WhatsApp and other messaging apps in medicine: opportunities and risks

Towards 'Formalising' WhatsApp Teledermatology Practice in KZ-N District Hospitals: Key Informant Interviews

INTRODUCTION

District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology.

AIM

To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service.

METHODS

Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed.

RESULTS

Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues.

CONCLUSIONS

These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries.

Instant messengers and health professionals' agency in Russian clinical settings

This research examines how Russian healthcare professionals use instant messengers (in particular, the group chat function on instant messengers) for work-related tasks. Based on qualitative interviews with Russian doctors and nurses conducted in spring 2020, the article explores how the informal implementation of instant messenger's group chat function facilitated and shaped health professionals' agency in two key areas of professional control: work regulation and medical knowledge. In the first case, front-line healthcare professionals used instant messengers to make horizontal connections, share relevant regulatory information, and smooth over organizational discrepancies. Hospital management, on the other hand, employed this technology as an additional tool for imposing top-down control on employees. The adoption of instant messengers for medical knowledge dissemination is more consistently linked with professional logic. By utilizing this technology, healthcare personnel not only shared clinical recommendations, publications, and clinical experience, but also fostered solidarity within the country's medical community and forged connections with international medical professionals. These findings support the social science assumption concerning the contextualized character of both professionalism and digital innovations in healthcare. In state-dominated Russian healthcare, instant messengers not only assist structurally disempowered professionals in dealing with pragmatic challenges, but also create more space for their ground-level discretion in the face of intense administrative pressure. Moreover, since the messaging technology helps Russian health workers in navigating and agentially connecting different knowledge and regulatory landscapes, it also fosters a new - trans-local and more reflexive - form of professionalism in post-socialist medicine.

Leveraging the use of a social media app as a collaborative medical information and knowledge sharing tool-insights from experiential use and survey of a CME WhatsApp community

BACKGROUND AND AIM

Continuing Medical Education (CME) is crucial for physicians to stay current in the rapidly advancing field of medicine. A WhatsApp (WA) based community of physicians was initiated in 2016 'WhatsApp CME India Group' to facilitate learning, knowledge sharing, and discussion among physicians. Due to participant size constraints of the technology, it evolved into seven distinct WA groups, overseen by a central administrator. A survey undertaken in the group's 7th year aimed to evaluate its effectiveness in achieving its goals, measure participant engagement, and uncover the primary factors driving its usage.

METHODS

The survey questionnaire was distributed to 3500 members across the 07 WhatsApp CME groups for voluntary participation. Data collected was analysed using SPSS version 24.0 (SPSS Inc., Chicago, IL, USA) and reported using descriptive statistics.

RESULTS

Among the 581 survey respondents, the study found 43% of physicians use the WhatsApp academic groups for CME content, with 32% accessing their group over four times daily. The primary motivation for 77% was to discuss challenging cases and to gain knowledge updates from fellow physician (70%). Medical websites (57%), referral books (49%), and Google (43%) were other significant resources. Every participant (100%) found the WhatsApp CME India group the most beneficial resource for daily medical science updates. A significant portion (57%) of the respondents found the group valuable for real-time information exchange. Over 78% stated it kept them current with knowledge and guidelines. Notably, 94% viewed WhatsApp CME as complementary to physical conferences, not a replacement. The post-conference/webinar summaries were appreciated by 81% participants. Case discussions (31%) and update posts from fellow physicians sharing their insights and learnings (24%) were noted as activities of great academic interest.

CONCLUSION

This study underscores the potential of digital platforms like WhatsApp in supplementing CME in India and potentially other comparable settings. The blend of digital and traditional resources suggests a balanced learning approach. While real-time engagement is a strength, challenges like information overload and privacy concerns require careful management. Striking a balance is crucial for ensuring content quality, structured discussions and privacy. As the digital age advances, professionals must critically assess shared information on these platforms to guarantee evidence-based and reliable knowledge dissemination.

TRIAL REGISTRATION

ARK 001.

