[Telemedicine: validation of a questionnaire to evaluate the experience of health professionalsTelemedicina: validação de um questionário para avaliar a experiência dos profissionais de saúde]. / Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud.

Objective: This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods: Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results: A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions: The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.

Objetivo: Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos: Com base na versão abreviada em espanhol ­ e validada localmente ­ do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliou-se a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados: Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões: O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a avaliação objetiva da experiência dos profissionais que realizam telemedicina.

[Implementation of telemedicine in the Americas: Barriers and facilitatorsBarreiras e facilitadores para a implementação da telemedicina nas Américas]. / Barreras y facilitadores a la implementación de la telemedicina en las Américas.

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.

Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

Information and communication technologies in neonatal health.

OBJECTIVES: To identify scientific evidence on the use and results of information and communication technologies for the improvement of neonatal health in general or specific health problems or interventions, and to describe the type of intervention and its results. METHODS: A systematic review of the available evidence was performed. The search was carried out in peer-reviewed journals between January 1, 2008 and April 30, 2018, in English and Spanish. The searched key terms were (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care). RESULTS: From a total of 305 articles initially identified, 10 articles fulfilled the inclusion criteria. The main domains of eHealth identified as applied to neonatal health were telemedicine (3 studies), eLearning (1 study) and mHealth (7 studies). Target population were health care providers or parents. The studies aimed at diagnosis, provision of health care and training, promoting adherence to interventions in parents or improving quality of care. CONCLUSIONS: The use of eHealth in general and specifically focused on neonatal health shows important possibilities for development and expansion, given the advances and present needs, and should be considered a key tool for the reduction of inequalities.

OBJETIVOS: Identificar la evidencia científica sobre el uso y los resultados de las tecnologías de la información y la comunicación para mejorar la salud neonatal en general o problemas de salud o intervenciones específicos, y describir el tipo de intervención y sus resultados. MÉTODOS: Se realizó una revisión sistemática de la evidencia disponible. La búsqueda se llevó a cabo en revistas revisadas por pares entre el 1 de enero de 2008 y el 30 de abril de 2018, en español e inglés. Los términos clave de la búsqueda fueron (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care). RESULTADOS: De un total de 305 artículos identificados inicialmente, 10 artículos cumplieron los criterios de inclusión. Los principales dominios de la eSalud aplicados a la salud neonatal fueron la telemedicina (3 estudios), el aprendizaje electrónico (1 estudio) y la salud móvil (7 estudios). La población destinataria consistió en los proveedores de atención de la salud o los padres. Los estudios tenían por objeto el diagnóstico, la prestación de atención sanitaria y la capacitación, la promoción del cumplimiento de las intervenciones en los padres o la mejora de la calidad de la atención. CONCLUSIONES: El uso de la eSalud en general, y específicamente en la salud neonatal, muestra importantes posibilidades de desarrollo y expansión, dados los avances y las necesidades actuales, y debería considerarse un instrumento clave para la reducción de las desigualdades.

Effectiveness, Costs and Satisfaction of Telemedicine: Review of the Current State.

The objective of this study was to summarize the evidence in relation to telemedicine systems as regards their effectiveness, costs and satisfaction in the last decade. A summary of main findings is presented. According to results telemedicine proved to be a feasible and effective tool to provide health care as a replacement or complement to usual care, especially when applied to chronic diseases.

Effect of the COVID-19 Lockdown on Patients Valuation of Usability of Telemedicine.

The aim of this paper was to report patient valuation of usability with our telemedicine system and to explore the effect of pandemic in its behavior. We conducted a cross-sectional study based on the prospective recollection of the results of the Spanish abbreviated version of the Telehealth Usability Questionnaire (TUQ), from October 2019 to July 2020. We observed an inflection point of growth of answers during the pandemic era and a trend of decrease in usability valuations coinciding with the massive and forced implementation of the system after lockdown. This effect was transitory, evidencing an improvement over time. These results might be explained with a sociotechnical approach that includes considering the learning curve and suggest the importance of a telemedicine usability tool to guide decision-making. In conclusion, tools to assess telemedicine services may identify facilitators and barriers to its use in a highly changing social and technological context.

