The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic results disclosure in diverse families.

Digital solutions are needed to support rapid increases in the application of genetic/genomic tests (GTs) in diverse clinical settings and patient populations. We developed GUÍA, a bilingual digital application that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GTs. The trial evaluated GUÍA's impact on understanding the GT results by randomizing families to results disclosure genetic counseling with GUÍA (intervention) or standard of care (SOC). Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6 months later. Survey measures assessed the primary study outcomes of participants' perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. The analysis included 551 diverse participants, 270 in the GUÍA arm and 281 in SOC. Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR = 2.8, CI[1.004, 7.617], p = 0.049) and maintained higher objective understanding over time (OR = 1.1, CI[1.004, 1.127], p = 0.038) compared to SOC. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR = 3.9, CI[1.603, 9.254], p = 0.003), confidence (OR = 2.7, CI[1.021, 7.277], p = 0.046), and objective understanding (OR = 1.1, CI[1.009, 1.212], p = 0.032) compared to SOC. This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions and builds a case for utilizing GUÍA to deliver complex results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics.

Rapid assessment of data systems for COVID-19 vaccination in the WHO African Region.

Most countries in Africa deployed digital solutions to monitor progress in rolling out COVID-19 vaccines. A rapid assessment of existing data systems for COVID-19 vaccines in the African region was conducted between May and July 2022, in 23 countries. Data were collected through interviews with key informants, identified among senior staff within Ministries of Health, using a semi-structured electronic questionnaire. At vaccination sites, individual data were collected in paper-based registers in five countries (21.7%), in an electronic registry in two countries (8.7%), and in the remaining 16 countries (69.6%) using a combination of paper-based and electronic registries. Of the 18 countries using client-based digital registries, 11 (61%) deployed the District Health Information System 2 Tracker, and seven (39%), a locally developed platform. The mean percentage of individual data transcribed in the electronic registries was 61% ± 36% standard deviation. Unreliable Internet coverage (100% of countries), non-payment of data clerks' incentives (89%), and lack of electronic devices (89%) were the main reasons for the suboptimal functioning of digital systems quoted by key informants. It is critical for investments made and experience acquired in deploying electronic platforms for COVID-19 vaccines to be leveraged to strengthen routine immunization data management.

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions.

PURPOSEOF REVIEW: Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. RECENT FINDINGS: We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.

Pilot of a digital contact tracing card in a hospital setting in New Zealand, 2020.

Countries are rapidly developing digital contact tracing solutions to augment manual contact tracing. There is limited empirical evidence evaluating these tools. We conducted a feasibility study of a Bluetooth-enabled card with hospital staff in New Zealand (n = 42). We compared the card data against self-report contact surveys and a stronger Bluetooth device. The cards detected substantially more contacts than self-report contact surveys, while the concordance between Bluetooth devices was high, suggesting that the cards detected clinically relevant close contacts. There was high acceptability among participants, suggesting that their integration would be accepted by healthcare staff. As the pandemic shifts, there is a need to rapidly contact trace and conduct informed risk management, particularly in critical settings such as healthcare.

Older adults in the digital health era: insights on the digital health related knowledge, habits and attitudes of the 65 year and older population.

BACKGROUND: The COVID-19 pandemic has increased internet use by older age groups to an unprecedented level in Hungary mirroring the general tendency in the total population. Nevertheless, international trends indicate that this group is less likely to use digital health technologies than younger ones. The aging population raises the question of successfully integrating elderly people into the digital health ecosystem. Our research aim is to investigate the digital health usage patterns and attitudes of the population aged 65 and over through a representative sample. METHODS: A national representative questionnaire survey was conducted by telephone (CATI), interviewing 1723 respondents. Within this sample we examined 428 people in the over-65 age group, 246 in the 65-74 age group and 182 in the over-75 age group. Predictors of demand for digital solutions were tested using binary logistic regression model. RESULTS: 50.8% of people aged 65-74 and 37.1. % of people aged 75 + use the internet for health-related purposes, mostly to access websites. 85% of respondents in 65-74 and 74% in 75 + age group have used more than one digital health device and around 70% of both age groups have a need for more than one digital solution. 90.2% (64-75 age group) and 85.7% (75 + age group) of respondents are familiar with e-prescription, 86.4% and 81.4% of them use it. 77.1% of 65-74-year-olds have heard of and nearly half 45.5% have used online appointment. More than half (52.7%) of the respondents in this age group have heard of and used electronic transmission of medical records and data. A similar proportion has heard about and used apps: 54.3% has heard of them, but only 17.3% has used them. The multivariate analyses emphasized that the need for digital solutions increases with the level of education and the more benefits one perceives in using digital solutions. CONCLUSION: Our research has shown that the senior age group has measurable needs in the field of digital health, so helping them on this journey is in the interest of the whole health ecosystem. Their high level of interest is indicated by the fact that more than a fifth of older adults would like to have access to between 7 and 10 of the maximum number of digital devices available. The differences between the two age groups - with younger people being more open to digital solutions and using them more - and the fact that the under 65s are better adapted digitally in all respects, raises the possibility that the specific trends in digital health for older people may virtually disappear in 10 years' time (when the under 65s now enter this age group).