Using a Mobile Messenger Service as a Digital Diary to Capture Patients' Experiences Along Their Interorganizational Treatment Path in Gynecologic Oncology: Lessons Learned

A digital diary in the form of a mobile messenger service offers a novel method for data collection in cancer research. Little is known about the things to consider when using this data collection method in clinical research for patients with cancer. In this Viewpoint paper, we discuss the lessons we learned from using a qualitative digital diary method via a mobile messenger service for data collection in oncology care. The lessons learned focus on three main topics: (1) data quality, (2) practical aspects, and (3) data protection. We hope to provide useful information to other researchers who consider this method for their research with patients. First, in this paper, we argue that the interactive nature of a digital diary via a messenger service is very well suited for the phenomenological approach and produces high-quality data. Second, we discuss practical issues of data collection with a mobile messenger service, including participant and researcher interaction. Third, we highlight corresponding aspects around technicalities, particularly those regarding data security. Our views on data privacy and information security are summarized in a comprehensive checklist to inform fellow researchers on the selection of a suitable messenger service for different scenarios. In our opinion, a digital diary via a mobile messenger service can provide high-quality data almost in real time and from participants' daily lives. However, some considerations must be made to ensure that patient data are sufficiently protected. The lessons we learned can guide future qualitative research using this relatively novel method for data collection in cancer research.

Utilizing social media for community risk communication in megacities: analysing the impact of WeChat group information interaction and perception on communication satisfaction during the COVID-19 pandemic in Shanghai

BACKGROUND

Against the backdrop of the global public health crisis, the COVID-19 pandemic has exposed significant disparities in the supply and demand of risk information related to public health crises, posing severe challenges to risk governance in megacities. Shanghai, China, introduced community WeChat groups for community communication, effectively facilitating the dissemination and response of grassroots information and providing a new path for interactive governance in the community.

METHODS

This study collected 1006 questionnaires from residents of 350 communities in Shanghai through an online survey between June 10 and July 10, 2022. Multiple linear regression analysis was conducted to examine the impact of different participants (including the community, core residents, and the combined community and core residents) on community risk communication, perceived communication quality, and dissemination themes related to COVID-19 on community communication satisfaction. Additionally, in-depth interviews were conducted with 20 core residents from different types of communities, focusing on the specific methods of risk communication through community WeChat groups and their ability to disseminate information, respond to, and solve problems.

RESULTS

Perceived information coverage and perceived response efficiency are significantly positively correlated with communication satisfaction. Notably, the speed of community information response has the greatest impact on communication satisfaction. Regarding COVID-19-related information dissemination themes, "community outbreaks, supplies, nucleic acids, outbreak prevention measures, and scientific content" all have a significant impact on communication effectiveness, with "nucleic acid testing information" having the greatest impact. Although the statistical data indicate that the participation of core residents in risk communication does not significantly affect communication satisfaction, it seems to be related to the size of the community, and the interview results further validate this conclusion.

CONCLUSION

In the future, grassroots communities should consider the affordances of social media, recognize the significant correlation between risk communication and grassroots trust, and formulate more detailed and targeted risk communication strategies. In particular, incorporating core residents into "semiformal" grassroots organizations can improve community service quality, thereby enhancing community resilience in the face of public health emergencies.

Use of Instant Messaging Applications by General Practitioners During Overseas Deployment: A Survey of the French Military Health Service

INTRODUCTION

Instant messaging applications (MAs) represent a major component of modern telecommunications for data transmission. During overseas deployments, military doctors increasingly rely on MAs due to their availability and the urgent need to obtain advice from specialists for optimal patient management. In this study, we aimed to describe and analyze the context and usage characteristics of these MAs for transmitting medical data by military general practitioners (GPs) during overseas missions.

MATERIALS AND METHODS

This observational study was conducted between June 2020 and December 2020, based on a survey sent to GPs from the French Military Health Service who had been deployed overseas in military operations between 2010 and 2020.

RESULTS

We received 233 surveys of which 215 were analyzed. Among these, 141 military GPs used instant MAs to transmit medical data during deployment. Notably, WhatsApp was used by 97% of the participants. The military GPs mainly used these applications for the speed of exchanges (45%) and their ease of use (28%). The physician specialties predominantly involved in data sharing were trauma and orthopedic surgery (38%) and dermatology (31%). The correspondents were mainly military specialist physicians from French military teaching hospitals (85%). A response time of less than 1 h was reported in 78% of the cases. Additionally, 72 doctors (51%) undertook their last deployment in an isolated post.

CONCLUSION

MAs were extensively utilized communication tools among GPs during their overseas deployments. Although the use of these applications seems essential in telemedicine, it raises several legal and ethical questions. Thus, we recommend employing these tools while ensuring medical and military confidentiality.

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

Impact of Mentoring for Underrepresented Groups in Undergraduate Medical Education: A Systematic Review

OBJECTIVES

Despite efforts to mitigate challenges to advance underrepresented groups (URG) groups' representation in medical education, diversity remains underwhelming. In response to this several mentoring programs to increase diversification within medical education have been implemented. However, the impact of these programs on URG representation across disciplines is unknown. The aim of this review is to evaluate the impact of structured mentoring programs on URGs in undergraduate medical education.

