[A look into the neighboring discipline: eHealth in oncology]. / Ein Blick in die Nachbardisziplin: eHealth in der Onkologie.

Digitalization is dramatically changing the entire healthcare system. Keywords such as artificial intelligence, electronic patient files (ePA), electronic prescriptions (eRp), telemedicine, wearables, augmented reality and digital health applications (DiGA) represent the digital transformation that is already taking place. Digital becomes real! This article outlines the state of research and development, current plans and ongoing uses of digital tools in oncology in the first half of 2024. The possibilities for using artificial intelligence and the use of DiGAs in oncology are presented in more detail in this overview according to their stage of development as they already show a noticeable benefit in oncology.

Aplicación de tecnologías móviles (m-Salud) y salud electrónica (e-Salud) en el manejo y en la prevención de la litiasis renal: revisión sistemática / Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

Introducción La litiasis renal (LR) es una enfermedad urológica común, que a menudo requiere de cuidados a largo plazo. Las tecnologías de salud móvil (m-Salud) y salud electrónica (e-Salud) tienen el potencial de mejorar el manejo de las enfermedades crónicas e impactar sobre los patrones de la conducta. Para evaluar la aplicabilidad de estas herramientas en la mejora del tratamiento y la prevención de la LR, nos propusimos evaluar los datos actuales sobre el uso, los beneficios y las limitaciones de la m-Salud y la e-Salud en la LR. Métodos Se realizó una revisión sistemática de los estudios de investigación primaria sobre m-Salud y e-Salud en la evaluación y tratamiento de la LR. Dos investigadores independientes examinaron las citas por título y resumen para determinar su pertinencia y, a continuación, se realizó una revisión del texto completo para obtener un resumen descriptivo de los estudios. Resultados Se incluyeron 37 artículos para el análisis. Las principales áreas de interés fueron: 1) botellas de agua «inteligentes» y aplicaciones de dispositivos móviles para el seguimiento del consumo de líquidos, que mostraron un aumento de la ingesta en la mayoría de los estudios; 2) plataformas de seguimiento de stent ureterales, que mejoraron la tasa de stent retenidos a largo plazo; 3) clínicas virtuales para el tratamiento de la LR, las cuales han mejorado el acceso, han reducido costes y han mostrado resultados satisfactorios; 4) plataformas de endoscopia para teléfonos inteligentes, que ofrecieron una buena calidad de imagen respecto a sus costes en entornos de recursos limitados, y 5) información sobre la LR en línea para pacientes, la cual generalmente se caracterizó por ser de mala calidad y/o precisión, particularmente en YouTube®. La mayoría de los estudios eran pruebas de concepto o estudios de intervención de un solo brazo, con una evaluación limitada de la eficacia o de los resultados clínicos a largo plazo. Conclusiones ... (AU)

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. (AU)

Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain / Evaluación de la satisfacción de los pacientes con las consultas telefónicas antes, durante y después de la pandemia de COVID-19 en España

Objective: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. Design: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. Setting: PC. Participants: 405 users of PC services in Zaragoza (Spain). Main outcome measure: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. Results: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. Conclusion: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.(AU)

Objetivo: Validar un cuestionario para analizar la percepción de los usuarios de atención primaria (AP) con la consulta telefónica (CT) y estudiar la satisfacción de la CT por parte de estos. Diseño: Estudio en dos fases. Se validó un cuestionario sobre satisfacción con los servicios de telemedicina. Después, se realizó un estudio transversal sobre la satisfacción con la CT. Emplazamiento: AP. Participantes: Un total de 405 usuarios de servicios de AP en Zaragoza (España). Medición principal: Satisfacción con los servicios de telemedicina de AP. El análisis factorial se realizó a través del exploratorio con rotación Varimax. La fiabilidad de las dimensiones se analizó con el alfa de Cronbach. El inferencial se efectuó mediante pruebas paramétricas. Resultados: El cuestionario resultó válido y fiable (α>0,9) para evaluar la satisfacción de los usuarios con la telemedicina. Antes de la COVID-19, esta era adecuada (media=6,111/10) con la AP. Durante la pandemia la atención en AP pasó a ser mayoritariamente telefónica y la satisfacción disminuyó (media=3,555/10). Con respecto al futuro de la telemedicina, los usuarios lo consideraron insatisfactorio (media=2,977/10). Ser mujer, estar en paro y pertenecer a una zona de baja vulnerabilidad conllevó una peor percepción de la telemedicina. Conclusiones: Nuestro cuestionario fue un instrumento válido y fiable para evaluar la satisfacción de los usuarios de servicios de AP con la telemedicina, la cual disminuyó durante la COVID-19. La CT es una buena opción cuando los pacientes la consideran una herramienta complementaria y no sustitutiva para el seguimiento de sus dolencias.(AU)