Evidence of mobile health integration into primary health care systems for better maternal mental health in LMICs during COVID-19 pandemic - Review.

Mental illnesses are prevalent worldwide, especially in the underdeveloped countries of the South Asian region, particularly in women, where they largely remain unaddressed. Evidence from the South Asian region indicates that there is a high burden of mental disorders in vulnerable populations such as pregnant women. Mental health problems during pregnancy and in the postpartum period are twice as common in LMICs as compared to HICs. Interventions delivered by community health workers (CHWs) in many health delivery and promotive initiatives have played a vital role in improving mental health. CHW-based interventions are cost-effective, efficient and acceptable for the local people and can strengthen the overall health system. This review aimed to explore integration of maternal mental health into existing maternal, newborn and child health (MNCH) programs so that delivery of mental health interventions can be done alongside MNCH interventions. Integrating maternal mental health programmes into existing MNCH programs and using digital platforms for expanding their delivery through CHWs, lay counsellors, and other frontline health workers can prove to be a promising strategy. Even though mHealth platforms for addressing a variety of health issues have been widely used during the COVID-19 pandemic, the use of digital platforms for addressing maternal mental health issues remains inadequate.

Accommodating clinical trials and other externally manufactured cellular therapy products: challenges, lessons learned and creative solutions.

BACKGROUND AIMS: The Division of Transfusion Medicine and Cellular Therapy at New York-Presbyterian/Columbia University Irving Medical Center (NYPH-CUIMC) comprises the immunohematology laboratory and blood bank (transfusion service), hemotherapy/apheresis and the cellular therapy laboratory (CTL). The CTL processes and stores hematopoietic progenitor cells for bone marrow transplantation from all currently acceptable sources, including bone marrow, peripheral blood and umbilical cord blood. The laboratory provides services for the pediatric and adult blood and marrow transplant programs at both NYPH-CUIMC and the Morgan Stanley Children's Hospital of New York-Presbyterian. The laboratory processes and stores approximately 200 cellular therapy products per year, and the division participates in numerous clinical trials within the institution and with external pharmaceutical manufacturing facilities. As a licensed tissue bank, commercial chimeric antigen receptor T-cell products and other cellular-based therapies that are approved by the US Food and Drug Administration (FDA) are routed through the CTL for storage, processing, coordination of transportation, chain of custody and, eventually, thaw and distribution. Currently, we are distributing four such products from Kite Pharma, Novartis and Bristol Meyers Squid. In comparison to the amount of work, we employ a small staff of only four full-time clinical laboratory technologists, one technical specialist, one quality and operations manager and one medical director. In recent years, the growing use of the hematology/oncology service and the introduction of new immunotherapies have put significant pressure on our division to accommodate and scale up operations. Accompanying this growth is a mounting administrative burden and upsurge in regulatory and protocol-specific oversight. The purpose of this article is to share lessons learned and creative solutions to help better accommodate the surge in development of novel cellular therapies. METHODS: To handle this increase in demand, the CTL worked to standardize administrative procedures, implement comprehensive document control solutions, digitize data collection and implement lean design concepts to increase effectiveness and mitigate risk. RESULTS: Distribution of a standard operating procedure for clinical trial management improved the "on-boarding" process and allowed the laboratory to have more influence in the decision-making process. Implementation of digital workflows and a comprehensive document control system allowed for improved organization of critical documents and proved to be flexible enough to accommodate various protocol-specific requirements. Introduction of visual ques and reorganization of the workspace facilitated better organization, mitigated risk and assisted the laboratory in maintaining regulatory compliance. CONCLUSIONS: Better-defined, structured and controlled laboratory processes helped laboratory management implement new clinical trials and track critical data. Implementing digital solutions using widely available tools like Microsoft SharePoint has proven to be a very secure, low-cost and flexible solution to keeping us "up-to-date" and inspection-ready.

