Cognitive function in Mexican older adults 6-months after recovering from SARS-CoV-2 infection.

BACKGROUND: SARS-CoV-2 infection has been associated with multiple short- and long-term complications including depression, and cognitive impairment (CI). However, older adults with CI after COVID-19 have not been fully documented. OBJECTIVE: To evaluate cognitive function in Mexican adults post-recovery from SARS-CoV-2 infection. METHODS: In this prospective observational cohort study, we assess cognitive function (CF) by the Montreal Cognitive Assessment (MOCA) test with a cut-off less than 26 points, and functional status via telemedicine. Eligible patients with a history of moderate-severe COVID-19 aged ≥60 years, cognitively healthy (evaluated by Everyday Cognition Scale) and required admission to an intensive care unit (ICU) were included. Patients with history of dementia, stroke, and delirium during the cognitive evaluation were excluded. The association between CI and COVID-19 was assessed with a Cox regression model. RESULTS: From the 634 patients admitted to the ICU, 415 survived, afterward 308 were excluded and 107 were analyzed. Mean age was 70 years, 58% were female, and 53% had severe COVID. The mean MoCA score was 21±5 points, CI was present in 61 patients (57%). Infection severity (RR 1.87; 95% CI: 1.11-3.15, p<0.05), lower education (RR 0.92; 95% CI: 0.87-0.97, p<0.01), and activity daily living disability (RR 1.87; 95% CI: 1.07-3.26, p<0.05) were the main factors associated with CI (unadjusted model by age and sex). The delayed recall, orientation, and language (83.2, 77.6 and 72.9% respectively) domains were the most affected in patients with CI. CONCLUSIONS: Fifty-seven percent of patients analyzed developed CI six months post-ICU discharge due to SARS-CoV-2, and COVID severity was the main factor associated to its outcome.

Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert.

INTRODUCTION AND OBJECTIVES: The multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. METHODS: The algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. RESULTS: We analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001). CONCLUSIONS: A standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease / Evaluación remota de la bradicinesia en la enfermedad de Parkinson mediante análisis intra e inter evaluadores

Introduction: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. Methods: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. Results: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. Conclusion: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.(AU)

Introducción: La evaluación confiable de las personas con la enfermedad de Parkinson (EP) es esencial para lograr con un tratamiento adecuado. La evaluación clínica es una tarea compleja y que requiere mucho tiempo, especialmente para la bradicinesia, ya que su evaluación puede verse influenciada por el grado de experiencia del examinador, la colaboración del paciente y el sesgo individual. La mejora de la evaluación clínica se puede obtener considerando las evaluaciones de varios profesionales. Sin embargo, esto solo es más preciso cuando el convenio intra e inter evaluadores es alto. Recientemente, la Sociedad de Trastornos del Movimiento destacó, durante la pandemia COVID-19, la necesidad de desarrollar y validar tecnologías para la evaluación remota del estado motor de las personas con EP. Por lo tanto, este estudio presenta una estrategia objetiva para la evaluación remota de la bradicinesia mediante un análisis multi evaluadores. Métodos: Participaron 12 voluntarios con EP y se les pidió que ejecutaran movimientos de golpeteo de dedos de las manos, movimientos con las manos y pronación-supinación de las manos. Cada ejecución del movimiento fue registrado y calificado por 14 expertos en salud. Las puntuaciones se evaluaron de forma individual. Se estimó el convenio y la correlación intra e inter evaluadores. Resultados: Los resultados mostraron que los convenios y las correlaciones inter evaluadores experimentados son altos con baja variabilidad. Además, se observó que el análisis de grupo posee el potencial de resolver el sesgo de inconsistencia individual. Conclusiones: De esta forma, este estudio demostró la necesidad de un grupo con formación y experiencia previa, señalando la importancia para el desarrollo de un protocolo clínico que utiliza la telemedicina para la evaluación de personas con EP y como la inclusión de un grupo mediador especializado. En realidad, esta investigación propone una evaluación remota eficaz de la bradicinesia.(AU)

[Teleconsultation: finding its place in primary care]. / Teleconsulta: encontrando su lugar en Atención Primaria.

Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Evaluación de la experiencia de telemedicina en consulta de Cirugía de cabeza y cuello en un centro de referencia en Manizales / Evaluation of telemedicine experience in head and neck surgery consultation in a referral center in Manizales

Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease.

INTRODUCTION: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.

Economic impact of outpatient follow-up using telemedicine vs in-person visits for patients in general surgery: A secondary analysis of a randomized clinical trial.

INTRODUCTION: Innovation in internet connectivity and the Covid 19 pandemic have caused a dramatic change in the management of patients in the medical field, boosting the use of telemedicine. A comparison of clinical outcomes and satisfaction between conventional face-to-face and telemedicine follow-up in general surgery, an economic evaluation is mandatory. The aim of the present study was to compare the differences in economic costs between these two outpatient approaches in a designed randomized controlled trial (RCT). METHODS: A RCT was conducted enrolling 200 patients to compare conventional in-person vs. digital health follow-up using telemedicine in the outpatient clinics in patients of General Surgery Department after their planned discharge. After a demonstration that no differences were found in clinical outcomes and patient satisfaction, we analyzed the medical costs, including staff wages, initial investment, patent's transportation and impact on social costs. RESULTS: After an initial investment of 7527.53€, the costs for the Medical institution of in-person conventional follow-up were higher (8180.4€) than those using telemedicine (4630.06€). In relation to social costs, loss of productivity was also increased in the conventional follow-up. CONCLUSION: The use of digital Health telemedicine is a cost-effective approach compared to conventional face-to-face follow-up in patients of General Surgery after hospital discharge.

[Tecuide. Telemonitoring of patients with dementia and their caregivers]. / Tecuide. Telemonitorización de pacientes con deterioro cognitivo y sus cuidadores.

INTRODUCTION: Given the growing increase in dementia, the need to control these patients, together with the rise of new technologies, makes a change in the current control system imperative. MATERIAL AND METHOD: We have carried out a single-center, clinical study with two groups, a control group of 72 patients/caregivers, who followed the usual controls in consultations, and another telematic group of 76 patients/caregivers, who followed the controls through of the Tecuide platform. The platform had a survey part to detect problems in patients and caregiver claudication, another training part and another chat for direct communication when the caregiver needed it and also served to respond when a problem was detected. RESULTS: After a year of monitoring with the platform we have obtained: a)in patients, reduce behavioral disorders and use of drugs, increase physical exercise and delay institutionalization (DS not found); b)in caregivers there is an improvement in satisfaction with respect to the control of patients with cognitive impairment, and c)in terms of resources, visits to emergency services and dementia consultations have decreased, although admissions to the psychogeriatric unit have increased. CONCLUSIONS: The use of Tecuide as a telematic tool in the control of patients with cognitive impairment does not seem to be inferior to the usual controls in consultations and improves caregiver satisfaction.

Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora / Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement

Objetivo: Conocer la opinión de los médicos de Atención Primaria de Aragón, sobre la interconsulta virtual y su repercusión sobre las distintas dimensiones de la calidad asistencial. Diseño: Estudio transversal, mediante encuesta, de elaboración propia. Se habilitó la recogida de respuestas entre el 14 de abril y el 31 de mayo de 2023. Emplazamiento: Médicos con labor asistencial en atención primaria de Aragón. Participantes: Médicos especialistas e internos residentes en Medicina Familiar y Comunitaria. Mediciones: Características del puesto de trabajo, variables Likert valorando la interconsulta virtual como herramienta y su repercusión en dimensiones de la calidad asistencial, detección de ventajas e inconvenientes y preguntas de respuesta libre planteando líneas de mejora. Resultados: Total de 202 respuestas. El 90,1% de los participantes consideran útil la interconsulta virtual, el 67,8% cree que mejora la calidad de la derivación. Las principales ventajas identificadas son su contribución al enriquecimiento profesional y la visión integral del paciente, y la mejora de la comunicación entre primer y segundo nivel asistencial; el principal inconveniente el papel de Atención Primaria como intermediario en la información al paciente. Las dimensiones de la calidad mejor valoradas fueron eficiencia y equidad, siendo la seguridad la menos valorada. Conclusiones: La interconsulta virtual puede favorecer la comunicación y coordinación asistencial y potenciar la capacidad de resolución de atención primaria. Su éxito radica en formación y tiempo para su uso, consensuar protocolos y homogeneizar la distribución de recursos; no obstante, existen todavía oportunidades de mejora, principalmente en el ámbito de la seguridad.(AU)

Objective: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. Design: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. Site: Physicians with healthcare duties in primary care in Aragon. Participants: Specialist physicians and resident interns in Family and Community Medicine. Meansurements: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. Results: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. Conclusions: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.(AU)

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.