Technological Challenges and Solutions in Emergency Remote Teaching for Nursing: An International Cross-Sectional Survey.

OBJECTIVES: With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education. METHODS: We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions. RESULTS: We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap. CONCLUSIONS: Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.

Limited carbon and mineral nutrient gain from mycorrhizal fungi by adult Australian orchids.

PREMISE OF THE STUDY: In addition to autotrophic and fully mycoheterotrophic representatives, the orchid family comprises species that at maturity obtain C and N partially from fungal sources. These partial mycoheterotrophs are often associated with fungi that simultaneously form ectomycorrhizas with trees. This study investigates mycorrhizal nutrition for orchids from the southwestern Australian biodiversity hotspot. METHODS: The mycorrhizal fungi of 35 green and one achlorophyllous orchid species were analyzed using molecular methods. Nutritional mode was identified for 27 species by C and N isotope abundance analysis in comparison to non-orchids from the same habitat. As a complementary approach, (13)CO(2) pulse labeling was applied to a subset of six orchid species to measure photosynthetic capacity. KEY RESULTS: Almost all orchids associated with rhizoctonia-forming fungi. Due to much higher than expected variation within the co-occurring nonorchid reference plants, the stable isotope approach proved challenging for assigning most orchids to a specialized nutritional mode; therefore, these orchids were classified as autotrophic at maturity. The (13)CO(2) pulse labeling confirmed full autotrophy for six selected species. Nonetheless, at least three orchid species (Gastrodia lacista, Prasophyllum elatum, Corybas recurvus) were identified as nutritionally distinctive from autotrophic orchids and reference plants. CONCLUSIONS: Despite the orchid-rich flora in southwestern Australia, partial mycoheterotrophy among these orchids is less common than in other parts of the world, most likely because most associate with saprotrophic fungi rather than ectomycorrhizal fungi.

An Online Community for Patient with Psoriasis with Built-in Self-Reported Questionnaires.

This study presents an online psoriasis community developed with dermatologists in a PHR. We describe the interaction of users with this platform and the relationship between the use of self-report questionnaires, their results and users' subsequent contact with the healthcare system. Out of 2175 users that interacted with the platform, 477 visited the forums. 60% of those who completed questionnaires presented at least one abnormal result that prompted a recommendation for an outpatient visit. Although our data suggest a trend, we failed to find a statistically significant association between questionnaire severity and visits scheduling. To our knowledge, this is the first study that analyses the relationship between patient self-reported disease severity and the subsequent contact with the healthcare system.

Information Needs at the O.R. Waiting Room.

The objective of this study was to investigate the difficulties and information needs that both patients and their companions have in the context of a scheduled surgery. Observations in the operating room waiting zone and semi-structured interviews were conducted to patients with scheduled surgeries, their companions, administrative staff members and surgeons. We developed a journey map to explain the patient's experience through the perioperative process. The emerging categories were Fragmented communication, Understanding the surgical process and Waiting times. Knowing the information needs of patients and companions was important to identify problems and opportunities for improvement in our institution's Personal Health Records.

Emergency Remote Learning in Nursing Education During the COVID-19 Pandemic.

Due to the corona (COVID-19) pandemic, several countries are currently conducting non-face-to-face education. Therefore, teachers of nursing colleges have been carrying out emergency remote education. This study developed a questionnaire to understand the status of Emergency Remote Learning (ERL) in nursing education internationally, translated it into 7 languages, and distributed it to 18 countries. A total of 328 nursing educators responded, and the most often used online methods were Social networking technology such as Facebook, Google+ and Video sharing platform such as YouTube. The ERL applied to nursing education was positively evaluated as 3.59 out of 5. The results of the study show that during the two semesters nursing college professors have well adapted to this unprecedent crisis of teaching. The world after COVID-19 has become a completely different place, and nursing education should be prepared for 'untact' education.

Nursing Informatics Research Trends: Findings from an International Survey.