DESIGN

Systematic review.

METHODS

A comprehensive search strategy was performed of electronic databases including PubMed, Ovid Medline, and EMBASE between January and September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Both qualitative and quantitative outcomes including characteristics of the mentoring structure explored within each study were collected, and differences in study outcomes analyzed.

RESULTS

In total 17 studies were included for analysis. Mentoring within URGs resulted in an increase in research opportunities, exam performance, medical specialty applications, and residency matching. Structured feedback yielded positive experiences by both mentors and mentees participating in programs, with both emotional and cultural competence issues explored across studies included for analysis.

CONCLUSIONS

Mentoring for medical students underrepresented in medicine across mentoring relationships including peer, senior, formal, and informal structures yield positive outcomes within research, academic modules, and career pathways. Future applications of mentoring programs should consider the use of tandem mentoring from both senior and peer mentors to optimize benefits URG students derive from each mentoring relationship.

Interprofessional actions in responsible discharge: contributions to transition and continuity of care

OBJECTIVE

To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the transition and continuity of patient care.

METHODS

A qualitative study was carried out in two hospitalization units, in October - November 2020, interviewing health professionals from a teaching hospital in the state of São Paulo. The reports were transcribed and subjected to thematic content analysis.

RESULTS

Twelve professionals participated (doctor, nurse, physiotherapist, nutritionist, speech therapist and social worker) and three thematic categories emerged from the interviews: 1. informational continuity in responsible discharge; 2. interaction between professionals and services for the transition of care; and 3. workload management for better transition and continuity of care.

CONCLUSION

The team recognized interprofessional advances and challenges in responsible discharge related to the informational and relational continuity of patient care and highlighted the (over)workload as an unfavorable aspect in the transition process, generating impacts for patients, professionals and health services.

WhatsApp-Based Record-Keeping System in a Private Neurosurgical Clinic Chain

Background The demanding nature of neurosurgical practice requires a reliable system for documentation and record-keeping. The cost of electronic health record systems can limit their availability in low- and middle-income countries. That is why less expensive and easily accessible technological alternatives should be sought. In this article, we describe our adopted system for medical record-keeping based on WhatsApp (Meta Platforms, Inc., Menlo Park, CA). Methods In our chain of six clinics, each clinic has its record-keeping WhatsApp group dedicated to sharing medical data of outpatients following up in that specific clinic and of inpatients cared for in hospitals in its area. After each encounter, our surgeons share smartphone-captured pictures of their patients' medical data on the WhatsApp group of the related clinic. The medical data are then categorized and stored by the secretary on the clinic's computer to be accessed at any time for record retrieval. Discussion Our five years of experience with the WhatsApp-based record-keeping system with medical records of 11,729 patients proved to be reliable, cost-effective, user-friendly, and efficient, and it positively impacted patient care. Responsible behavior, security precautions, and regulating policies are essential to protect patient confidentiality. Conclusion Our system can be an inexpensive alternative to the electronic health record system in small healthcare facilities. It can help physicians practicing in low- and middle-income countries to improve medical records documentation, thereby improving patient care. There is a need for policies to regulate the use of instant messaging applications in professional medical communication.

Social presence and dynamics of group communication: An analysis of a health professionals WhatsApp group chats

WhatsApp has become a medium of communication with the potential of promoting collaborative environment with peers, patients and general population. Till date, no analysis of professional WhatsApp groups' activities exists in physiotherapy. The official WhatsApp group chats of the Association of Clinical and Academic Physiotherapists of Nigeria (ACAPN) was analyzed. A total of 20760 chats were gleaned from July 2020 to June 2021. Videos, audios and emoticons were excluded in the analysis. Administrative permission to conduct was obtained from ACAPN leadership. Two consenting physiotherapists who had never deleted their ACAPN group chats shared and exported all chats to a Gmail. The social presence theory for group communication was used as the framework of analysis. Thematic content analysis was used to analyze qualitative data. Descriptive statistics of frequency and percentages were used to summarize data. Based on social presence theory classifications, interactive messages (64.5%) followed by cohesive messages (30%) were predominant. Members used the platform more for expression of emotions affectively (100%), referring explicitly to others' messages interactively (56.6%) and for greetings (phatic and salutation) cohesively (61.8%). Qualitative themes indicate that all three categories of social presence theory communications were present sufficiently with interactive category being the most common, as members used the WhatsApp platform to interact, construct and share knowledge. Group WhatsApp platform is a veritable means of communication and an indicator of level of social presence among Nigerian physiotherapists. Communication among Nigerian physiotherapists is mostly interactive, then cohesive and affective in terms of dynamics.

