Enhancing patient informed consent in elective skin cancer surgeries: a comparative study of traditional and digital approaches in a German public hospital.

BACKGROUND: This study aims to investigate the integration of modern sources of patient information, such as videos, internet-based resources, and scientific abstracts, into the traditional patient informed consent process in outpatient elective surgeries. The goal is to optimize the informed consent experience, enhance patient satisfaction, and promote shared decision making (SDM) between patients and surgeons. By exploring different patient informed consent formats and their impact on patient satisfaction, this research seeks to improve healthcare practices and ultimately enhance patient outcomes. The findings of this study will contribute to the ongoing efforts to improve the informed consent process in public hospitals and advance patient-centred care. METHODS: Data collection occurred at the day care clinic of a prominent German public hospital, forming an integral component of a prospective clinical investigation. The study exclusively focused on individuals who had undergone surgical intervention for skin cancer. For the purpose of meticulous data examination, the statistical software SPSS version 21 was harnessed. In the course of this study, a chi-square test was aptly employed. Its purpose was to scrutinize the nuances in patient experiences pertaining to informed consent across four distinct categories, viz., oral informed consent discussion (Oral ICD), written informed consent discussion (Written ICD), video-assisted informed consent discussion (video-assisted ICD), and digitally assisted informed consent discussion (digital-assisted ICD). The primary dataset of this inquiry was diligently gathered via a structured questionnaire administered to a targeted cohort of 160 patients. Within this sample, a balanced representation of genders was observed, encompassing 82 males and 78 females. Their collective age span ranged from 18 to 92 years, with an average age of 71 years. A randomized selection methodology was employed to include participants in this study during the period spanning from July 2017 to August 2018. RESULTS: Significant differences were observed across the groups for all research questions, highlighting variations in patient responses. Video-assisted and digital-assisted IC were rated as superior in patient satisfaction with information compared to written and oral IC. Demographic profiles of the four study groups were found to be comparable. CONCLUSION: The findings of this study indicate that the incorporation of digital technologies in the informed consent process can enhance patient understanding during outpatient elective skin cancer surgeries. These results have important implications for increasing patient satisfaction and improving the SDM process within the hospital environment.

[Transparency and Efficiency through Digital Healthcare? Results of a Survey of Generation Y]. / Transparenz und Effizienz durch digitale Gesundheitsversorgung? Ergebnisse eines Surveys der Generation Y.

BACKGROUND: Generation Y represents a special target group in healthcare. Young, healthy and digitally socialized with integration of technologies into everyday life, they have specific needs. In the context of societal challenges such as demographic change and securing a skilled workforce, taking these needs into account, especially for maintaining health, should be the goal of public health as well as specific actors such as health insurers and employers. AIM OF THE WORK: The research was intended to test and deepen the findings of two previous stages of work, specifically a qualitative survey. In this way, two research questions were to be answered: I: the importance of transparency and efficiency in the use of digital health innovations by Generation Y and II: the influence of socio-demographic and technology-associated factors on the use of digital health innovations by Generation Y in addition to the needs. MATERIAL AND METHODS: As a conclusion of a sequential approach, assessments of transparency- and efficiency-associated needs in context of the use of digital health innovations of persons from Generation Y were collected in a quantitative online survey. 355 fully completed data sets were analyzed using SPSS software. An ordinal regression analysis was used to test the influence of predictors from six previously formulated hypotheses. RESULTS: The study was able to describe influences of the constructs transparency and efficiency on the use of apps and smart devices. The need for a sense of control had a significantly negative effect, while the need for structuring and seamless integration into everyday life had a significantly positive effect. Gender and technology readiness also had an impact. According to the data analysis, efficiency and thus a concrete everyday benefit from digital health innovations seems to be more relevant for Generation Y than autonomous empowerment and thus transparency. CONCLUSION: By taking into account the needs described as well as corresponding preferences, the target group could be addressed and usage could potentially be increased. Prevention and health promotion, as well as their organization, should be able to be incorporated into everyday life at a low threshold, and everyday life should be positively supplemented and efficiently supported.

[Patients' Use of Digital Innovations in the Care Process: A Scoping Review]. / Nutzung digitaler Innovationen durch Patient*innen im Versorgungsprozess ­ Ein Scoping Review.

