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1.
BMJ ; 367: l5922, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690561

RESUMO

OBJECTIVE: To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice. DESIGN: Pragmatic, three armed, parallel group, individually randomised controlled trial. SETTING: 59 general practices in the Netherlands. PARTICIPANTS: 322 adults aged 50 and older with a chronic vestibular syndrome. INTERVENTIONS: Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions. MAIN OUTCOME MEASURES: The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events. RESULTS: In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference -4.1 points, 95% confidence interval -5.8 to -2.5; and -3.5 points, -5.1 to -1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial. CONCLUSION: Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice. TRIAL REGISTRATION: Netherlands Trial Register NTR5712.


Assuntos
Medicina Geral/métodos , Modalidades de Fisioterapia , Qualidade de Vida , Telemedicina/métodos , Doenças Vestibulares/reabilitação , Idoso , Doença Crônica/psicologia , Doença Crônica/reabilitação , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Países Baixos , Síndrome , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/psicologia
2.
Pan Afr Med J ; 33: 305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723372

RESUMO

Introduction: Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang health district, West Region of Cameroon.ng ba. Methods: This was a cross sectional descriptive study in the Dschang health district, West region of Cameroon. Key informants were all pregnant women from 18 years and above and a total of 372 pregnant women were included. This study was carried out from March to July 2017. Results: Majority of the women, that is, 252(67.74%) were married, 117(31.45%) declaredtheir status as being single, while 3(0.81%) were devorced. Out of the 335 women that declared wanting an mHealth intervention, 41.79% of this number preferred SMS texts in the afternoon, 111(33.13%) in the evening, 46(13.73%) anytime and 38(11.34%) in the morning hours. A total of 83.33% women confirmed using telephone services. Conclusion: This study reveals that cell phones would be the acceptable medium of providing pregnancy and postpartum support to women in the Dschang health district. This is justified by the fact that a vast majority of women interviewed had access to a cell phone and referred to it as their desired and accepted means of communication.


Assuntos
Cuidado Pós-Natal/métodos , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adolescente , Adulto , Camarões , Telefone Celular , Estudos Transversais , Feminino , Humanos , Gravidez , Mensagem de Texto , Adulto Jovem
3.
BMC Public Health ; 19(1): 1311, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623589

RESUMO

BACKGROUND: The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. METHODS: The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. RESULTS: Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. CONCLUSIONS: This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.


Assuntos
Doença das Coronárias/prevenção & controle , Exercício , Promoção da Saúde/organização & administração , Telemedicina/organização & administração , Adulto , Feminino , Promoção da Saúde/métodos , Humanos , Inteligência , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Telemedicina/métodos
4.
Health Psychol ; 38(12): 1168-1174, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31580127

RESUMO

To optimize digital health interventions, intervention creators must determine what intervention dose will produce the most substantial health behavior change-the dose-response relationship-while minimizing harms or burden. In this article we present important concepts, considerations, and challenges in studying dose-response relationships in digital health interventions. We propose that interventions make three types of prescriptions: (1) intervention action prescriptions, prescriptions to receive content from the intervention, such as to read text or listen to audio; (2) participant action prescriptions, prescriptions to produce and provide content to the intervention, such as to send text messages or post intervention-requested photos on social media; and (3) behavioral target action prescriptions, prescriptions to engage in behaviors outside the intervention, such as changing food intake or meditating. Each type of prescription has both an intended dose (i.e., what the intervention actually prescribes) and an enacted dose (i.e., what portion of the intended dose is actually completed by the participant). Dose parameters of duration, frequency, and amount can be applied to each prescription type. We consider adaptive interventions and interventions with ad libitum prescriptions as examples of tailored doses. Researchers can experimentally manipulate the intended dose to determine the dose-response relationship. The enacted dose cannot be directly manipulated; however, we consider the applicability of "controlled concentration" research design to the study of enacted dose. We consider challenges in dose-response research in digital health interventions, including characterizing amount with self-paced activities and combining doses across modality. The presented concepts and considerations may help contribute to the optimization of digital health interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Telemedicina/métodos , Relação Dose-Resposta a Droga , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Projetos de Pesquisa , Mensagem de Texto
6.
BMC Health Serv Res ; 19(1): 686, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597555

RESUMO

BACKGROUND: Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). METHODS: A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. RESULTS: The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. CONCLUSIONS: This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.