A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study.

BACKGROUND: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. OBJECTIVE: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. METHODS: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. RESULTS: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. CONCLUSIONS: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. TRIAL REGISTRATION: ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363.

Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study.

BACKGROUND: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. OBJECTIVE: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. METHODS: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. RESULTS: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. CONCLUSIONS: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174.

Experience of a tertiary acute care hospital in Southeast Asia in initiating patient engagement with the aid of digital solutions.

Introduction: With the goal of patient engagement, an initiative was formulated to equip each patient in the general wards with a tablet whereby they can access their health information and patient education materials and communicate with their healthcare team. This paper presented the methodology of the implementation efforts as well as an evaluation of the preliminary outcomes. Methods: The process of hospital-wide implementation was shared using the implementation research logic model. The bedside tablets were rolled out hospital-wide in a step-wedge manner over 12 months. Barriers and facilitators to this implementation were discussed together with strategies to optimize the situation. Preliminary outcomes of the implementation were evaluated using the RE-AIM framework. Results: The initial adoption rate for the bedside tablet was low. Additional strategies, such as survey audits and provision of feedback, development of education materials for patients, facilitation, and purposefully re-examining the implementation strategies, were used to improve adoption. The trend of adoption increased over the course of 2 years from the start of implementation. Discussion: The initial lower adoption rates may reflect Singapore's paternalistic healthcare culture. While this implementation was driven by the need to move away from paternalism and toward patient engagement, more time is required for significant cultural change.

Innovative approaches in discussions of diabetes among healthcare sector actors in Germany.

The dramatic growth in the rate of diabetes prompts serious debates about awareness, early diagnosis, and care interventions. This Viewpoint aims to explore, from the perspectives of healthcare sector representatives, what challenges and difficulties they face in dealing with diabetes and how these can be overcome. We applied the World Café method for group discussions, which enabled us to bring together 50 stakeholders. They identified challenges at institutional and structural levels under the concepts of awareness, digitalisation, and new forms of care and shared their suggestions for feasible solutions. We learned there is a need for a diabetes map of Germany to identify risk groups and that hybrid solutions should be implemented for treatment, care, prevention, and early diagnosis, considering digital infrastructure. Also, the demand for digital innovation in the healthcare system raised concerns about information transparency and data management.

The effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being: a systematic review and meta-analysis.

Background: Widespread challenges to mental well-being among nurses and healthcare professionals threaten the productivity and quality of healthcare. Digital solutions may prove to effectively support nurses' and healthcare professionals' mental well-being. Aim: To synthesise evidence regarding the effectiveness of digital solutions in improving nurses' and healthcare professionals' mental well-being. Methods: This systematic review followed the JBI guidance for systematic reviews of effectiveness. The PubMed, CINAHL, Scopus, Pro-Quest and APA PsycArticles databases were reviewed for randomised controlled trials and quasi-experimental studies published at any point prior to the 26th of October 2021. Meta-analysis and narrative synthesis were performed. Results: Fourteen studies were included. Personal mental well-being solutions significantly improved nurses' and healthcare professionals' mental well-being. The effectiveness of work-related digital solutions could not be demonstrated. The meta-analysis revealed little to no effect on professionals' work engagement. Conclusions: Personal digital solutions may have the potential to improve the mental well-being of nurses and healthcare professionals. With the support of nurse managers' facilitation, nurses have a key role to promote their own mental well-being by utilising digital mental health solutions. Nevertheless, further adequately powered, well-designed research is required.

Professional-Facing Digital Health Solutions for the Care of Patients With Chronic Pain: Protocol for a Systematic Scoping Review.