SIG Tel@ rBLH 21 de Novembro de 2011: Perspectivas da Telessaúde no Estado do Amazonas

Palestra com o tema, Perspectivas da Telessaúde no Estado do Amazonas, proferida pelo Dr. Jefferson Guilherme em Congresso Brasileiro de Telessaúde e Telemedicina Manaus/AM.

Hospital de día psiquiátrico en tiempos de COVID: grupos y telemedicina / Psychiatric day hospital in times of covid: Groups and telemedicine

Tras decretarse el estado de alarma y el confinamiento por la amenaza del COVID-19, el acceso a los servicios de salud mental y recursos psicosociales se vio obstaculizado, incluso interrumpido.Un colectivo especialmente en riesgo es el de pacientes diag-nosticados de Trastorno Mental Grave. Estos presentan una serie de características que los hace más vulnerables a padecer un em-peoramiento en su salud mental.Desde el Hospital de Día para primeros brotes psicóticos de Pontones se intentó mantener la atención y el seguimiento estre-cho de los pacientes mediante la reestructuración del programa de tratamiento, optando por una intervención terapéutica alternativa mixto (con atención individual presencial y telefónica y terapias grupales por videoconferencia).El objetivo de este trabajo es dar a conocer la experiencia de la implementación de la telemedicina en nuestro HD como res-puesta a la emergencia sanitaria que ocasionó la pandemia, así como recoger el programa de actividades que se desarrollaron y el nivel de satisfacción con el tratamiento recibido de los pacientes que participaron.(AU)

Following the state of alarm and containment due to the CO-VID-19 threat, access to mental health services and psychosocial resources was hampered, even interrupted.A particularly at-risk group is that of patients diagnosed with Severe Mental Disorder. They present a series of characteristics that make them more vulnerable to a worsening of their mental health.From the Day Hospital for first psychotic outbreaks in Pontones we tried to maintain the attention and close monitoring of patients by restructuring the treatment programme, opting for a mixed al-ternative therapeutic intervention (with individual face-to-face and telephone attention and group therapies by videoconference).The aim of this paper is to report on the experience of implemen-ting telemedicine in our HD as a response to the health emergency caused by the pandemic, as well as to record the programme of activities that were developed and the level of satisfaction with the treatment received by the patients who participated.(AU)

Telehealth and In-Person Mental Health Service Utilization and Spending, 2019 to 2022.

This cohort study assesses trends in monthly telehealth vs in-person utilization and spending rates for mental health services among commercially insured US adults before and during the COVID-19 pandemic.

A regulação jurídica brasileira do exercício da telemedicina no contexto da pandemia do COVID-19 / La regulació jurídica brasilera de l'exercici de la telemedicina en el context de la pandèmia de COVID-19 / La regulación jurídica brasileña del ejercicio de la telemedicina en el contexto de la pandemia de COVID-19 / The Brazilian legal regulation of the exercise of telemedicine in the context of the COVID-19 pandemic

O presente artigo tem como tema central a regulação jurídica do exercício da telemedicina, especialmente a partir do contexto criado na pandemia do COVID-19. Neste sentido, o estudo aborda os mecanismos legais e as orientações dadas pelo Conselho Federal de Medicina (CFM) para adoção da prática. Surgem, em virtude disso, diversos questionamentos referentes à situação trabalhista dos profissionais de saúde que utilizam a telemedicina como mecanismo de trabalho. O artigo, portanto, explanará a importância da adoção da telemedicina, como também as problemáticas oriundas de sua utilização.(AU)