Assuntos
Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Adulto , Idoso , Transtorno Depressivo/psicologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Projetos de Pesquisa , Telemedicina/métodos , Telefone , Resultado do Tratamento
7.
Cardiovasc Hematol Agents Med Chem ; 17(2): 125-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512999

RESUMO

BACKGROUND: Mobile health technology offers promising means to implement public health strategies for the prevention and management of chronic conditions. However, at the moment, there is a dearth of both; specific mobile health tools tailored for the knowledge and language needs of Indian population; as well as enough systematic and scientific clinical data to analyse their impact in varied Indian socioeconomic and disease populations. OBJECTIVE: To develop a smartphone-based bilingual educational mobile application for heart patients and pilot test in an Indian clinical setting. METHODS: An Android™ based mobile application was developed according to a systematic instructional design model. Thereafter, expert assessment was done by 3 software engineers and 2 healthcare professionals using a peer-reviewed, objective and multidimensional Mobile Application Rating Scale (MARS). A pilot user satisfaction evaluation was done based on feedback from 35 Coronary Artery Disease patients visiting Cardiology outpatient Department of a North Indian tertiary care centre. RESULTS: An Android™ based mobile application named as 'Happy Heart' was developed. The content was developed in both Hindi and English under professional supervision. For this mobile application, the Mean MARS score was 3.60 ± 0.86 and subjectivity score was 3.30 ± 1.03. The overall user satisfaction response for the mobile application was 4.09 ± 0.75 indicating that most of the testers found it useful. CONCLUSION: This mobile application is developed as a research tool to further conduct a clinical study in Coronary Artery Disease Patients. Current evaluation was a pilot testing wherein this application showed promising results.


Assuntos
Doença da Artéria Coronariana/terapia , Aplicativos Móveis , Educação de Pacientes como Assunto/métodos , Telemedicina/métodos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/prevenção & controle , Humanos , Índia/epidemiologia , Estilo de Vida , Saúde Pública , Smartphone
8.
BMC Infect Dis ; 19(Suppl 1): 786, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31526387

RESUMO

BACKGROUND: Although the use of technology viz. mobile phones, personalised digital assistants, smartphones, notebook and tablets to monitor health and health care (mHealth) is mushrooming, only small, localised studies have described their use as a data collection tool. This paper describes the complexity, functionality and feasibility of mHealth for large scale surveillance at national and sub-national levels in South Africa, a high HIV-prevalence setting. METHODS: In 2010, 2011-12 and 2012-13 three nationally representative surveys were conducted amongst infants attending 580 facilities across all 51 districts, within all nine provinces of South Africa, to monitor the effectiveness of the programme to prevent mother-to-child transmission of HIV (PMTCT). In all three surveys a technical protocol and iterative system for mobile data collection was developed. In 2012-13 the system included automated folders to store information about upcoming interviews. Paper questionnaires were used as a back-up, in case of mHealth failure. These included written instructions per question on limits, skips and compulsory questions. Data collectors were trained on both systems. RESULTS: In the 2010, 2011-12 and 2012-2013 surveys respectively, data from 10,554, 10,071, and 10,536 interviews, and approximately 186 variables per survey were successfully uploaded to 151 mobile phones collecting data from 580 health facilities in 51 districts, across all nine provinces of South Africa. A technician, costing approximately U$D20 000 p.a. was appointed to support field-based staff. Two percent of data were gathered using paper- questionnaires. The time needed for mHealth interviews was approximately 1,5 times less than the time needed for paper questionnaires 30-45 min versus approximately 120 min (including 60-70 min for the interview with an additional 45 min for data capture). In 2012-13, 1172 data errors were identified via the web-based console. There was a four-week delay in resolving data errors from paper-based surveys compared with a 3-day turnaround time following direct capture on mobile phones. CONCLUSION: Our experiences demonstrate the feasibility of using mHealth during large-scale national surveys, in the presence of a supportive data management team. mHealth systems reduced data collection time by almost 1.5 times, thus reduced data collector costs and time needed for data management.