BACKGROUND: Chronic pain is a highly prevalent condition and one of the most common reasons why people seek health care. As a result, chronic pain has a significant personal and economic burden. The COVID-19 pandemic has aggravated the situation for patients with chronic pain through increased risk factors (eg, anxiety or depression) as well as decreased access to health care. Digital health solutions to support people with chronic pain are becoming increasingly popular. Most of the research has focused on patient-facing digital health solutions, although it is clear that the involvement of health and care professionals is crucial in chronic pain care. Certainly, digital health solutions intended for the use of health and care professionals in the care of patients with chronic pain (ie, professional facing) exist, for example, for clinical decision support; however, no review has investigated the studies reporting these interventions. OBJECTIVE: The overall aim of this scoping review is to identify the available professional-facing digital health solutions for the purpose of chronic pain management. The objectives of this review are to investigate the components, target populations, and user settings of the available professional-facing digital solutions; health and care professionals' perspectives on using digital health solutions (if reported); the methods in which the digital health solutions are developed; and the outcomes of using professional-facing digital health solutions. METHODS: Databases including MEDLINE, Embase, CINAHL, PsycInfo, and Inspec will be searched for studies reporting professional-facing digital health solutions for chronic pain care, using a comprehensive search strategy developed for each of the specific databases. A total of 2 independent reviewers will screen the titles and abstracts for review inclusion and then conduct full-text screening. Any conflicts in study inclusion will be resolved by a third reviewer at each stage of the screening process. Following data extraction and quality assessment, a qualitative content analysis of the results will be conducted. This review will identify the available professional-facing digital health solutions for chronic pain management. The results of this review are likely to be heterogeneous in terms of content (ie, the digital solutions will serve a variety of purposes, settings, target populations, etc) and methods (ie, experimental and nonexperimental designs). RESULTS: The review is expected to finish in March 2024 and published in the summer of 2024. CONCLUSIONS: This protocol outlines the need for a scoping review to identify professional-facing digital health solutions for the management of chronic pain. Results from this review will contribute to the growing field of research into the utility of digital health for chronic pain management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51311.

Improving Vaccine Clinic Efficiency Through the CANImmunize Platform.

Unlabelled: Our objective was to evaluate the CANImmunize digital solution and measure the impact on workflow and appointment booking at Bruyère Hospital.

Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach.

BACKGROUND: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.

The NYCKidSeq randomized controlled trial: Impact of GUÍA digitally enhanced genetic counseling in racially and ethnically diverse families.

Background: Digital solutions are needed to support rapid increases in the application of genetic and genomic tests (GT) in diverse clinical settings and patient populations. We developed GUÍA, a bi-lingual web-based platform that facilitates disclosure of GT results. The NYCKidSeq randomized controlled trial evaluated GUÍA's impact on understanding of GT results. Methods: NYCKidSeq enrolled diverse children with neurologic, cardiac, and immunologic conditions who underwent GT. Families were randomized to genetic counseling with GUÍA (intervention) or standard of care (SOC) genetic counseling for results disclosure. Parents/legal guardians (participants) completed surveys at baseline, post-results disclosure, and 6-months later. Survey measures assessed the primary study outcomes of perceived understanding of and confidence in explaining their child's GT results and the secondary outcome of objective understanding. We used regression models to evaluate the association between the intervention and the study outcomes. Results: The analysis included 551 participants, 270 in the GUÍA arm and 281 in SOC. Participants' mean age was 41.1 years and 88.6% were mothers. Most participants were Hispanic/Latino(a) (46.3%), White/European American (24.5%), or Black/African American (15.8%). Participants in the GUÍA arm had significantly higher perceived understanding post-results (OR=2.8, CI[1.004,7.617], P=0.049) and maintained higher objective understanding over time (OR=1.1, CI[1.004, 1.127], P=0.038) compared to those in the SOC arm. There was no impact on perceived confidence. Hispanic/Latino(a) individuals in the GUÍA arm maintained higher perceived understanding (OR=3.9, CI[1.6, 9.3], P=0.003), confidence (OR=2.7, CI[1.021, 7.277], P=0.046), and objective understanding (OR=1.1, CI[1.009, 1.212], P=0.032) compared to SOC . Conclusions: This trial demonstrates that GUÍA positively impacts understanding of GT results in diverse parents of children with suspected genetic conditions. These findings build a case for utilizing GUÍA to deliver complex and often ambiguous genetic results. Continued development and evaluation of digital applications in diverse populations are critical for equitably scaling GT offerings in specialty clinics. Trial Registration: Clinicaltrials.gov identifier NCT03738098.

Scaling digital solutions for wicked problems: Ecosystem versatility.

Digital solutions are increasingly used to address "wicked problems" that are locally embedded but require global approaches. Scaling these solutions internationally is imperative for their success, but to date we know little about this process. Using a qualitative case study methodology, our paper analyzes how four digital solutions driven by the United Nations are built and how they scale internationally. These solutions address wicked problems through artificial intelligence, blockchain, and geospatial mapping, and are embedded in networks of partners which evolve during scaling to create unique ecosystem roles and configurations. We identify different ecosystem roles and find that the specific properties of digital solutions - modularity, generativity and affordances - enable either adaptation or replication during scaling. Building on these insights, we derive a typology of four different types of international scaling, which vary in their ecosystem versatility (how the ecosystem changes across locations) and the local adaptation of the application (the problems the solution addresses). This study presents a new way to examine the replication and adaptation dilemma for ecosystems and extends internationalization theory to the digital world.