Brazilian Immigrant Parents' Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children's Healthful Energy Balance-Related Behaviors

Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.

Assessment of the Association Between Use of WhatsApp for Work-Related Purposes and Levels of Depression, Anxiety, and Stress Among Healthcare Workers from Jazan, Saudi Arabia

Purpose

This study aims to investigate the potential association between use of WhatsApp in healthcare settings for work-related purposes and depression, stress, and anxiety levels among a sample of healthcare workers in Saudi Arabia.

Methods

This was a cross-sectional study of healthcare employees working in different hospitals in Jazan. The data was collected via a semi-structured, self-administered questionnaire with three components that measured the demographics of the sample; the presence of depression, anxiety, and stress; and their use of WhatsApp in the work environment. A multivariate regression analysis was carried out to estimate the statistical likelihood of depression, anxiety, and stress as a result of using WhatsApp and how these factors affected occupational and social relationships.

Results

A total of 294 healthcare workers participated in the current study. The median age of the participants was 32 years, and the gender distribution was almost even. Over 90% of the participants stated that they were members of work-related WhatsApp groups, and nearly 70% agreed that use of WhatsApp in work-related settings could be stressful. Among the recruited sample, 48.6% exhibited abnormal levels of depression, 55.8% had abnormal levels of anxiety, and 63% showed abnormal levels of stress. The findings of the regression analysis (P values <0.05) indicated that the likelihood of these participants suffering with depression, anxiety, and stress was high, with the participants themselves agreeing that using WhatsApp in work settings could be stressful and affect their relationships with colleagues, friends, and family members.

Conclusion

The findings suggests the presence of a potential association between use of WhatsApp for work-related purposes and levels of depression, anxiety, and stress, especially among those who perceive its use as a stressor and influencer on occupational and social relationships.

Implementation of electronic messaging protocol for pediatric urology preoperative scheduling: A pilot study

INTRODUCTION

Preparing patients for surgery is a task healthcare organizations strive to optimize. Electronic messaging (EM) provides an opportunity for streamlining components of this arduous process. Our study aims to evaluate our early experience in utilizing EM to provide preoperative information to pediatric urology patients.

OBJECTIVE

To assess the effectiveness of EM in preparing patients for pediatric urologic surgery.

STUDY DESIGN

This study compared a 6-week pilot program of EM (Figure 1) with traditional nurse phone calls (NPC) in preoperative instruction of pediatric urology patients. The same preoperative instructional information was provided via either source. Data collected included time and resources used by the healthcare system and patient/parent satisfaction.

RESULTS

The EM group included 98 patients, while the NPC group included 212 patients. Case cancellation rate between the two cohorts was similar, with a 6.67% cancellation rate in the EM cohort and a 10.55% cancellation rate in the NPC cohort (z = -1.137, p = 0.25). There were 4 EM-related operating room delays with an average case delay of 31.5 min (5-60 min). Twenty-four (24%) EM patients/families required secondary phone calls, while 106 (50%) NPC required a follow up phone call (p < 0.01). 94% of EM participants recommended EM for future perioperative instructions. Accounting for the average case volume within our entire children's hospital, the average total daily cost for EM is $5.96/day, as compared to an average total cost of $87.78/day to perform NPC. This represents an estimated cost savings of $81.82 per day or $21,273.20 per year, based upon average total case volume at our institution.

DISCUSSION

In our initial experience, EM effectively communicates the necessary preoperative information to patients and/or families undergoing pediatric urology surgery. Our results demonstrate low case cancellation and delay rates and high patient/family satisfaction. Also demonstrated was the cost savings by replacing the NPC with EM. A great benefit of EM was the increased time it provided for nurses to perform other patient care duties, which is important given our current nationwide nursing shortage. Limitations of the study included a narrow scope assessing only pediatric urology patients as well as a short study period. Further studies will further define and refine the role of perioperative EM.

CONCLUSION

Changing to an EM system for preoperative instructions in the pediatric urology population met with a high degree of patient satisfaction and decreased costs for healthcare systems without increasing case delay or cancellation rates.

Interventions to improve consultations in the emergency department: A systematic review

OBJECTIVES

Emergency department (ED) consultations with specialists are necessary for safe and effective patient care. Delays in the ED consultation process, however, have been shown to increase ED length of stay (LOS) and contribute to ED crowding. This review aims to describe and evaluate the effectiveness of interventions to improve the ED consultation process.