Assuntos
Telefone Celular , Processamento Eletrônico de Dados/métodos , Vigilância em Saúde Pública/métodos , Telemedicina/métodos , Cuidadores , Estudos Transversais , Assistência à Saúde , Teste em Amostras de Sangue Seco , Estudos de Viabilidade , Seguimentos , Instalações de Saúde , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães , África do Sul , Inquéritos e Questionários , Telemedicina/economia
9.
J Clin Neurosci ; 69: 160-165, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471078

RESUMO

Acute ischemic strokes (AIS) with severe neurologic deficits are associated with poor short- and long-term prognosis. Thrombectomy alone or in combination with thrombolysis is used for reperfusion in patients with moderate-to-severe AIS. However, the best therapeutic approach within the setting of telemedicine networks needs to be elucidated further. The objective of this study was to analyze clinical and imaging based outcomes of moderate to severe stroke following treatment with thrombolysis, thrombectomy or a combination of both in a telemedicine network. Data of this retrospective study was abstracted from the institutional telestroke database. Patients with a National Institute of Health Stroke Scale score (NIH-SS ≥ 10) were included into the study. Primary outcome measure was the difference in NIH-SS at admission compared to discharge from the hospital. Secondary outcome measure was the discharge disposition defined as favorable (discharge to home or rehabilitation) versus unfavorable disposition (discharge to hospice/death). Furthermore, outcome was analyzed based on reperfusion status following thrombectomy using the Thrombolysis in Cerebral Infarction (TICI) scale. The NIH-SS improved in all three groups, independent of treatment subtype, with a trend towards best outcomes following thrombolysis and combined treatment therapy compared to thrombectomy alone. In addition, reperfusion rates were higher in the combination group compared to the thrombectomy only group. The number of favorable discharges was similar in all three groups. The present study stresses the benefits of tele-stroke networks in allowing to early identify and treat even patients with severe strokes and benefit from different treatment modalities.


Assuntos
Acidente Vascular Cerebral/terapia , Telemedicina/métodos , Trombectomia/métodos , Terapia Trombolítica/métodos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
10.
J Consult Clin Psychol ; 87(9): 802-814, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31403816

RESUMO

OBJECTIVE: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers' treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. METHOD: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive-behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. RESULTS: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO's emotional consequences: d = -0.90, 95% CI [-1.47, -0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = -0.45, 95% CI [-0.81, -0.09]; depression: d = -0.49, 95% CI [-0.82, -0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect = 0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). CONCLUSION: The results confirm earlier studies' findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO's coping and well-being. The trial's outcome data and scripts are available for download (https://osf.io/awtg7/). (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Família/psicologia , Amigos/psicologia , Jogo de Azar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Telemedicina/métodos , Adulto , Depressão/psicologia , Feminino , Jogo de Azar/terapia , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Listas de Espera
11.
J Rehabil Med ; 51(9): 665-674, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31414140

RESUMO

OBJECTIVE: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. DESIGN: Cross-sectional survey. SUBJECTS: Stroke patients, informal caregivers, health-care professionals. METHODS: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. RESULTS: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34-5.33), informal caregivers (OR 8.98; 95% CI 1.70-47.33) and healthcare professionals (OR 6.25; 95% CI 1.17-10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17-0.74). Limitations of the study include low response rates and possible response bias. CONCLUSION: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation.


Assuntos
Cuidadores/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Telemedicina/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
J Athl Train ; 54(9): 929-938, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31411898