[Implementation and use of telemedicine in health care during the outbreak of monkeypox in the health area of Ibiza and Formentera]. / Implantación y uso de la telemedicina en la asistencia sanitaria del brote de viruela símica en el Área de Salud de Ibiza y Formentera.

OBJECTIVE: The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. DESIGN AND SITE: A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. PARTICIPANTS AND METHODS: All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. RESULTS AND CONCLUSIONS: The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.

Telesurgery and telementoring.

Telemedicine has revolutionized the field of surgery, with telemonitoring and telesurgery being 2 of its most promising applications. Telesurgery and telemonitoring are revolutionary applications that have the potential to change the way surgical operations are performed. These applications can allow surgeons to perform operations, enable surgeons to perform operations by assisting or supervising others through mentoring from a different location (telementoring). Despite the potential benefits of telemedicine and telementoring, there are still challenges that must be overcome before they can be widely used in clinical practice. For example, latency in data transmission can be a problem in telemedicine, as even a small delay in data transmission can affect the accuracy of the operation. Additionally, a sophisticated and expensive technological infrastructure is required, which can limit their use in some clinical settings. Although we need to work on its development technologically, ethically and legally, it is a promising tool.

[Usefulness of e-consultation in cardiology]. / Utilidad de la teleconsulta en cardiología.

INTRODUCTION AND OBJECTIVES: The development of IT tools and interlevel relationships in the management of the most prevalent processes has led to a semi-presential assessment approach. In cardiology, this form of assessment is possible through a close collaboration with primary care. The aim of this study is to analyze the results of our e-consultation program and to establish the effectiveness of this new form of assistance. METHODS: Single-center study that included e-consultations referred from 15 September 2021 to 30 September 2022. Subsequently, we analyzed the events in which patients were discharged directly during the e-consultation with no need for an on-site visit. RESULTS: We included 3,155 e-consultations. The mean age of the patients was 57±17.6 years. Of the consultations, 75% were answered within 48h (62% within 24h). A total of 1,988 patients completed one year of follow-up in e-consultation. Out of these, 1,278 patients (64.2%) were discharged from the e-consultation with no need for an on-site visit: 685 patients (53.5%) during the first consultation, and 593 (46.5%) upon request of a complementary test. After one year of follow-up, 13 patients (0.006%) were admitted due to cardiological pathology, and 16 patients (0.008%) died, only one due to cardiovascular causes. The mean age of the deceased was 80.5 years. CONCLUSIONS: E-consultation as a single referral system from primary care to cardiology improves patient accessibility, speeds up patient assessment and is effective for patients discharged without the need for an on-site consultation.

AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. / Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera.

OBJECTIVE: To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD: Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS: A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION: The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

La web 2.0 como un nuevo apoyo a la lactancia materna: percepción de madres y profesionales mediante un enfoque cualitativo / Web 2.0 as a new support for breastfeeding: Perception of mothers and professionals through a qualitative approach

Objetivo: El objetivo del presente trabajo es explorar la influencia de la web 2.0 como una red de apoyo complementaria a las redes tradicionales para el fomento de la lactancia materna (LM). Método: Estudio cualitativo explorativo, desarrollado del 8 de septiembre al 31 diciembre de 2022, en el Centro Sanitario «Las Vegas» (Corvera), Servicio de Salud del Principado de Asturias (SESPA). Las participantes fueron 5 profesionales expertas en LM y 7 madres lactantes, que constituyeron 2 grupos focales, seleccionadas por muestreo por conveniencia. El análisis consistió en transcripción de datos, lectura en profundidad, análisis mediante agrupación de conceptos y clasificación de la información en categorías. Resultados: Tras el análisis final se identificaron 7 categorías, organizadas según la proximidad del tema y el objetivo propuesto, a partir de los discursos más significativos del estudio: dificultades durante la LM, importancia de recibir ayuda, primeras redes de apoyo, otras redes de apoyo, un sistema sanitario con deficiencias, pandemia y LM 2.0, Salud 2.0 y app en LM: nueva forma de apoyo y características de una app sobre LM «ideal». Conclusiones: La web 2.0 ha revolucionado la forma en que las madres acceden a la información y al apoyo sobre LM, creando una red de ayuda en línea conectando a madres y profesionales de todo el mundo, proporciona información actualizada y posibilita una fuente de apoyo emocional mediante la creación de grupos de iguales. Esta influencia positiva de la web 2.0 ha tenido un impacto significativo en el fomento de la LM y el empoderamiento materno para tomar decisiones informadas sobre su proceso de amamantamiento.(AU)

