive AF management and supports integrated care through teleconsultation during COVID-19. It incorporates three important components: (i) a structured teleconsultation ('Tele'), (ii) a CE-marked app-based on-demand heart rate and rhythm monitoring infrastructure ('Check'), and (iii) comprehensive AF management ('AF'). In this article, we describe the components and implementation of the TeleCheck-AF approach in an integrated and specialized AF-clinic through teleconsultation. The TeleCheck-AF approach is currently implemented in numerous European centres during COVID-19.

Employment of Telemedicine in Nursing Homes: Clinical Requirement Analysis, System Development and First Test Results.

PURPOSE: Demographic change and lack of specialized workforces are challenging. Likewise, home visits by general practitioners (GPs) become rarer. If a nursing home resident develops acute symptoms, nurses are often inclined to call the rescue service. Besides patient-related consequences, this might lead to unnecessary hospitalization and far-reaching health economic costs. Due to legal restrictions of remote treatment in Germany, which were recently loosened, telemedicine is still in the early stages. The aim of this study was to employ a holistic telemedical system for nursing homes which facilitates the connection to a GP and thus avoids unnecessary hospitalizations in the case of ambulatory-sensitive illnesses. MATERIALS AND METHODS: After an inter-professional requirement analysis, the iterative development was started. In addition to an audio-video connection, several point of care measurements were integrated. Finally, first field tests were performed in a nursing home in a rural area in Germany. RESULTS: One nursing home was equipped with telemedical system based on the results of the requirement analysis and tele-medically connected to a GP. Over a period of seven months, 56 routine and emergency teleconsultations took place. Only one of those required a hospital admission. In addition to video telephony, electrocardiography and assessment of vitals such as pulse, blood pressure, oxygen saturation and auscultation of heart and lungs were applied frequently. CONCLUSION: A telemedical system including integrated medical devices was successfully developed and has turned out to be helpful and even necessary for careful and reliable decision-making by the GP. First test results show high acceptance for elderly care. Involved patients, nurses, and the GP itemize various specific benefits, including economic, personal, and altruistic issues. Another issue that the current COVID-19 crisis brought to light is lowering the risk of contagion; GPs can replace their home visits by using telepresence combined with point of care measures.

Apps móviles sanitarias para Ginecología y Obstetricia / Healthcare mobile apps for Ginecology and Obstetrics

Las apps sanitarias móviles, incluidas en el ecosistema de la mSalud (salud móvil), se están configurando como la punta de lanza de una nueva Enfermería obstétrica caracterizada por una aplicación intensiva de las nuevas tecnologías. Su adaptabilidad y facilidad de programación e instalación les permite funcionar como herramientas de exámenes clínicos, bases de datos de referencia, guías técnicas o calculadoras, facilitando el proceso de la toma de decisiones por parte del profesional sanitario. La normalización, el aseguramiento de la calidad y seguridad de los datos personales manejados, junto con el problema de la validación necesaria son los temas pendientes de resolver. Las nuevas tecnologías y el surgimiento de un nuevo arquetipo de gestante empoderada obligan, a los profesionales de la obstetricia, a adaptarse al nuevo entorno tecnológico desarrollando nuevas competencias e incrementando su implicación

Healthcare mobile apps, included in the mHealth (mobile health) ecosystem, are shaping themselves as the spear head of a new Obstetrical Nursing, characterized by an intensive application of new technologies. Their adaptability and ease of programming and installation allows them to work as clinical examination tools, reference databases, technical guidelines or calculators, facilitating the decision making process by healthcare professionals. Standarization, quality assurance and safety of the personal data managed, together with the problem of required validation, are matters still pending solution. New technologies and the emergence of a new archetype of empowered pregnant woman will force obstetrical professionals to adapt to the new technological setting, by developing new competences and increasing our involvement

Integration of a mobile-integrated therapy with electronic health records: lessons learned.

BACKGROUND: Responses to the chronic disease epidemic have predominantly been standardized in their approach to date. Barriers to better health outcomes remain, and effective management requires patient-specific data and disease state knowledge be presented in methods that foster clinical decision-making and patient self-management. Mobile technology provides a new platform for data collection and patient-provider communication. The mobile device represents a personalized platform that is available to the patient on a 24/7 basis. Mobile-integrated therapy (MIT) is the convergence of mobile technology, clinical and behavioral science, and scientifically validated clinical outcomes. In this article, we highlight the lessons learned from functional integration of a Food and Drug Administration-cleared type 2 diabetes MIT into the electronic health record (EHR) of a multiphysician practice within a large, urban, academic medical center. METHODS: In-depth interviews were conducted with integration stakeholder groups: mobile and EHR software and information technology teams, clinical end users, project managers, and business analysts. Interviews were summarized and categorized into lessons learned using the Architecture for Integrated Mobility® framework. RESULTS: Findings from the diverse stakeholder group of a MIT-EHR integration project indicate that user workflow, software system persistence, environment configuration, device connectivity and security, organizational processes, and data exchange heuristics are key issues that must be addressed. CONCLUSIONS: Mobile-integrated therapy that integrates patient self-management data with medical record data provides the opportunity to understand the potential benefits of bidirectional data sharing and reporting that are most valuable in advancing better health and better care in a cost-effective way that is scalable for all chronic diseases.