RESUMO

CONTEXT: Interest in identifying the effects of physical and mental activity on recovery after sport-related concussion is growing. Clinical studies of concussed athletes' activities require well-validated methods for tracking their intensity and timing. OBJECTIVE: To develop and validate a novel multimodal approach to monitoring activity postconcussion using mobile (mHealth) technologies. DESIGN: Cohort study. SETTING: Translational research unit. PATIENTS OR OTHER PARTICIPANTS: A total of 40 high school and collegiate football players were evaluated at preseason and followed longitudinally after either concussion (n = 25; age = 17.88 ± 1.74 years, height = 182.07 ± 8.08 cm, mass = 98.36 ± 21.70 kg) or selection as a nonconcussed control (n = 15; age = 18.27 ± 1.83 years, height = 180.01 ± 7.19 cm, mass = 93.83 ± 24.56 kg). MAIN OUTCOME MEASURE(S): Participants wore a commercial actigraph and completed a daily mobile survey for 2 weeks. Analyses focused on comparisons between groups for actigraph-based physical activity and self-reported physical and mental activity during the follow-up period. RESULTS: For the first 2 days postinjury, objective measures showed fewer daily steps in concussed (6663 ± 2667 steps) than in control (11 148 ± 3381 steps) athletes (P < .001), and both objective and self-reported measures indicated less moderate to vigorous physical activity in concussed (27.6 ± 32.6 min/d and 25.0 ± 43.6 min/d, respectively) than in control (57.3 ± 38.6 min/d and 67.5 ± 40.1 min/d, respectively) athletes (both P values < .05). Correlations between objective and self-reported measures of moderate to vigorous physical activity were moderate across select 1-week and 2-week averages. We observed no group differences in self-reported mental activities. CONCLUSIONS: Physical activity after sport-related concussion varied widely across athletes but on average was reduced during the acute and early subacute postinjury periods for both objective and self-reported measures. The lack of differences in mental activities between groups may reflect limited change in mental exertion postconcussion or difficulty accurately measuring mental activities. Assessing concussed athletes' activities using actigraphy and self-reported scales may help monitor their compliance with activity recommendations and be useful in studies aimed at better understanding the effects of physical activity on concussion recovery.


Assuntos
Actigrafia , Traumatismos em Atletas , Concussão Encefálica , Exercício , Futebol Americano/lesões , Telemedicina/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Adulto Jovem
13.
Diabetes Metab Syndr ; 13(4): 2507-2512, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405669

RESUMO

AIMS: To identify mobile health applications with features for improving the lifestyle of patients with chronic diseases. METHODS: We performed a systematic literature review between November 2017 and May 2018 on the Virtual Health Library's interface. A total of 816 records were identified. In the selection process, 24 studies met inclusion criteria for analysis. Study characteristics were extracted and synthesized. RESULTS: We identified applications with similar functionalities, such as the use of reminders and medical monitoring. Most of them addressed the treatment of conditions related to an already diagnosed chronic disease, including Diabetes Mellitus, Hypertension, Cardiovascular Diseases, Asthma, Neoplasms, and chronic conditions in general. The main lifestyle changes were the reduction of body weight, promotion of healthy eating, and adherence to the regular practice of physical exercises. CONCLUSIONS: Technology can facilitate health care with simple messages and alerts that aid in adherence to treatment. Changes in lifestyle with the use of applications are remarkable. Benefits may be even greater if more applications address the importance of prevention and not just treatment.


Assuntos
Doença Crônica/terapia , Estilo de Vida , Qualidade de Vida , Autocuidado , Telemedicina/métodos , Humanos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31370191

RESUMO

A recent Dutch efficacy trial showed the efficacy of a telephone smoking cessation counseling tailored to smoking parents. Currently, it is unknown whether such telephone counseling would be effective under more real-world conditions. This study aimed to examine the effectiveness of parent-tailored telephone smoking cessation counseling in a two-arm randomized controlled effectiveness trial and whether the effectiveness depended on the recruitment approaches that were used to recruit parents (mass media vs. health care). In total, 87 parents received either telephone counseling (intervention) or a self-help brochure (control). Parents were asked to complete questionnaires at baseline and three months post-intervention. Results showed that the odds of reporting 7-day point-prevalence abstinence at three months post-intervention was 7.54 higher for parents who received telephone counseling than for parents in the control condition (53.3% vs. 13.2%, 95% CI = 2.49-22.84). Because inclusion was lower than anticipated, interaction-effects of condition and recruitment approach could not be interpreted. The present study demonstrates that the parent-tailored smoking cessation telephone counseling is effective in helping parents to quit smoking. Yet, before large-scale implementation, future research should focus on how recruitment of parents via the recruitment approaches could be improved.


Assuntos
Aconselhamento/métodos , Pais , Abandono do Hábito de Fumar/métodos , Telemedicina/métodos , Telefone , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego
15.
Einstein (Sao Paulo) ; 17(4): eAO4609, 2019 Aug 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460616

RESUMO

OBJECTIVE: To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones. METHODS: This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers. RESULTS: We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment. CONCLUSION: Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.