METHODS

Eight primary literature databases and the gray literature were searched to identify comparative studies assessing ED-based interventions to improve the specialist consultation process. Two independent reviewers identified eligible studies, assessed study quality, and extracted data. Individual or pooled meta-analysis for continuous outcomes were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model was conducted.

RESULTS

Thirty-five unique comparative intervention studies were included. While the interventions varied, four common components/themes were identified including interventions to improve consultant responsiveness (n = 11), improve access to consultants in the ED (n = 9), expedite ED consultations (n = 8), and bypass ED consultations (n = 7). Studies on interventions to improve consult responsiveness consistently reported a decrease in consult response times in the intervention group with percent changes between 10% and 71%. Studies implementing interventions to improve consult responsiveness (MD -2.55, 95% CI -4.88 to -0.22) and interventions to bypass ED consultations (MD -0.99, 95% CI -1.43 to -0.56) consistently reported a decrease in ED LOS; however, heterogeneity was high (I²  = 99%). Evidence on whether any of the interventions were effective at reducing the proportion of patients consulted or subsequently admitted varied.

CONCLUSIONS

The various interventions impacting the consultation process were predominately successful in reducing ED LOS, with evidence suggesting that interventions improving consult responsiveness and improving access to consultants in the ED also improve consult response times. Health care providers looking to implement interventions to improve the ED consultation process should identify key areas in their setting that could be targeted.

Combining portable coagulometers with the Internet: A new model of warfarin anticoagulation in patients following mechanical heart valve replacement

Heart valve replacement, as a safe and effective treatment for severe valvular heart disease, can significantly improve hemodynamics in patients. However, such patients then require lifelong anticoagulant therapy. Warfarin, a cheap and highly effective vitamin K antagonist, remains the major anticoagulant recommended for lifelong use following mechanical heart valve replacement. However, the effect of warfarin anticoagulant therapy is complicated by physiological differences among patients and non-compliance with treatment at different degrees. Effective management of warfarin therapy after heart valve replacement is currently an important issue. Portable coagulometers and the emergence of the Internet have provided new opportunities for long-term management of anticoagulation therapy, but the safety and affordability of this approach remain to be fully evaluated. This paper reviews recent progress on the use of portable coagulometers and the Internet in the management of warfarin anticoagulation therapy following mechanical heart valve replacement, which offers opportunities for reducing complications during postoperative anticoagulation and for facilitating patient compliance during follow-up.

Smartphone technology for communications between clinicians - A scoping review

OBJECTIVES

This scoping review aims to review explore, assess, and map the literature to inform clinical practice regarding communication between clinicians. Specific Apps/channels used were identified and assessed with a focus on data security with key concepts and knowledge gaps identified.

DATA

The Joanna Briggs Institute framework is followed, with search results reported as per the PRISMA ScR for scoping reviews guidelines.

SOURCES

A systematic search strategy encompassing EBSCO and OneSearch databases was conducted - two identical searches, (June and October 2020) limited to English language articles published 2016-2020. A narrative synthesis was used to integrate and report the findings.

STUDY SELECTION

Sixty-six publications were selected. Twelve from EBSCO, thirty-five from OneSearch, nineteen were hand searched. Sixteen of the publications were research studies, nine were literature reviews, twenty-six were editorial, one was a newspaper article and fourteen were grey literature. Instant Messaging (40%, n = 23), image sharing (41%, n = 24), and video conferencing (19%, n = 11) were functions most popular with clinicians. WhatsApp, generic instant messaging, Facebook messenger, ZOOM, and Skype are evidenced as channels for communication between clinicians within the EU. A sizeable proportion of the publications (38%; n = 25) failed to identify or adequately address technical security concerns and requirements around privacy and data protection.

CONCLUSIONS

Clinicians use smartphones /Apps to communicate clinical information with each other. The security and privacy issues arising from their communication of sensitive data is absent or only superficially acknowledged within the literature.

CLINICAL SIGNIFICANCE

Clinician's need clearer guidance on the use of smartphone technology for clinical communications.

Telemedicine in Low- and Middle-Income Countries During the COVID-19 Pandemic: A Scoping Review

Background

COVID-19 has impacted the capacity of healthcare systems worldwide, particularly in low- and middle-income countries (LMICs), which are already under strain due to population growth and insufficient resources. Since the COVID-19 pandemic's emergence, there has been an urgent need for a rapid and adequate reaction to the pandemic's disruption of healthcare systems. To this end, telemedicine has been shown in prior research to be a feasible approach. The overarching objective of this scoping review was to determine the extent and acceptance of telemedicine in healthcare in low- and middle-income countries (LMICs) during the COVID-19 pandemic.