Remote monitoring of patients with implanted devices: data exchange and integration.

BACKGROUND: Remote follow-up of implanted implantable cardioverter defibrillators (ICDs) may offer a solution to the problem of overcrowded outpatient clinics, and may also be effective in detecting clinical events early. Data obtained from remote follow up systems, as developed by all major device companies, are stored in a central database system, operated and owned by the device company. A problem now arises that the patient's clinical information is partly stored in the local electronic health record (EHR) system in the hospital, and partly in the remote monitoring database, which may potentially result in patient safety issues. METHODS: To address the requirement of integrating remote monitoring data in the local EHR, the Integrating the Healthcare Enterprise (IHE) Implantable Device Cardiac Observation (IDCO) profile has been developed. This IHE IDCO profile has been adapted by all major device companies. RESULTS: In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System (EPD-Vision). Data is exchanged via a HL7/XML communication protocol, as defined in the IHE IDCO profile. CONCLUSIONS: By implementing the IHE IDCO profile, we have been able to integrate the data from the remote monitoring databases in our local EHRs. It can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. Data retrieved from these systems should form an integral part of the electronic patient record as more and more out-patient clinic care will shift to personalized care provided at a distance, in other words at the patient's home.

Telestroke network fundamentals.

The objectives of this manuscript are to identify key components to maintaining the logistic and/or operational sustainability of a telestroke network, to identify best practices to be considered for assessment and management of acute stroke when planning for and developing a telestroke network, to show practical steps to enable progress toward implementing a telestroke solution for optimizing acute stroke care, to incorporate evidence-based practice guidelines and care pathways into a telestroke network, to emphasize technology variables and options, and to propose metrics to use when determining the performance, outcomes, and quality of a telestroke network.

Overcoming challenges to sustain a telestroke network.

Our objectives are to identify and help overcome obstacles to telestroke practice, to present tips for sustaining a telestroke network, to suggest strategies for obtaining buy-in from clinicians and administrative leadership and providers, and to identify and engage champions and stakeholders of telestroke.

Technology complementing military behavioral health efforts at tripler army medical center.

The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

[EEG-based communication--a new concept for rehabilitative support in patients with severe motor impairment]. / "EEG-basierende Kommunikation"--ein neues Konzept zur rehabilitativen Unterstützung von Patienten mit schwerer motorischer Beeinträchtigung.

This paper describes a paralyzed patient diagnosed with severe infantile cerebral palsy, trained over a period of several months to use an EEG-based brain-computer interface (BCI) for verbal communication. The patient learned to "produce" two distinct EEG patterns by mental imagery and to use this skill for BCI-controlled spelling. The EEG feedback training was conducted at a clinic for Assisted Communications, supervised from a distant laboratory with the help of a telemonitoring system. As a function of training sessions significant learning progress was found, resulting in an average accuracy level of 70% correct responses for letter selection. At present, "copy spelling" can be performed with a rate of approximately one letter per minute. The proposed communication device, the "Virtual Keyboard", may improve actual levels of communication ability in completely paralyzed patients. "Telemonitoring-assisted" training facilitates clinical application in a larger number of patients.

Internet-based telehealth system for the treatment of agoraphobia.

In this work that is being validated within the VEPSY project, we present a system that allows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its difficulty level. The stimuli that are used at each level are controlled automatically by the system. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient's PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual reality hardware at home, so head rotations have been simulated with the navigation system.

Video-hypnosis--the provision of specialized therapy via videoconferencing.

Hypnosis is not normally accessible to patients living in remote areas. We conducted a pilot study to evaluate the feasibility of providing hypnosis via videoconferencing, using ISDN at 384 kbit/s. Eleven of 15 patients invited to do so took part. Ten of the 11 stated that they were satisfied with the video-hypnosis session and all indicated that they would like to have further video-hypnosis sessions in the future. Sound quality and image quality were acceptable during nearly all sessions, in spite of some interference as a result of technical problems and weather conditions. The results suggest that hypnosis can be provided successfully via videoconferencing.

Teleophthalmology link between a primary health care centre and a reference hospital.

We have evaluated a teleophthalmology service linking a primary health care centre and an eye clinic at a reference hospital. General practitioners at the primary care centre serving a population of 15,000 and ophthalmologists at the reference hospital participated in this study. Eye fundus digital images were taken from 278 eye fundi of 139 consecutive patients with clinical conditions that could potentially produce fundus alterations. Fundus images were obtained with a non-mydriatic fundus camera (Canon CR6-45M) and were electronically sent reference hospital where ophthalmologist inspected the images and returned the diagnosis. In 18 patients (13%) the images did not have good enough quality to exclude eye fundus lesions. In 24 patients (17%) clear eye fundus alterations were found in at least one eye. In 14 patients (10%) there were image features suggesting retinal alterations that could not be confirmed by image inspection. Media opacity (13 eyes, 5%, seven patients, 5%) was the most common cause of poor image quality. The most difficult assessment was the evaluation of optic nerve head cupping. Retinal oedema was not observable in the digital images. In our experience teleopthalmology services seem to be an effective alternative for eye fundus diagnosis and patient follow-up.