Assuntos
Transtornos Cerebrovasculares/diagnóstico por imagem , Smartphone , Telemedicina/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/cirurgia , Criança , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Telemedicina/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Surg Infect (Larchmt) ; 20(7): 541-545, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31460834

RESUMO

Background: Surgical site infection (SSI) continues to be a common and costly complication after surgery. The current commonly used definitions of SSI were devised more than two decades ago and do not take in to account more modern technology that could be used to make diagnosis more consistent and precise. Patient-generated health data (PGHD), including digital imaging, may be able to fulfill this objective. Methods: The published literature was examined to determine the current state of development in terms of using digital imaging as an aide to diagnose SSI. This information was used to devise possible methodology that could be used to integrate digital images to more objectively define SSI, as well as using these data for both surveillance activities and clinical management. Results: Digital imaging is a highly promising means to help define and diagnose SSI, particularly in remote settings. Multiple groups continue to actively study these emerging technologies, however, present methods remain based generally on subjective rather than objective observations. Although current images may be useful on a case-by-case basis, similar to physical examination information, integrating imaging in the definition of SSI to allow more automated diagnosis in the future will require complex image analysis combined with other available quantified data. Conclusions: Digital imaging technology, once adequately evolved, should become a cornerstone of the criteria for both the clinical and surveillance definitions of SSI.


Assuntos
Processamento Eletrônico de Dados/métodos , Monitoramento Epidemiológico , Processamento de Imagem Assistida por Computador/métodos , Dados de Saúde Gerados pelo Paciente/métodos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Telemedicina/métodos , Processamento Eletrônico de Dados/tendências , Humanos , Processamento de Imagem Assistida por Computador/tendências , Dados de Saúde Gerados pelo Paciente/tendências , Telemedicina/tendências
17.
Pan Afr Med J ; 33: 50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448013

RESUMO

Introduction: The World Health Organization estimates that up to half of vaccines are wasted, however only a minority of mHealth programs in Africa have been directed at vaccine supply chain optimisation. We piloted a novel mHealth solution dependent only on short message services (SMS) technology that allowed workers in rural health centres in Zambia to report vaccine stock levels directly to an online platform. Small airtime incentives were offered to encourage users to engage with the system, as well as weekly reminder messages asking for stock updates. Methods: The primary outcome measured was the percentage-of-doses-tracked, calculated over the study period. Each vaccine box was randomly allocated to offer either a standard or double airtime incentive and either weekly or daily reminders, in a 2 x 2 design; ANOVA was used to calculate if any of these factors affected time-to-reply. Results: Over the study period, the total percentage-of-doses-tracked was 39.9%. Within the subset of users who sent at least one message to the platform, the percentage-of-doses-tracked was 93.8%. There was no significant difference in average time-to-reply between the standard airtime incentive and double airtime incentive groups, nor was there a significant difference between the standard reminder and daily follow-up reminder groups. Conclusion: This pilot study found that in an active subgroup of health workers, an incentivised mHealth solution was able to collect tracking data for 93.8% of doses. More research is needed to identify methods to encourage healthcare workers to engage in timely stock reporting practices.


Assuntos
Vacina contra Difteria, Tétano e Coqueluche/provisão & distribução , Serviços de Saúde Rural/organização & administração , Telemedicina/métodos , Mensagem de Texto , Telefone Celular , Agentes Comunitários de Saúde/organização & administração , Humanos , Projetos Piloto , Fatores de Tempo , Zâmbia
18.
Surg Infect (Larchmt) ; 20(7): 566-570, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31429637

RESUMO

Background: The implementation of health information technology interventions is at the forefront of most hospital institutional policy agendas. Despite the availability of numerous apps and mobile platforms focusing on specific areas in healthcare the widespread integration into clinical practice can be a complex process. Here we present guidelines and methodology that we have learned in the implementation process of new technology and an overview of some of the current barriers and enablers specific to implementation of post-surgical site surveillance technology. Methods: Analysis of the experience of successful information technology (IT) implementation in different healthcare systems reveals that, despite differences among patient groups, care providers, and hospitals, there are common barriers and enablers to implementation of health IT. Results: The process of implementation in organizations and among individuals can be most successful by identifying barriers and enablers within three key stakeholder groups: (1) patients; (2) care providers/clinicians; and (3) manager/administration within healthcare systems. This can be achieved by specific engagement and co-design processes establishing clear benefits, sufficient incentives, and adequate support for clinicians as well as payer-provider relationships, marketplace competition and privacy legislation. Conclusions: The successful implementation of such programs requires appropriate strategic planning to address the needs of three specific components: patients, care provider, and policymakers/healthcare management understanding and acceptance.