Methods

This scoping review followed PRISMA guidelines and Arksey and O'Malley's five-stage framework to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between January 2020 and April 2021: Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for grey literature.

Results

The search identified 54 articles with 45,843 participants, including 6,966 healthcare professionals and 36,877 healthcare users. We identified a range of reasons for introducing telemedicine in LMICs during COVID-19, most notably to maintain non-emergency healthcare, enhance access to healthcare providers, and reduce the risk of infection among health users and providers. Overall, healthcare providers and users have shown a high level of acceptance for telemedicine services. During the COVID-19 pandemic, telemedicine provided access to healthcare in the majority of included articles. Nonetheless, some challenges to accepting telemedicine as a method of healthcare delivery have been reported, including technological, regulatory, and economical challenges.

Conclusion

Telemedicine was found to improve access to high-quality healthcare and decrease infection risk in LMICs during COVID-19. In general, infrastructure and regulatory barriers found to be the most significant barriers to wider telemedicine use, and should be considered when implementing telemedicine more broadly. There appears to be a need to prioritize patient data safety, as many healthcare practitioners utilized commercial apps and services as telemedicine systems. Additionally, it appears as though there is a need to increase capacity, skill, and transparency, as well as to educate patients about telemedicine.

Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial

OBJECTIVE

Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP).

METHODS

A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up.

RESULTS

There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found.

CONCLUSION

Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.

WhatsApp Messenger use in oncology: a narrative review on pros and contras of a flexible and practical, non-specific communication tool

The spread of instant messenger systems provides an excellent opportunity and a helpful tool to healthcare professionals. WhatsApp instant messenger use is widely prevalent among health professionals, cancer patients, caregivers and the general population. It is a quick and easy communication tool that may also be used on personal computers and business purposes. WhatsApp instant messenger and other similar tools may be a very useful complement for e-medicine. Instant messaging systems may be helpful, especially in rural areas, in medium- or low-income countries, or to avoid unnecessary travels, improve knowledge and awareness of cancer, monitor home care and support the delivery of home care. The unregulated use of WhatsApp instant messenger requires sound and shared guidelines to assure impeccable professional service. Although a significant number of papers have investigated the roles of social networks in connecting patients to health professionals, there is still a lack of information and scientific data about their uses, benefits and limitations in connecting health providers only for professional communication. The role of instant messenger systems in cancer practice and research needs to be clarified. In this paper, we report a focus on available data, pros and contras of the unregulated use of WhatsApp instant messaging, in the context of e-medicine, as an interprofessional and doctor/patient communication tool in oncology.

WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review

The use of WhatsApp in health care has increased, especially since the COVID-19 pandemic, but there is a need to safeguard electronic patient information when incorporating it into a medical record, be it electronic or paper based. The aim of this study was to review the literature on how clinicians who use WhatsApp in clinical practice keep medical records of the content of WhatsApp messages and how they store WhatsApp messages and/or attachments. A scoping review of nine databases sought evidence of record keeping or data storage related to use of WhatsApp in clinical practice up to 31 December 2020. Sixteen of 346 papers met study criteria. Most clinicians were aware that they must comply with statutory reporting requirements in keeping medical records of all electronic communications. However, this study showed a general lack of awareness or concern about flaunting existing privacy and security legislation. No clear mechanisms for record keeping or data storage of WhatsApp content were provided. In the absence of clear guidelines, problematic practices and workarounds have been created, increasing legal, regulatory and ethical concerns. There is a need to raise awareness of the problems clinicians face in meeting these obligations and to urgently provide viable guidance.

Adapting non-medical applications for medical use: Ethical limits, coverage, and validation

The widespread adoption of smartphones and other mobile devices amongst healthcare providers opened new possibilities arising from the use of non-medical apps, social media, meeting platforms, and non-medical devices with intended medical purposes, thus expanding the communication and imaging chat systems between these professionals and their patients, as well as amongst healthcare professionals. However, adapting non-medical applications, social media, videoconference platforms and devices for medical use present potential limitations, barriers, and risks, which should be fully recognized to reduce crossing the fine line between ethical and unethical. In the herein study, we analyse the ethical limits, coverage, and validation of non-medical applications adapted for medical use. Level of evidence: IV (evidence from well-designed case-control or cohort studies).