BACKGROUND: Digital innovations in healthcare continue to be extensively researched and publicly discussed. The research perspective is often indication-specific or process-oriented and focuses on an application by health professionals in care settings. From the patient's perspective, there are additional digital innovations and opportunities for use that take place privately in addition to sectoral care services. AIM: The aim of this scoping review was to map digital innovations currently available for patients and their possible applications in the care process by exploring the following question: Which digital innovations are currently available for patients in health care? MATERIAL AND METHODS: A systematic literature search in four databases helped identify 44 international publications as relevant for our analysis. They were categorized and analyzed according to the types of digital innovations, their use by patients, and their location within the care process. In addition, the intentions whereby digital innovations can be applied were discussed. RESULTS: We found that current research was focused on patient-applied digital innovations in the therapeutic field, and a broad application spectrum of interfaces for digital care was emerging. These included apps, smart devices, teleconsultation, patient portals, games, implants, robotics, intelligent information and communication systems, and ambient assisted living environments. CONCLUSION: Many digitally supported health applications are designed to be used exclusively by patients themselves, or are performed in only partial interaction with providers. In this respect, the active participation and personal responsibility of patients in the treatment process could be strengthened with the help of digital innovations.

[Nursing home-sensitive conditions and approaches to reduce hospitalization of nursing home residents]. / Pflegeheim-sensitive Krankenhausfälle und Ansätze zur Verringerung der Hospitalisierung von Pflegeheimbewohnerinnen und -bewohnern.

BACKGROUND: Interventions to reduce potentially risky hospitalizations among nursing home residents are highly relevant for patient safety and quality improvement. A catalog of nursing home-sensitive conditions (NHSCs) grounds the policy recommendations and interventions. METHODS: In two previous research phases, an expert panel developed a catalog of 58 NHSCs using an adapted Delphi-procedure (the RAND/UCLA Appropriateness Method). This procedure was developed by the North American non-profit Research and Development Organisation (RAND) and clinicians of the University of California in Los Angeles (UCLA). We present the third phase of the project focused on the development of interventions to reduce NHSCs starting with an expert workshop. The workshop results were then evaluated by six experts from related sectors, supplemented, and systematically used to produce recommendations for action. Possible implementation obstacles were considered and the time horizon of effectiveness was estimated. RESULTS: The recommendations address communication, cooperation, documentation and care competence as well as facility-related, financial, and legal aspects. Indication bundles demonstrate the relevance for the German healthcare system. To increase effectiveness, the experts advise a meaningful combination of individual recommendations. DISCUSSION: By optimizing multidisciplinary communication and cooperation, combined with an- also digital - expansion of the infrastructure and the creation of institution-specific and legal prerequisites as well as remuneration structures, an estimated 35% of all hospitalizations, approximately 220,000 hospitalizations for Germany, could be prevented. The implementation expenditure could be refinanced by avoided hospitalization savings amounting to 768 million euros.

Effectiveness of Digital Forced-Choice Nudges for Voluntary Data Donation by Health Self-trackers in Germany: Web-Based Experiment.

BACKGROUND: Health self-tracking is an evidence-based approach to optimize health and well-being for personal self-improvement through lifestyle changes. At the same time, user-generated health-related data can be of particular value for (health care) research. As longitudinal data, these data can provide evidence for developing better and new medications, diagnosing rare diseases faster, or treating chronic diseases. OBJECTIVE: This quantitative study aims to investigate the impact of digital forced-choice nudges on the willingness of German health self-trackers to donate self-tracked health-related data for research. This study contributes to the body of knowledge on the effectiveness of nonmonetary incentives. Our study enables a gender-specific statement on influencing factors on the voluntary donation of personal health data and, at the same time, on the effectiveness of digital forced-choice nudges within tracking apps. METHODS: We implemented a digital experiment using a web-based questionnaire by graphical manipulation of the Runtastic tracking app interface. We asked 5 groups independently to indicate their willingness to donate tracked data for research. We used a digital forced-choice nudge via a pop-up window, which framed the data donation request with 4 different counter values. We generated the counter values according to the specific target group needs identified from the research literature. RESULTS: A sample of 919 was generated, of which, 625 (68%) were women and 294 (32%) were men. By dividing the sample into male and female participants, we take into account research on gender differences in privacy tendencies on the web and offline, showing that female participants display higher privacy concerns than male participants. A statistical group comparison shows that with a small effect size (r=0.21), men are significantly more likely (P=.04) to donate their self-tracked data for research if the need to take on social responsibility is addressed (the prosocial counter value in this case-contributing to society) compared with the control group without counter value. Selfish or pseudoprosocial counter values had no significant effect on willingness to donate health data among male or female health self-trackers in Germany when presented as a forced-choice nudge within a tracking app. CONCLUSIONS: Although surveys regularly reveal an 80% to 95% willingness to donate data on average in the population, our results show that only 41% (377/919) of the health self-trackers would donate their self-collected health data to research. Although selfish motives do not significantly influence willingness to donate, linking data donation to added societal value could significantly increase the likelihood of donating among male self-trackers by 15.5%. Thus, addressing the need to contribute to society promotes the willingness to donate data among male health self-trackers. The implementation of forced-choice framing nudges within tracking apps presented in a pop-up window can add to the accessibility of user-generated health-related data for research.