This follow-up survey on trends in Nursing Informatics (NI) was conducted by the International Medical Informatics Association (IMIA) Student and Emerging Professionals (SEP) group as a cross-sectional study in 2019. There were 455 responses from 24 countries. Based on the findings NI research is evolving rapidly. Current ten most common trends include: clinical quality measures, clinical decision support, big data, artificial intelligence, care coordination, education and competencies, patient safety, mobile health, description of nursing practices and evaluation of patient outcomes. The findings help support the efforts to efficiently use resources in the promotion of health care activities, to support the development of informatics education and to grow NI as a profession.

Designing a Patient-Centered Notification System into a PHR.

Personal health records could help patients overcome the anxiety related to gaps on health related information. The objective of this research was to explore what type of information was perceived by patients as useful to receive as a notification on their PHR as a framework for the design of a patient-centered notification system. We applied a qualitative approach followed by usability tests. From interviews to patients, we obtained main categories of notifications to include according to its perceived usefulness while, from iterative usability tests, we obtained a final version of prototypes developed according to patient-interface interaction experiences. This research helped us to understand patients needs and behavior to design an efficient notification system and also represents the first step for the development of clinical decision support systems for patients into the PHR with the potential to improve clinical outcomes and healthcare delivery.

Qualitative Study to Design an Online Community for Patients with Psoriasis.

The aim of this research was to understand the needs of patients with psoriasis and the concerns of specialists in this pathology. Interviews with adults with psoriasis and dermatologists were conducted. We found 4 main dimensions: Frequently asked questions; Social stigma; Education to patients and Patient empowerment. The findings represent a first approach to understand the needs and perceptions of patients and dermatologists, for the design of a virtual community.

[Spanish translation and transcultural adaptation of a questionnaire on telemedicine usability]. / Traducción al español y adaptación transcultural de un cuestionario sobre la usabilidad de la telemedicina.

Telemedicine is the provision of services by health professionals, through the use of information and communication technologies. Its implementation helps to shorten distances, facilitate access to the health system, improve the effectiveness of care and reduce costs. In 2016, Bambang Parmanto et al, developed and validated a questionnaire in English that measures its usability and allows to evaluate all the factors that influence it. Since similar tools do not exist in the Spanish language to date, a research work was carried out for transcultural translation and adaptation that included seven steps. The questionnaire obtained after this process provides a valuable tool to objectify information that is vital to contribute to the cycle of continuous improvement of the care process of these characteristics, in which patients, health professionals and funders are involved.

La telemedicina es la prestación de servicios por profesionales de la salud, mediante la utilización de tecnologías de la información y la comunicación. Su implementación contribuye a acortar distancias, facilitar el acceso al sistema de salud, mejorar la efectividad de los cuidados y reducir costos. En 2016, Bambang Parmanto y col., desarrollaron y validaron un cuestionario en inglés que mide su usabilidad y permite evaluar todos los factores que influyen en la misma. Dado que no existen hasta la fecha herramientas similares en el idioma español, se llevó a cabo un trabajo de investigación para la traducción y adaptación transcultural que incluyó siete pasos. El cuestionario obtenido luego de este proceso brinda una herramienta valiosa que permite objetivar información que resulta vital para contribuir al ciclo de mejora continua del proceso asistencial de estas características, en el que están involucrados los pacientes, los profesionales de la salud y los financiadores.

Teletriage Pilot Study (Strategy for Unscheduled Teleconsultations): Results, Patient Acceptance and Satisfaction.

Non-urgent consultations to an Emergency Department (ED) contribute to overcrowding. Telecommunications represent a potential strategy to reduce some face-to-face consultations. OBJECTIVES: To describe characteristics of patients who used the Teletriage Program during the pilot study, to explore safety and to report user acceptance and satisfaction. METHODS: Cross-sectional study, including all adult patients affiliated to our health insurance attended to via this telemedicine service between January 18th and May 31st, 2019 (during pilot-study). Patients were followed-up for seven days to assess re-consultation to ED or unscheduled hospitalization. RESULTS: 276 effective consultations occurred, corresponding to 241 patients, with a mean of age of 50 years, 68% (189) were women. Chief complaints were related to clinical issues (70%) and remaining (30%) were administrative problems. Only four patients were suggested a referral or face-to-face assessment. Rate of re-consultation to the ED was 18% (51) at seven days of follow-up, and the rate of unscheduled hospitalization was <1% (2), both with good clinical evolution. Patient satisfaction was 72.73%, and regarding acceptability, 66.12% stated that without this channel they would have attended to a face-to-face consultation and 64.02% that they would do so if their needs remained unmet. CONCLUSIONS: Implementing this new communication channel could be a useful and safe strategy to reduce unnecessary non-urgent consultations to the ED.