Les solutions numériques sont de plus en plus utilisées pour résoudre les "problèmes vicieux" (wicked problems) qui sont localement encastrés mais nécessitent des approches globales. La mise à l'échelle internationale de ces solutions est essentielle pour leur succès, mais, à ce jour, nous savons peu de choses sur ce processus. À l'aide d'une méthodologie qualitative fondée sur l'étude de cas, notre article analyse les façons dont se construisent et se mettent à l'échelle internationale quatre solutions numériques pilotées par l'Organisation des Nations unies. Ces solutions résolvent les problèmes vicieux par les biais d'intelligence artificielle, de blockchain et de cartographie géospatiale, et sont encastrées dans des réseaux de partenaires qui évoluent pendant la mise à l'échelle pour créer des rôles et des configurations uniques de l'écosystème. Nous identifions différents rôles de l'écosystème, et observons que les propriétés spécifiques des solutions numériques ­ modularité, générativité et affordances ­ permettent soit l'adaptation soit la réplication pendant la mise à l'échelle. Nous appuyant sur ces observations, nous élaborons une typologie de quatre types différents de mise à l'échelle internationale, lesquels varient en fonction de la versatilité de l'écosystème (comment l'écosystème change d'un endroit à l'autre) et de l'adaptation locale de l'application (les problèmes auxquels la solution répond). Cette recherche présente une nouvelle façon d'examiner le dilemme de la réplication et de l'adaptation des écosystèmes, et étend la théorie de l'internationalisation au monde numérique.

Las soluciones digitales se usan cada vez para abordar "problemas perversos" que están arraigados localmente, pero que requieren enfoques globales. Escalar estas soluciones internacionalmente es imperativo para su éxito, pero hasta la fecha sabemos muy poco sobre este proceso. Usando metodología de estudio de caso, nuestro manuscrito analiza como se construyen cuatro soluciones digitales impulsadas por Naciones Unidas y cómo se escalan internacionalmente. Estas soluciones abordan problemas perversos mediante inteligencia artificial, cadena de bloques (blockchain) y mapeo geoespacial, y están integradas en las redes de los socios que evolucionan durante el escalamiento para crear roles y configuraciones únicas en el ecosistema. Identificamos diferentes roles en el ecosistema y encontramos que las propiedades especificas de las soluciones digitales -modularidad, generatividad y asequibilidad- permiten la adaptación o la replicación durante el escalamiento. Sobre la base de estos aportes, derivamos una tipología de cuatro tipos diferentes de escalamiento internacional las cuales varían en versatilidad en el ecosistema (cómo cambia el ecosistema a través de los lugares) y la adaptación local para la aplicación (los problemas que la solución aborda). Este estudio presenta una nueva manera de examinar el dilema de la replicación y la adaptación para ecosistemas y extiende la teoría de internacionalización al mundo digital.

Soluções digitais são cada vez mais usadas para lidar com "problemas perversos" que são incorporados localmente, mas exigem abordagens globais. Escalar tais soluções internacionalmente é imperativo para o seu sucesso, mas até hoje sabemos pouco sobre esse processo. Usando uma metodologia de estudo de caso qualitativo, nosso artigo analisa como quatro soluções digitais impulsionadas pelas Nações Unidas são construídas e como atingem escala internacional. Essas soluções abordam problemas perversos por meio de inteligência artificial, tecnologia blockchain e mapeamento geoespacial e são incorporadas em redes de parceiros que evoluem durante a escalada para criar papeis e configurações de ecossistema únicos. Identificamos diferentes papeis de ecossistema e descobrimos que as propriedades específicas das soluções digitais ­ modularidade, generatividade e utilidades ­ permitem adaptação ou replicação durante a escalada. Com base nesses insights, derivamos uma tipologia de quatro tipos diferentes de escalada internacional que variam em sua versatilidade de ecossistema (como o ecossistema muda entre locais) e na adaptação local da aplicação (os problemas que a solução aborda). Este estudo apresenta uma nova maneira de examinar o dilema de replicação e adaptação para ecossistemas e estende a teoria da internacionalização ao mundo digital.

Digital solutions for decision support in general practice - a rapid review focused on systems developed for the universal healthcare setting in Denmark.