Supporting family care: a scoping app review.

BACKGROUND: Mobile applications (apps) may provide family caregivers of people with chronic diseases and conditions with access to support and good information. However, thorough understanding of how these apps meet the main needs and requirements of the users is currently lacking. The aim of this study was to review the currently available apps for family caregivers and evaluate their relevance to main domains of caregiving activities, caregivers' personal needs, and caregivers' groups found in previous research on family caregivers. METHODS: We conducted a scoping review on English-language and German-language apps for family caregivers on two major app stores: Google Play Store and iOS App Store. Apps were included if the main target group were family caregivers. Data were extracted from the app descriptions provided by the app producers in the app stores. RESULTS: The majority of the apps was designed to assist caregivers in their caregiving activities. Apps were rarely tailored to specific groups of family caregivers such as young carers and their needs. Further, apps addressing caregivers' personal health, financial security, and work issues were scarce. Commercial apps dominated the market, often intermediating paid services or available for users of specific hardware. Public and non-profit organizations provided best-rated and free-of-charge apps but had a very limited range of services with focus on caregivers' health and training. CONCLUSIONS: Our results indicate that current apps for family caregivers do not distinguish specific groups of family caregivers, also they rarely address caregivers' personal needs.

[Highly Burdened Groups of Family Caregivers - Results of a Cluster Analysis]. / Hochbelastete Gruppen pflegender Angehöriger ­ Ergebnisse einer Clusteranalyse.

AIM: The aim of this study was to explore caregiving situations and to identify highly burdened caregiver groups. METHODOLOGY: Survey data was collected from 1,429 family caregivers. Family caregivers were defined as relatives, friends, or neighbors who take care of and look after a person in need of care. Cluster analysis identified groups of family caregivers. Group differences were tested for statistical significance using the chi-squared test and analysis of variance. RESULTS: Five groups of family caregivers were identified based on their caregiving tasks. Groups were characterized by the care situation (relationship to the person in need, intensity, and duration of care) and socio-demographic factors (gender, age, and employment). Groups differed in the perception of the care-related burden. While emotional burden was high in almost all groups, caregivers who provided everyday care reported high physical burden and those who provided continuous care over a long period reported high financial burden. CONCLUSIONS: Caregivers are not a homogeneous group. They take on different roles and are exposed to various health and financial burdens. Information and services need to be addressed target group specifically. The presented typology supports health insurances and municipalities by enabling effective support approaches for highly burdened groups of family caregivers.

[Expectations of generation Y for digital health innovations]. / Erwartungen der Generation Y an digitale Gesundheitsinnovationen.

BACKGROUND AND AIM: "Generation Y" is the term used to describe younger adults born between approximately 1980 and 2000. The generation is attributed with being digitally savvy and technically adept. It can thus be assumed that there is an increased desire among these people to use digital healthcare innovations when needed. However, the exact expectations in this regard are largely unknown. The aim of this study is to examine the expectations and needs of Generation Y in more detail. MATERIALS AND METHODS: For data collection, five focus group interviews were conducted in April 2021, each with six people between 23 and 36 years of age, with three people per group working in the health sector. The interview material was analyzed using content analysis according to Mayring. RESULTS: One of the expectations among respondents was to use low-threshold digital healthcare innovations. There was also a great demand for health information. The focus was on increasing efficiency in everyday life, in particular a reduction in the amount of time required. Influences of the corona pandemic on expectations were observed. DISCUSSION: Three functions of digital applications emerge as particularly relevant: "administration," "tracking," and "information." For these, preference profiles of Generation Y were created. Customized solutions offered by digital innovations could help to implement target-group-specific health promotion and prevention more concretely and generate added value for Generation Y. Since the everyday life of the target group is already characterized by digitization and digital innovations, there is great potential here.