Assuntos
Processamento Eletrônico de Dados/métodos , Informática Médica/métodos , Dados de Saúde Gerados pelo Paciente , Telemedicina/métodos , Processamento Eletrônico de Dados/organização & administração , Guias como Assunto , Humanos , Informática Médica/organização & administração
19.
Surg Infect (Larchmt) ; 20(7): 535-540, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31429644

RESUMO

Background: As the use of patient-owned devices, including smartphones and tablets, to manage day-to-day activities grows, so does healthcare industry's interest to better leverage technology to engage patients. For surgical care, a unique opportunity exists to capture patient-generated health data (PGHD) including photographs. As part of a broader initiative to evaluate PGHD for surgical site infection (SSI) surveillance, we sought evidence regarding patient involvement and experience with PGHD for SSI monitoring and surveillance. Methods: Through a scoping review of the literature and semi-structured stakeholder interviews we gathered evidence on what is currently known about patient perspectives of and experiences with mobile health (mHealth) interventions for post-operative recovery. We presented findings to and discussed with the ASSIST PGHD Stakeholder Advisory Group (PSAG) to generate priorities for further examination. Results: Our scoping review yielded 34 studies that addressed post-discharge use of PGHD for monitoring and surveillance of SSI. Of these, 16 studies addressed at least one outcome regarding patient experience; the most commonly measured outcome was patient satisfaction. Only three studies reported on patient involvement in the development of PGHD tools and interventions. We conducted interviews (n = 24) representing a range of stakeholder perspectives. Interviewees stressed the importance of patient involvement in tool and program design, noting patient involvement ensures the "work" that patients do in their daily lives to manage their health and healthcare is recognized. Discussion of evidence with the ASSIST PSAG resulted in formal recommendations for direct involvement of patients and caregivers for future work. Conclusions: While mHealth initiatives to advance post-operative management offer the ability to improve patient engagement, work is needed to ensure the patient voice is reflected. Active engagement with patients and caregivers in the development of new technology, the design of new workflows, and the conduct of research and evaluation ensures that the patient experiences and values are incorporated.


Assuntos
Testes Diagnósticos de Rotina/métodos , Monitoramento Epidemiológico , Participação do Paciente/métodos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Telemedicina/métodos , Processamento Eletrônico de Dados/métodos , Humanos , Dados de Saúde Gerados pelo Paciente
20.
Surg Infect (Larchmt) ; 20(7): 555-565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31424335

RESUMO

Background: Emerging technologies such as smartphones and wearable sensors have enabled the paradigm shift to new patient-centered healthcare, together with recent mobile health (mHealth) app development. One such promising healthcare app is incision monitoring based on patient-taken incision images. In this review, challenges and potential solution strategies are investigated for surgical site infection (SSI) detection and evaluation using surgical site images taken at home. Methods: Potential image quality issues, feature extraction, and surgical site image analysis challenges are discussed. Recent image analysis and machine learning solutions are reviewed to extract meaningful representations as image markers for incision monitoring. Discussions on opportunities and challenges of applying these methods to derive accurate SSI prediction are provided. Conclusions: Interactive image acquisition as well as customized image analysis and machine learning methods for SSI monitoring will play critical roles in developing sustainable mHealth apps to achieve the expected outcomes of patient-taken incision images for effective out-of-clinic patient-centered healthcare with substantially reduced cost.


Assuntos
Processamento Eletrônico de Dados/métodos , Processamento de Imagem Assistida por Computador/métodos , Dados de Saúde Gerados pelo Paciente , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Telemedicina/métodos , Processamento Eletrônico de Dados/tendências , Humanos , Processamento de Imagem Assistida por Computador/tendências , Telemedicina/tendências
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