BACKGROUND: Digital health solutions hold the potential for supporting general practitioners in decision-making, and include telemedicine systems, decision support systems, patient apps, wearables, fitness trackers, etc. AIM: This review aimed to identify digital solutions developed for, tested, or implemented in general practice to support the decisions of GPs in disease detection and management, using Denmark as an example country of a universal healthcare setting. METHODS: This study was conducted as a rapid review. The primary search included a database search conducted in Embase and MEDLINE. The supplementary search was conducted in Infomedia and additionally included a snowball search in reference lists and citations of key articles identified in the database search. Titles were screened by two reviewers. RESULTS: The review included 15 studies as key articles describing a total of 13 digital solutions for decision support in general practice in Denmark. 1.123 titles were identified through the database search and 240 titles were identified through the supplementary and snowball search. CONCLUSIONS: The review identified 13 digital solutions for decision support in general practice in a Danish healthcare setting aimed at detection and/or management of cancer, COPD, type 2 diabetes, depression, liver disease or multiple lifestyle-related diseases. Implementation aspects should be reported more transparently in future publications to enable applicability of digital solutions as decision support to aid general practitioners in disease detection and management.

Technology-Based Interventions to Address Social Isolation and Loneliness Among Informal Dementia Caregivers: A Scoping Review.

OBJECTIVE: Social isolation and loneliness are major public health concerns. Informal dementia caregivers are particularly vulnerable, as many are older adults themselves and at elevated risk of adverse mental and physical health outcomes. Technology-based interventions could offer accessible, affordable, and convenient solutions. A previous review included Internet-based supportive interventions for informal dementia caregivers published up to 2013; however, new publications, technological advances, and targeted outcomes justify conducting this scoping review. Here, we identified and synthesized recent technology-based interventions that addressed social isolation and loneliness among informal dementia caregivers. DESIGN: Scoping review. SETTING AND PARTICIPANTS: Informal dementia caregivers in the community. METHODS: Following Arksey and O'Malley's scoping review framework, we conducted a systematic search of peer-reviewed studies across 6 databases within the last 11 years, including identifying research questions, selecting relevant studies, charting data, and summarizing results. RESULTS: From the 2937 articles identified, 10 eligible studies were included in this review. The intervention type, format, and duration varied widely. Three categories of interventions to address social isolation and loneliness among informal dementia caregivers included technology-assisted peer support, newly developed Web-based multicomponent psychoeducational programs and platforms, and virtual adaptation and modification of existing programs. Predominantly qualitative evidence suggests that technology-based interventions have the potential to reduce feelings of loneliness and improve caregiver well-being. Quantitative evidence tends to be preliminary and inconclusive. CONCLUSIONS AND IMPLICATIONS: The findings offer preliminary evidence for technology-based interventions to reduce or prevent social isolation and loneliness in informal dementia caregivers. Technology-based interventions addressing social isolation and loneliness in informal dementia caregivers have the potential to overcome barriers to low uptake of services and withdrawal from interventions and improve the sustainability of the interventions. In the long run, by reducing or preventing social isolation and loneliness in informal dementia caregivers, the transition from home care to facility-based care might be delayed.

The Potential of the Remote Monitoring Digital Solutions to Sustain the Mental and Emotional Health of the Elderly during and Post COVID-19 Crisis in Romania.

The COVID-19 pandemic amplified the elderly's aging-related dysfunctionalities and vulnerabilities. Research surveys, aimed at evaluating the socio-physical-emotional state of the elderly and obtaining data on their access to medical services and information media services during the pandemic, were carried out on Romanian respondents aged 65+. Identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection, based on the implementation of a specific procedure, can be performed through Remote Monitoring Digital Solutions (RMDSs). The aim of this paper is to propose a procedure for the identification and mitigation of the risk of emotional and mental long-term decline of the elderly after SARS-CoV-2 infection that comprises RMDS. The importance of using the knowledge obtained by COVID-19-related surveys corroborating the necessity of including personalized RMDS in the procedure is highlighted. The Non-invasive Monitoring System and Health Assessment of the Elderly in a Smart Environment (RO-SmartAgeing) is an RMDS designed to address the improved preventative and proactive support for diminishing this risk and to provide suitable assistance for the elderly through a safe and efficient smart environment. Its comprehensive functionalities targeted supporting primary healthcare assistance, specific medical conditions-as the mental and emotional disorders post-SARS-CoV-2 infection-and enlarged access to aging-related information, together with customizable features, illustrated the match with the requirements included in the proposed procedure.