[Balancing Work and Caregiving: Impact of Employment on the Health of Family Caregivers]. / Vereinbarkeit von Beruf und Pflege: Wie wirkt sich Erwerbstätigkeit auf die Gesundheit pflegender Angehöriger aus?

AIM: The aim of this study was to investigate how the health effects of informal care are influenced by the contextual factor employment. METHODOLOGY: The analysis is based on representative German population data for 2015 and 2016 (n=19 791). The focus group "family caregivers" includes persons who informally support or care for a person at least one hour a week. A comparison group was identified by using propensity score matching. Relations in these two groups were examined by employing multivariate regression analysis. For a graphic presentation, subgroups were formed with regard to the amount of time spent on family caregiving and work. RESULTS: The mental health of family caregivers deteriorated with increasing effort for caregiving (B=-0.44; p=0.02). The negative health effects of family caregiving were reduced through employment (B=0.58; p<0.01), but only up to a certain number of working hours. With a higher workload for both activities, there was a decrease in the moderating effect (up to 32% of standard deviation). CONCLUSIONS: The significant moderating effect of employment is mainly influenced by the overall burden in the two areas of activity. Results suggest the potentially protective and restorative effects of employment on family caregivers' health.

Selling health and happiness how influencers communicate on Instagram about dieting and exercise: mixed methods research.

BACKGROUND: Eating disorders among adolescents are an ongoing public health concern. Sustainable health promotion programmes require a thorough understanding of the social context in which minors engage. Initial studies show that young people make extensive use of social networks in order to exchange experiences and gather information. During this process their (buying) behaviour is significantly affected by so-called influencers. METHODS: The exploratory research studies non-campaign driven health communication on dieting and exercise by influencers in social networks with a focus on content, techniques and visible impact. In a mixed methods approach, we initially analysed 1000 posts from influencers on Instagram quantitatively. Subsequently we conducted an in-depth content analysis of 9 extreme and 27 typical communication threads. RESULTS: Influencers gain the trust and friendship of their followers by designing body-shape focused visual content and targeted communication techniques. They identify and define diet and exercise as factors to be controlled for body perfection. By consuming dietary supplements and wearing tight-fitting branded sportswear, influencers promise a simplified way of optimizing one's appearance as the key to happiness. Direct and surreptitious advertising of industry-specific products constitutes the communicative focus. At the same time, minors identify with the roles and ideals demonstrated by influencers and their needs are satisfied on several different levels. This creates a relationship of dependency between influencers and their followers. CONCLUSIONS: The dynamics in the field of health communication by influencers on social networks will become increasingly important in the coming years. This is largely due to the targeted demand on the part of (mainly) underage users and the high attractiveness of influencer marketing on the part of companies. Influencers suggest a dependence on happiness, well-being, health and beauty. Only those who create a body shaped through control and discipline are healthy and beautiful - and can be happy. The indirectly communicated conclusions, which can be considered as extremely critical, illustrate the need for action in order to protect and positively accompany young people in their psychological and physical development. The shift of authority figures within Generation Z, as well as identified communication techniques, can be considered and may be harnessed by targeted, group-oriented campaign designs.

[Emerging structures in wound care : Counselling on and prescription of medicinal products in nursing homes]. / Emergente Strukturen in der Wundversorgung : Beratung zu und Verschreibung von Medizinprodukten im Pflegeheim.