L'article té com a tema central la regulaciójurídica de l'exercici de la telemedicina, especialment des del context creat en la pandèmia COVID-19. L'article aborda els mecanismes legals i les directrius donades pel Consell Federal de Medicina (CFM) per a l'adopció de la pràctica. Com a conseqüència, sorgeixen diverses preguntes sobre la situació laboral dels professionals sanitaris que utilitzen la telemedicina com a mecanisme de treball. L'article, per tant, explicarà la importància d'adoptar la telemedicina, així com els problemes derivats del seuús.(AU)

El artículo tiene como tema central la regulación jurídica del ejercicio de la telemedicina, especialmente desde el contexto creado en la pandemia COVID-19. El artículo aborda los mecanismos legales y las directrices dadas por el Consejo Federal de Medicina (CFM) para la adopción de la práctica. Como consecuencia, surgen varias preguntas sobre la situación laboral de los profesionales sanitarios que utilizan la telemedicina como mecanismo de trabajo. El artículo, por tanto, explicará la importancia de adoptar la telemedicina, así como los problemas derivados de su uso.(AU)

This article has as its central theme the legal regulation of the exercise of telemedicine, especially from the context created in the COVID-19 pandemic. In this sense, the study addresses the legal mechanisms and guidelines given by the Federal Council of Medicine (CFM) for the adoption of the practice. As a result, several questions arise regarding the work situation of health professionals who use telemedicine as a work mechanism. The article, therefore, will explain the importance of adopting telemedicine, as well as the problems that arise through it.(AU)

Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED-1).

OBJECTIVE: Supported by the state government, three health networks partnered to initiate a virtual ED (VED), as part of a broader roll-out of emergency telehealth services in Victoria. The aim of the present study (Southeast Region Virtual Emergency Department-1 [SERVED-1]) was to report the initial 5-month experience and included all patients assessed through the service over the first 5 months (1 February 2022 to 30 June 2022). METHODS: VED consults occurred after referral from paramedics in the pre-hospital setting. Electronic medical records were retrospectively reviewed for demographic, presenting complaint and outcome data. The primary outcome was the count of VED consultations. The secondary outcome was the proportion of patients where physical ED attendance was avoided within 72 h. The proportion of physical ED attendances avoided sub-grouped by primary presenting complaints were reported. RESULTS: There were 1748 patients who had a VED consultation, of which 1261 (72.1%; 95% confidence interval [CI] 70.0-74.2) patients had physical presentation to an ED avoided in the 72 h following the consult. There was a significant increase in consultations over the 5-month period (incidence rate ratio 1.27; 95% CI 1.23-1.31, P < 0.001) that was consistent in the three health services. The most common presenting complaints were COVID-19 and shortness of breath, and physical presentation was avoided most often among younger patients and those with COVID-19. CONCLUSIONS: Initial experience demonstrated a significant increase in adoption of the service and an overall avoidance of physical ED attendance by a majority of patients. These results support ongoing VED consultations, complemented by follow up and health economic evaluations.

Estado actual de la telemedicina en el ámbito de la Hepatología en España: desafíos, retos y pasos a seguir para una transformación digital inteligente / Current state of telemedicine in the field of Hepatology in Spain: challenges, challenges and steps to follow for an intelligent digital transformation

La medicina y la tecnología están en continua evolución. La pandemia ha acelerado el desarrollo de la digitalización del sector sanitario y, en concreto, de la telemedicina. Mediante una revisión bibliográfica estructurada siguiendo la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), en este trabajo se definen los conceptos relacionados con la telemedicina, su aplicación y el contexto regulatorio legal. Con esta información, se proponen unas recomendaciones y códigos de buenas prácticas para su implementación efectiva en el ámbito de la Hepatología (AU)

Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis.

BACKGROUND: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. OBJECTIVE: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. RESULTS: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study. CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.

Utilizing Data from Wearable Technologies in the Era of Telemedicine to Assess Patient Function and Outcomes in Neurosurgery: Systematic Review and Time-Trend Analysis of the Literature.