Implementing "Chest Pain Pathway" Using Smartphone Messaging Application "WhatsApp" as a Corrective Action Plan to Improve Ischemia Time in "ST-Elevation Myocardial Infarction" in Primary PCI Capable Center "WhatsApp-STEMI Trial"

BACKGROUND

ST-elevation myocardial infarction (STEMI) is a life-threatening medical emergency that requires immediate medical attention. Each hospital should implement a clinical pathway with the main objective to reduce ischemia time from diagnosis to revascularization (because this has shown to save myocardial tissues and, subsequently, patients' lives), utilizing the most evidence-based approach and the most up-to-date management protocol. In this study, we aimed to assess the utility of structuring chest pain pathway (CPP) with the instantaneous case-by-case feedback protocol using WhatsApp and its impact on improving 2 major key performance indicators-the impact on initial emergency room (ER) door-to-electrocardiogram (ECG) time, and door-to-balloon time-in a predefined 6-month corrective action period.

METHODS

A prospective, quality improvement plan was set to reduce door-to-first-ECG and door-to-balloon times to less than 10 and 90 minutes, respectively, in all acute coronary syndrome cases (including STEMI cases), from August 2020 to April 30, 2021. Several measures were done to attain the goal, including strict compliance to CPP with documentation, ruling out possible mimickers, and reducing false activation and time delays in ER. Direct feedback on cases was provided using WhatsApp messaging app on smartphones; protocol and results of time lines were accessed by all healthcare providers associated with CPP, including ER nurses, ER doctors, Cardiology residents, specialists, Catheterization laboratory nurses, technicians, and interventionalists. Bimonthly meetings with all stake holders were reinforced, and minutes of meeting were reviewed and corrective actions were implemented the next day. On a daily basis, all cases were analyzed and tabulated by a dedicated nurse and a doctor from ER, and another nurse and doctor from the quality assurance department.

RESULTS

After a 6-month period of implementing improvement plan and sticking to a comprehensive chest pain clinical pathways strategy with a case-by-case review on a shared smartphone messaging application, the rate of door-to-first-ECG improved from 76% to 93% in patients with chest pain, and the door-to-balloon time targeting less than 90 minutes improved significantly from only 77% to 92% in STEMI patients. This was statistically significant with a P value of 0.0001 and 0.001, respectively, and the rate of false activation was reduced from 23% to 16% and 10% 3 and 6 months of time, respectively, with a significant P value of <0.01. Finally, a strict 100% rate of timely documentation on patients with chest pain was achieved.

CONCLUSIONS

An improvement plan of implementing the CPP, cut-time policy, and using smartphone WhatsApp messaging for a case-to-case instantaneous feedback has significantly improved key performance indicators and, subsequently, ischemia time in acute coronary syndrome patients (including STEMI patients) in 6 months time, indicating that this strategy works.

Meeting them where they are on the web: addressing structural barriers for Latinos in telehealth care

As we enter an era of health care that incorporates telehealth for routine provision of care, we can build a system that consciously and proactively includes vulnerable patients, thereby avoiding further exacerbation of health disparities. A practical way to reach out to Latino patients is to use media they already widely use. Rather than expect patients to adapt to suboptimal systems of telehealth care, we can improve telehealth for Latinos by using platforms already familiar to them and thereby refocus telehealth delivery systems to provide patient-centered care. Such care is responsive to patients' needs and preferences; for Latinos, this includes using digital devices that they actually own (ie, smartphones). Equity-centered telehealth is accessible for all, regardless of linguistic, literacy, and socioeconomic barriers.

Radiological Imaging Transmission via Smartphones by Neurosurgery Residents in the United States

BACKGROUND

Neurosurgery requires the communication of radiological imaging. Smartphones are increasingly used for this purpose because of the efficiency and convenience of integrated cameras and native Multimedia Messaging Service (MMS) functionality. There is inconsistency among hospitals regarding policies addressing this use as it relates to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Some hospitals offer a HIPAA-compliant secure messaging application (SMA) as a substitute. The authors hypothesized that the use of smartphones for sharing radiological imaging would be commonplace among residents. We sought to characterize usage patterns, resident awareness of policies and HIPPA, and the effectiveness of SMAs as a means of avoiding HIPAA violations.

METHODS

An electronic dynamic questionnaire was sent to all 116 Accreditation Council for Graduate Medical Education-accredited US neurosurgery residency program directors and coordinators to be forwarded to their residents.

RESULTS

A total of 100 responses were received, representing 49 residency programs. Ninety-two (92%) residents reported using MMS to transmit radiological imaging. Twenty-six (26%) reported doing so with patient identifiers. Roughly half (48%) of residents were unaware of policies regarding imaging transmission via MMS at their institutions. Among the 17 (35%) programs providing SMAs, only 3 of 27 (11%) residents in these programs did not use MMS for image transmission.