BACKGROUND-OBJECTIVE: In 2015 almost 2.9 million people in Germany received nursing care insurance benefits. More than 27% of those in need of long-term care lived in inpatient care facilities. Of the residents 6% included in the examination by the Medical Services of the Leading Association of Healthcare Insurances (MDS) had chronic wounds or bedsores requiring treatment. The aim of the study was to gain insights into care decisions and the research question was: what is the process of wound care in nursing homes? METHODS: The study used a qualitative design. Based on four inpatient nursing facilities of different ownership, the data were collected with 19 guideline-based interviews, the average duration being 62 min. All interviews were transcribed and analyzed using the qualitative MAXQDA 18 software. RESULTS: The exclusively resident-related rule processes with the known interface problems pose challenges for general practitioners and nursing homes and reach their limits. They promote the emergence of additional players, so-called homecare companies, which are not provided for in the German healthcare system and thus also not in the remuneration system. In new care structures, homecare companies are taking over the wound care process almost completely. They are financed through prescription business, i.e. through discounts granted by drug manufacturers. CONCLUSION: For nursing homes and general practitioners, homecare companies offer a welcome opportunity to meet the complex requirements of the care process while simultaneously saving their own resources. The financing of services from manufacturer discounts gives rise to fears that products with a higher cost margin will be preferentially used, thus counteracting the economic viability requirement for services provided by statutory healthcare insurance.

The Impact of Digital Transformation on Inpatient Care: Mixed Methods Study.

BACKGROUND: In the context of the digital transformation of all areas of society, health care providers are also under pressure to change. New technologies and a change in patients' self-perception and health awareness require rethinking the provision of health care services. New technologies and the extensive use of data can change provision processes, optimize them, or replace them with new services. The inpatient sector, which accounts for a particularly large share of health care spending, plays a major role in this regard. OBJECTIVE: This study examined the influences of current trends in digitization on inpatient service delivery. METHODS: We conducted a scoping review. This was applied to identify the international trends in digital transformation as they relate to hospitals. Future trends were considered from different perspectives. Using the defined inclusion criteria, international peer-reviewed articles published between 2016 and 2021 were selected. The extracted core trends were then contextualized for the German hospital sector with 12 experts. RESULTS: We included 44 articles in the literature analysis. From these, 8 core trends could be deduced. A heuristic impact model of the trends was derived from the data obtained and the experts' assessments. This model provides a development corridor for the interaction of the trends with regard to technological intensity and supply quality. Trend accelerators and barriers were identified. CONCLUSIONS: The impact analysis showed the dependencies of a successful digital transformation in the hospital sector. Although data interoperability is of particular importance for technological intensity, the changed self-image of patients was shown to be decisive with regard to the quality of care. We show that hospitals must find their role in new digitally driven ecosystems, adapt their business models to customer expectations, and use up-to-date information and communications technologies.

Prevalence and patterns of mobile device usage among physicians in clinical practice: A systematic review.

Mobile devices and corresponding applications (apps) offer a unique potential for clinical work improvement. Healthcare employees already use them for a variety of clinical purposes. Even though their use might affect patients' health and data security, they have rarely found their way into organizational knowledge management strategies. We present the current state of research regarding the prevalence, patterns, and trends of smartphone and tablet usage among physicians in clinical practice. Five electronic databases were searched for quantitative studies. The extracted data were systematically analyzed and visualized in boxplots. The results show an increasing prevalence of smartphones and medical apps in clinical practice, especially among junior physicians. Current applications can be subdivided into four categories: Communication and Organization, Documentation and Monitoring, Diagnostic and Therapeutic Decision Support, and Education. Among them, there is a large number of applications with a direct impact on physicians' clinical actions and therefore on patients' health and data security. In consequence, healthcare organizations should systematically integrate mobile devices and apps into their knowledge management strategies, including a modern IT infrastructure and training courses. Further studies are necessary to identify organizational and external factors that support an efficient mobile device usage during clinical practice.

Technical Readiness and Stereotypes in Hospital Nursing-A Question of Gender and Age?

(1) Background: The nursing profession is associated with various stereotypes. These social images or prejudices against specific groups can inhibit the personal growth of individuals, e.g., sociodemographic characteristics influence the social image of nurses. Based on the forward-looking topic digitization, we examined and discussed the influences of sociodemographic characteristics and motives of hospital nurses on technical readiness to gain insights into the digitization process in hospital nursing. (2) Methods: As part of an online survey on technical readiness among German hospital nurses, we particularly examined sociodemographic influences on technical readiness and the relationship between sociodemographic characteristics and professional motives. Furthermore, we included a qualitative analysis of optional comment fields. (3) Results: The analysis included 295 responses. Age and gender had a significant influence on technical readiness. Furthermore, the importance of motives differed between gender and age. The analysis of the comments produced three categories specifying our results: beneficial experiences, obstructive experiences and further conditions. (4) Conclusions: In general, the nurses showed high technical readiness. In order to gain high motivation for digitization and promote personal growth, special targeting and cooperation between gender and age groups can be beneficial. However, there are more sites at system level, such as funding, cooperation and consistence.