BACKGROUND: The COVID-19 pandemic has driven the increased use of telemedicine and the adoption of wearable technology in neurosurgery. We reviewed studies exploring the use of wearables on neurosurgical patients and analyzed wearables' scientific production trends. METHODS: The review encompassed PubMed, EMBASE, Web of Science, and Cochrane Library. Bibliometric analysis was performed using citation data of the included studies through Elsevier's Scopus database. Linear regression was utilized to understand scientific production trends. All analyses were performed on R 4.1.2. RESULTS: We identified 979 studies. After screening, 49 studies were included. Most studies evaluated wearable technology use for patients with spinal pathology (n = 31). The studies were published over a 24-year period (1998-2021). Forty-seven studies involved wearable device use relevant to telemedicine. Bibliometric analysis revealed a compounded annual growth rate of 7.3%, adjusted for inflation, in annual scientific production from 1998 to 2021 (coefficient=1.3; 95% Confidence Interval = [0.7, 1.9], P < 0.01). Scientific production steadily increased in 2014 (n = 1) and peaked from 2019 (n = 8) to 2021 (n = 13) in correlation with the COVID-19 pandemic. Publications spanned 34 journals, averaged 24.4 citations per article, 3.0 citations per year per article, and 8.3 authors per article. CONCLUSION: Wearables can provide clinicians with objective measurements to determine patient function and quality of life. The rise in articles related to wearables in neurosurgery demonstrates the increased adoption of wearable devices during the COVID-19 pandemic. Wearable devices appear to be a key component in this era of telemedicine and their positive utility and practicality are increasingly being realized in neurosurgery.

Telemedicine for the Clinical Management of Diabetes; Implications and Considerations After COVID-19 Experience.

Telemedicine is a clinical approach that was seldom used in the day-to-day practice, if not only in certain settings, before the COVID-19 pandemic. As stated by the WHO, telemedicine is: the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, …. Telemedicine has actually represented the most useful and employed tool to maintain contacts between patients and physicians during the period of physical distance imposed by the pandemic, especially during the lockdown. Diabetes in particular, a chronic disease that often needs frequent confronting between patient and health professionals has taken advantage of the telehealth approach. Nowadays, technological tools are more and more widely used for the management of diabetes. In this review results obtained by telemendicine application in type 1 and type 2 diabetic individuals during COVID-19 are revised, and future perspectives for telemedicine use to manage diabetes are discussed.

Uso de la telesalud en terapia ocupacional: estudio de casos / Use of telehealth in occupational therapy: a case study

Objetivos: la telesalud conecta a las personas en situación de dependencia y a sus cuidadoras con el servicio de Terapia Ocupacional a través de tecnologías de la información y la comunicación, permitiendo intervenciones interactivas en tiempo real a las personas que no pueden acceder fácilmente a los servicios de terapia ocupacional de clínicas o centros sociosanitarios. El objetivo del presente artículo fue describir las experiencias del servicio de terapia ocupacional al explorar la telesalud para potenciar el desempeño ocupacional de las personas usuarias y facilitar el cuidado a sus cuidadoras. Métodos: se llevó a cabo tres estudios de casos con personas en situación de dependencia utilizando la telesalud en terapia ocupacional para evaluar el desempeño ocupacional de la persona usuaria, asesorar en el diseño de un producto de apoyo de bajo costo y asesorar en la adaptación de la vivienda. Conclusión: estos casos destacan que el uso de la telesalud en terapia ocupacional ofrece disponibilidad, accesibilidad y facilidad en la prestación de servicios telemáticos, logrando un contacto y una relación continuada con la persona usuaria en su entorno, detectando las fortalezas y los desafíos que presenta en cuanto al desempeño ocupacional y su cuidado. (AU)

Objective: Telehealth connects people with different dependency levels and their caregivers with the Occupational Therapy services through information and communication technologies, allowing interactive interventions in real time for people who cannot easily access health services, Occupational Therapy clinics or social-health centers.The objective of this article was to describe the experiences of the Occupational Therapy service regarding telehealth in order to enhance clients’ occupational performance and improve caregiving. Methods Three case studies were carried out with people with different dependency levels using telehealth in Occupational Therapy to assess the clients’ occupational performance and advise on the design of low-cost assistive productsas well as on home modification. Conclusion: These cases highlight that the use of telehealth in Occupational Therapy offers availability, accessibility and ease of delivery of telematic services achieving long-term contact and relationship with the client in their environment and identifying their strengths and challenges in terms of occupational performance and care. (AU)

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics.

In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.