Objective: The objective of this paper is to explore the influence of web 2.0 as a complementary support network to traditional networks for the promotion of breastfeeding (BF). Method: Qualitative and exploratory study carried out from September 8 to December 31, 2022, at the Las Vegas Health Centre (Corvera), Health Service of the Principality of Asturias (SESPA). The participants were 5 professional experts in BF and 7 breastfeeding mothers, who made up two focus groups, selected by convenience sampling. The analysis consisted of transcription of data, in-depth reading, analysis by grouping concepts and classification of the information into categories. Results: After the final analysis, seven categories were identified, organised according to the proximity of the topic and the proposed objective, based on the most significant discourses of the study: Difficulties during BF, Importance of receiving help: First support networks, Other support networks, A health system with deficiencies, Pandemic and BF 2.0, Health 2.0 and apps in BF: new form of support and Characteristics of an “ideal” app on BF. Conclusions: Web 2.0 has revolutionised the way mothers access information and support on BF, creating an online support network connecting mothers and professionals around the world, providing up-to-date information and enabling a source of emotional support through the creation of peer groups. This positive influence of web 2.0 has had a significant impact on promoting BF and empowering mothers to make informed decisions about their breastfeeding process.(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)

Ayudando a la toma de decisiones en el diagnóstico, tratamiento y seguimiento de úlceras de etiología vascular mediante el empleo de una aplicación móvil / A mobile decision support system for diagnosis, treatment and follow-up of vascular ulcers

Introducción y objetivo: los sistemas de ayuda a la decisión médica (SADM) son sistemas computacionales que utilizan dispositivos inteligentes, lo que facilita el diagnóstico y el tratamiento de múltiples patologías, transformando la atención sanitaria en un sistema dinámico y de precisión. Las úlceras de etiología vascular representan un importante problema de salud que suponen un gran consumo de recursos. La transformación digital puede mejorarla calidad de los diagnósticos, de los tratamientos y de los seguimiento de los pacientes, mejorando la eficacia y la eficiencia de la asistencia sanitaria. El objetivo es desarrollar una aplicación móvil que facilite el diagnóstico y el tratamiento de úlceras de etiología vascular. Métodos: para desarrollar este SADM se elaboraron algoritmos para los diagnósticos y los tratamientos capaces de generar una respuesta correcta, guiando al usuario hacia un diagnóstico más probable o a la aplicación del tratamiento específico. En Android se empleó el entorno de programación Android Studio y el lenguaje de programación JAVA, y para el desarrollo en iOS se empleó XCode y el lenguaje de programación Swift. El diagnóstico de úlceras de etiología vascular incluye: úlcera neuropática, isquémica, neuroisquémica, venosa o flebostática, úlceramixta y úlcera hipertensiva o de Martorell. Resultados: UlcerAPP es visual e intuitiva. Orientará en el diagnóstico en respuesta a los algoritmos desarrollados. Además, podrá accederse al tratamiento específico de cada una de ellas. Incluirá recomendaciones de seguimiento y criterios de derivación. Conclusiones: UlcerAPP es un proyecto desarrollado para mejorar el manejo clínico de las úlceras en el entorno de la Atención Primaria y potenciar el conocimiento de la patología vascular y del tratamiento de las úlceras de dicha etiología. (AU)