Big Data Analytics to Reduce Preventable Hospitalizations-Using Real-World Data to Predict Ambulatory Care-Sensitive Conditions.

The purpose of this study was to develop a prediction model to identify individuals and populations with a high risk of being hospitalized due to an ambulatory care-sensitive condition who might benefit from preventative actions or tailored treatment options to avoid subsequent hospital admission. A rate of 4.8% of all individuals observed had an ambulatory care-sensitive hospitalization in 2019 and 6389.3 hospital cases per 100,000 individuals could be observed. Based on real-world claims data, the predictive performance was compared between a machine learning model (Random Forest) and a statistical logistic regression model. One result was that both models achieve a generally comparable performance with c-values above 0.75, whereas the Random Forest model reached slightly higher c-values. The prediction models developed in this study reached c-values comparable to existing study results of prediction models for (avoidable) hospitalization from the literature. The prediction models were designed in such a way that they can support integrated care or public and population health interventions with little effort with an additional risk assessment tool in the case of availability of claims data. For the regions analyzed, the logistic regression revealed that switching to a higher age class or to a higher level of long-term care and unit from prior hospitalizations (all-cause and due to an ambulatory care-sensitive condition) increases the odds of having an ambulatory care-sensitive hospitalization in the upcoming year. This is also true for patients with prior diagnoses from the diagnosis groups of maternal disorders related to pregnancy, mental disorders due to alcohol/opioids, alcoholic liver disease and certain diseases of the circulatory system. Further model refinement activities and the integration of additional data, such as behavioral, social or environmental data would improve both model performance and the individual risk scores. The implementation of risk scores identifying populations potentially benefitting from public health and population health activities would be the next step to enable an evaluation of whether ambulatory care-sensitive hospitalizations can be prevented.

Digitization in Everyday Nursing Care: A Vignette Study in German Hospitals.

(1) Background: Digitization in hospital nursing promises to transform the organization of care processes and, therefore, provide relief to nurse staffing shortages. While technological solutions are advanced and application fields numerous, comprehensive implementation remains challenging. Nursing leadership is crucial to digital change processes. This vignette study examined the effects of the motives and values on nurses' motivation to use innovative technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess a fictitious situation about the introduction of digital technology. We varied the devices on the degree of novelty (tablet/smart glasses), addressed motives (intrinsic/extrinsic), and values (efficiency/patient orientation). (3) Results: The analysis included 299 responses. The tablet vignettes caused more motivation than those of the smart glasses (Z = -6.653, p < 0.001). The dataset did not show significant differences between intrinsic and extrinsic motives. The nursing leader was more motivating when emphasizing efficiency rather than patient orientation (Z = -2.995, p = 0.003). (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. The nursing staff's willingness to use digital technology is generally high. Management actions can provide a structural framework and training so that nursing leaders can ensure their staff's engagement in using also unknown devices.

Smartphone Use and Security Challenges in Hospitals: A Survey among Resident Physicians in Germany.

Although mobile devices support physicians in a variety of ways in everyday clinical practice, the use of (personal) mobile devices poses potential risks for information security, data protection, and patient safety in hospitals. We used a cross-sectional survey-based study design to assess the current state of smartphone use among resident physicians in hospitals and to investigate the relationships between working conditions, current smartphone usage patterns, and security-related behavior. In total, data from 343 participating physicians could be analyzed. A large majority (98.3%) used their smartphones during clinical practice. Of the respondents who used a smartphone during clinical practice, only 4.5% were provided with a smartphone by their employer. Approximately three-quarters of the respondents who used their smartphones for professional communication never/almost never used dedicated GDPR-compliant messenger services. Using a hierarchical regression model, we found a significant effect of the organizational resources Social Support (Supervisor) and Information Security-related Communication on security-related behavior during the selection of medical apps (App Selection). Smartphones are an important part of digital support for physicians in everyday clinical practice. To minimize the risks of use, technical and organizational measures should be taken by the hospital management, resulting, for example, in a Bring-Your-Own-Device (BYOD) initiative.