[Validation of a Spanish questionnaire on telemedicine usability]. / Validación de un cuestionario en español sobre la usabilidad de la telemedicina.

Telemedicine is the provision of services by health professionals through the use of information and communication technologies. Its implementation is usually carried out through systems of va riable usability. In 2016, Parmanto et al, developed and validated a questionnaire in English that measures its usability and allows to evaluate all factors that influence it. In 2019, we translated, adapted cross-culturally, and published this questionnaire in Spanish. With the aim of transforming it into a reliable and accessible tool, the utility of which is indisputable in the current context, we carried out a research work that allowed its validation and simplification.

La telemedicina es la prestación de servicios de la salud mediante la utilización de tecnologías de la información y la comunicación. Su implementación se realiza a través de sistemas cuya usabilidad es variable. En 2016, Parmant y col., desarrollaron y validaron un cuestionario en inglés que mide su usabilidad y permite evaluar los factores que influyen en la misma. En 2019, tradujimos, adaptamos transculturalmente y publicamos este cuestionario en español. Con el objetivo de transformar el mismo en una herramienta confiable y accesible, cuya utilidad es indiscutible en el contexto actual, llevamos a cabo un trabajo de investigación que permitió su validación y simplificación.

User-Centered Design of a Pediatric Vaccination Module for Patients.

Immunization information systems and registries are essential for vaccine programs to succeed. Personal Health Record should improve decision making of healthcare providers and consumer outcomes. This article aims to describe the software development of an immunization module using a user-centered design, starting from the analysis of potential users' needs. The design was made through cycles of iterations, adjustments were made validating real scenarios and taking into account the user needs. The main features identified through interviews were: vaccination schedule, further information on vaccines' usefulness, notification, downloadable patient vaccination status and other vaccines outside the official calendar. The final scope is to create a simple, efficient and safe platform for patient immunization management.

User-Centered Design of a Patient Medication Reconciliation Module in an Integrated Personal Health Record.

With the adoption of Personal Health Records (PHRs) integrated with Electronic Health Records (EHRs) and the increase of accessibility to data, institutions have the possibility of exchanging medical information with their patients. Involving the patient reported data has the potential to improve the quality of care and safety and create a feedback loop between patients and health professionals. The objective of this study is to describe a user-centered design of a module for medication list with reconciliation functionalities managed by the patients themselves, and connected to their EHR for supervision and medical validation. We conducted 42 interviews (31 patients and 11 general practitioners). From the interviews, we performed qualitative analysis and extracted the main findings from comments in both groups. Correctitude rate was 57 to 100%, and satisfaction of use (SUS) maximum was 96% and 92%. These findings may be relevant to patients, health care providers, and policymakers.

Fall Risk Assessment Through a Self-Service Terminal in the Outpatient Setting.

Health organizations aim to identify patients with high fall risk in the different attention scenarios in order to provide safety and quality care. In order to address this issue, we designed an assessment tool that surveys fall risk through three questions in self-service terminals in the outpatient setting. Our objectives in this article are to describe the implementation process. A cross sectional design was used for the pilot (between October and November 2018). The issued tickets rate with high fall risk (defined as 2/3 positive responses) was 34.3%. Some adjustments needed to be done because some patients did not have true risk criteria due to self-report. We conclude that this tool will allow quicker identification of patients with true high risk. Effective prevention strategies will be necessary to improve safety after risk fall identification.

Implementation of an Inpatient Portal Integrated to an EHR: First Stage Evaluation.

Technology has led to the communication of the hospitalized patient and their family with clinical knowledge. The objective of this study is to describe the rate of use of the Inpatient Personal Health Record of Hospital Italiano de Buenos Aires. A cross-sectional study was conducted between May and September of 2018. The rate of use was 2.10% (95% CI 1.89-2.32). The most used functionalities were analyzed. New strategies are needed to improve the rate of use.