Introduction and objective: decision support systems (DSS) are computer systems that use computer devicesor smartphones, facilitating the diagnosis and properly treatment of multiple pathologies, transforming healthcare into a dynamic, preventive and precision system. Vascular ulcers represent an important health problem, witha great consumption of resources. Digital transformation can improve the quality of diagnoses, treatments andpatient follow-up, and therefore improve the effectiveness and efficiency of healthcare. This paper aims to develop UlcerApp, a totally new mobile DSS for vascular ulcers management, which facilitates the diagnosis, treatment andmonitoring of ulcers of vascular etiology, in the primary health care. Methods: for achieving the main purpose of this research work, a decision algorithm will be developed and implemented by an Android (Android Studio- JAVA) and iOS (XCode- Switf ) mobile applications. Results: the App developed which implements the algorithms UlcerApp is capable of diagnose 6 kind of vascularulcers: neuropathic, ischemic, neuroischemic, venous ulcer, mixed ulcer and hypertensive or Martorell ulcer. UlcerAPP is a visual and intuitive application that will guide the user to correct diagnosis. After them, users will be able to access the specific treatment. It will include follow-up recommendations as well as referral criteria. Conclusions: UlcerAPP is a project developed to improve the clinical management of vascular ulcers in the primary health care, enhance knowledge of vascular pathology and treatment of ulcers of said etiology. (AU)

Evaluación de la usabilidad de la teleconsulta durante la pandemia por COVID-19 en un hospital pediátrico / Assessment of the usability of teleconsultations during the COVID-19 pandemic at a children's hospital

Introducción. La usabilidad en un sistema de teleconsulta afecta directamente la eficiencia y efectividad de la atención médica remota. Objetivo. Evaluar la usabilidad de la teleconsulta durante la pandemia por COVID-19. Población y método. Estudio de corte transversal. Incluimos a los cuidadores de niños/as de 1 mes a 12 años. Evaluamos la usabilidad mediante el Telehealth Usability Questionnaire adaptado en español. Además, evaluamos datos socioeconómicos. Resultados. Tasa de respuesta del 70,2 % (n = 221). La mayoría eran mujeres, edad promedio 33 años, con educación secundaria y cobertura de salud pública. El 87,8 % eligió atención telefónica y el 88,2 % tenía su primera teleconsulta. Alta satisfacción general con puntuaciones menores en facilidad de uso y aprendizaje en videollamadas. Conclusión. La teleconsulta mostró alta usabilidad, independientemente de la modalidad, para cuidadores de niños/as de 1 mes a 12 años.

Introduction. Usability in a telemedicine system directly affects the efficiency and effectiveness of remote health care. Objective. To assess the usability of teleconsultations during the COVID-19 pandemic. Population and method. This was a cross-sectional study. The caregivers of children aged 1 month to 12 years were included. Usability was assessed with the Telehealth Usability Questionnaire, adapted to Spanish. Socioeconomic data were also assessed. Results. The response rate was 70.2% (n = 221). Most responders were women whose average age was 33 years, had completed secondary education and had public health insurance. Of them, 87.8% selected telephone health care and 88.2% had their first teleconsultation. The overall satisfaction was high, with lower scores for ease of use and learning how to use video calls. Conclusion. Regardless of modality, the usability of teleconsultations by caregivers of children aged 1 month to 12 years was adequate.

The effect of telehealth on incontinence severity given to women with urinary incontinence: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Although urinary incontinence does not cause mortality, it is a global health problem that adversely affects the quality of life and health of women. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of the studies investigating the effect of telehealth given to women with urinary incontinence (UI) on the severity of incontinence. METHODS: The literature review for this systematic review was conducted between August-Semptember 2023 using four electronic databases. Y-based articles were scanned using MeSH-based keywords. Randomized Controlled Trials conducted over the last decade were included in the screening. RESULTS: The analysis included six studies involving 826 women with UI. After telehealth intervention, there was a significant difference in UI symptom severity (MD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) and quality of life (SMD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) compared to the control groups. It had no effect on sexuality (MD: -4.65 95% CI: -9.60 to 0.30, Z=1.84, p=0.07), and anxiety (SMD: -0.15, 95% CI: -0.38 to 0.08, Z=1.27, p=0.21). CONCLUSION: In this analysis, it was found that telehealth interventions performed on women with UI increased the quality of life while reducing the severity of incontinence in women, but had no effect on sexuality, and anxiety.