Planetary Health and Hospitals' Contribution-A Scoping Review.

Climate change is one of the greatest global threats for planetary and human health. This leads to new challenges for public health. Hospitals emit large amounts of greenhouse gases (GHG) in their healthcare delivery through transportation, waste and other resources and are considered as key players in reducing healthcare's environmental footprint. The aim of this scoping review is to provide the state of research on hospitals' carbon footprint and to determine their contribution to mitigating emissions. We conducted a systematic literature search in three databases for studies related to measurement and actions to reduce GHG emissions in hospitals. We identified 21 studies, the oldest being published in 2012, and the most recent study in 2021. Eight studies focused on GHG emissions hospital-wide, while thirteen studies addressed hospital-based departments. Climate actions in the areas of waste and transportation lead to significant reductions in GHG emissions. Digital transformation is a key factor in implementing climate actions and promoting equity in healthcare. The increasing number of studies published over time indicates the importance of the topic. The results suggest a need for standardization of measurement and performance indicators on climate actions to mitigate GHG emissions.

How can Big Data Analytics Support People-Centred and Integrated Health Services: A Scoping Review.

Introduction: Health systems in high-income countries face a variety of challenges calling for a systemic approach to improve quality and efficiency. Putting people in the centre is the main idea of the WHO model of people-centred and integrated health services. Integrating health services is fuelled by an integration of health data with great potentials for decision support based on big data analytics. The research question of this paper is "How can big data analytics support people-centred and integrated health services?" Methods: A scoping review following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review (PRISMA-ScR) statement was conducted to gather information on how big data analytics can support people-centred and integrated health services. The results were summarized in a role model of a people-centred and integrated health services platform illustrating which data sources might be integrated and which types of analytics might be applied to support the strategies of the people-centred and integrated health services framework to become more integrated across the continuum of care. Additional rapid literature reviews were conducted to generate frequency distributions of the most often used data types and analytical methods in the medical literature. Finally, the main challenges connected with big data analytics were worked out based on a content analysis of the results from the scoping literature review. Results: Based on the results from the rapid literature reviews the most often used data sources for big data analytics (BDA) in healthcare were biomarkers (39.3%) and medical images (30.9%). The most often used analytical models were support vector machines (27.3%) and neural networks (20.4%). The people-centred and integrated health services framework defines different strategic interventions for health services to become more integrated. To support all aspects of these interventions a comparably integrated platform of health-related data would be needed, so that a role model labelled as people-centred health platform was developed. Based on integrated data the results of the scoping review (n = 72) indicate, that big data analytics could for example support the strategic intervention of tailoring personalized health plans (43.1%), e.g. by predicting individual risk factors for different therapy options. Also BDA might enhance clinical decision support tools (31.9%), e.g. by calculating risk factors for disease uptake or progression. BDA might also assist in designing population-based services (26.4% by clustering comparable individuals in manageable risk groups e.g. mentored by specifically trained, non-medical professionals. The main challenges of big data analytics in healthcare were categorized in regulatory, (information-) technological, methodological, and cultural issues, whereas methodological challenges were mentioned most often (55.0%), followed by regulatory challenges (43.7%). Discussion: The BDA applications presented in this literature review are based on findings which have already been published. For some important components of the framework on people-centred care like enhancing the role of community care or establishing intersectoral partnerships between health and social care institutions only few examples of enabling big data analytical tools were found in the literature. Quite the opposite does this mean that these strategies have less potential value, but rather that the source systems in these fields need to be further developed to be suitable for big data analytics. Conclusions: Big data analytics can support people-centred and integrated health services e.g. by patient similarity stratifications or predictions of individual risk factors. But BDA fails to unfold its full potential until data source systems are still disconnected and actions towards a comprehensive and people-centred health-related data platform are politically insufficiently incentivized. This work highlighted the potential of big data analysis in the context of the model of people-centred and integrated health services, whereby the role model of the person-centered health platform can be used as a blueprint to support strategies to improve person-centered health care. Likely because health data is extremely sensitive and complex, there are only few practical examples of platforms to some extent already capable of merging and processing people-centred big data, but the integration of health data can be expected to further proceed so that analytical opportunities might also become reality in the near future.