CONCLUSIONS

The data suggest that there is widespread resident use of MMS for image transmission, regardless of policy and the availability of alternative HIPAA-compliant applications. Knowledge of local institutional policies and HIPAA privacy rules is poor. Alternative strategies are needed to prevent HIPAA-noncompliant transmission of imaging by residents.

Instant messaging apps and data protection: combining to improve hip fracture care?

Introduction

The General Data Protection Regulation (GDPR) continues to have implications for how healthcare information is managed and shared. This presents challenges as telemedicine plays a more central role in service healthcare service provision, particularly since the beginning of 2020. We aim to measure how improved communication through a GDPR-compliant messaging app can influence time-dependent key performance indicators for hip fracture management in a tertiary-referral trauma hospital.

Methods

Using an instant messaging service, a hip fracture group was created and access was provided to all stakeholders in hip fracture care—trainee and consultant emergency physicians and orthopaedic surgeons, as well as advanced nurse practitioners, bed managers, ward managers and theatre managers. Irish Hip Fracture Database (IHFD) standard compliance was compared from April to December 2017 and April to December 2018.

Results

Two periods in 2017 and 2018 saw 121 and 122 hip fracture patients admitted, respectively. Mean time to admission to an orthopaedic ward in 2017 was 47 ± 42.9 h and 33.3 ± 42 h in 2018 (P = 0.5). Mean time to surgery in 2017 was 83.66 ± 53.46 h and 39.11 ± 10.84 h in 2018 (p = 0.026).

Conclusions

Irish Hip Fracture Database Standards present a challenge to orthopaedic departments competing with other hospital specialties for access to beds and theatre space. The introduction of a GDPR-compliant social media messaging service has contributed to significantly reducing the time to surgery for these patients. Streamlining communication through messaging services has and continues to be vital to improving care for hip fracture patients, both in the healthcare environment and beyond.

Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist

BACKGROUND

Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine.

METHODS

Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient.

RESULTS

Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922).

CONCLUSIONS

Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions.

PRACTICAL IMPLICATIONS

Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.

How can WhatsApp® facilitate the future of medical education and clinical practice?

As part of the modern generation of medical students and prospective future doctors of the United Kingdom's Nation Health Service (NHS), we have grown up in an age where smartphones and instant messaging applications (IMAs) are ubiquitous across all aspects of society. With IMAs being so familiar, we recognise their scope for facilitating our learning of the pre-registration syllabus and how their practical nature could potentially revolutionise healthcare worldwide. It is, therefore, rational to further investigate the benefits of incorporating such technology into these respective settings. In this article, we will further expand on some of the advantages highlighted by E. Colman & E. O'Connor that IMAs, particularly WhatsApp, have in the academic environment which resonate with us. We illustrate our views on IMAs being incorporated into health systems globally through exemplifying the NHS, using reviewed literature.

A telemedicine communication exchange network in Gorno-Badakhshan Autonomic Oblast in collaboration with Swiss Surgical Teams

INTRODUCTION

The purpose of this article is to report on the implementation of a telemedicine network serving as a second opinion pool for a surgeon in a remote area of a developing country.

METHODS

This study involved an international collaboration between two members of Swiss Surgical Teams at a tertiary referral hospital and a surgeon in a remote area in Gorno-Badakhshan Autonomic Oblast, Tajikistan, which established a second opinion pool discussing diagnostics and therapeutic options via a messenger application. A retrospective analysis of response times was performed using a series of 50 challenging cases.

RESULTS

The median time to receive a first telemedical response from any of the two contacts was 24 min (interquartile range 6-73). Urgent and emergent pathologies accounted for 57% of cases. The suggested treatment was carried out in 90% (n = 44) of cases.

CONCLUSIONS

Timely and convenient telemedicine support to provide diagnostic and therapeutic reassurance and improve treatment quality for patients presenting to a general and vascular surgeon in the large and remote region of Gorno-Badakhshan Autonomic Oblast can be installed via a messenger application.

Foot and ankle service adaptation in response to COVID-19 and beyond

The disruption to healthcare provision as a result of the COVID-19 pandemic has compelled us to streamline healthcare delivery. This has given us an opportunity to implement healthcare technology, reform inter-disciplinary collaboration and ultimately enhance patient care. We discuss some of the advances made by the foot and ankle department at our hospital. These innovations have broad applicability and will hopefully ignite discussion amoung a number of healthcare teams about improving the future care of their patients.