Telemedicine and e-Health research solutions in literature for combatting COVID-19: a systematic review

How to assess blepharoptosis via telemedicine: method and its reliability

PURPOSE

To report the method to assess belpahroptosis and its reliability of adult ptosis using video consultation.

METHODS

This is a retrospective, comparative, case series. The surgical waiting list for ptosis surgery between 8/2020 and 1/2021 was checked and only cases listed for surgery via video consultation assessment, without any previous face-to-face consultation, were included. The following data were collected for patients who underwent video consultation before surgery: Demographic data, level of experience of clinician, levator function, Cogan's twitch sign, fatigability test, eye motility, presence of lagophthalmos, clinical history to rule out Myasthenia Gravis, other myopathies or Horner syndrome, whether the surgery was performed or canceled, reason for cancellation, date of surgery, type of procedure and surgeon experience.

RESULTS

A total of 176 patients underwent ptosis surgery. From those, 45 patients (25.6%) had only video assessment prior to surgery, 36 patients (80%) eventually underwent ptosis surgery. Surgery was canceled in 20% of the cases: in 2 cases (4.44%) due to misdiagnosis of ptosis during video consultation, confirmed on the day of surgery during pre-surgical face-to-face assessment; the other 7 cases (15.55%) belpharoptosis was confirmed on face-to-face examination but the surgery was canceled due to other reasons. The diagnosis of ptosis assessment via video consultation was corrected in 43 cases (95%) (p_value = 0.156, chi_ square). The accuracy of ptosis diagnosis was 13 out of 15 (86.7%) by fellow assessments and 30 out of 30 (100%) by consultant assessments (p_value = 0.041, chi_ square). In most of the cases ptosis assessment in video consultation included: rough judgment of levator function, eye motility and checking signs of lagophthalmos.

CONCLUSIONS

Video consultation is an efficient and reliable way to assess patients with ptosis, with 95% of reliability. Although a thorough ptosis assessment is advised, there was no difference between the accuracy of diagnosis on those who did not have the full suggested assessment.

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

BACKGROUND

The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service.

METHODS

An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis.

RESULTS

Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers.

CONCLUSIONS

Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

Validation of a Satisfaction Scale with a Telemedicine COVID-19 Service: Satis-COVID

Objectives: Despite being a widespread tool, telehealth was significantly incorporated during the COVID-19 pandemic period, but it still lacks analysis methodologies, greater digital security, and satisfaction assessment instruments that are still little explored and validated. The objective is to assess user satisfaction through the validation of a satisfaction scale with a telemedicine COVID-19 service (TeleCOVID). Methods: Cross-sectional study of a cohort of confirmed COVID-19 cases evaluated and monitored by the TeleCOVID team. To study the scale's measurement qualities, a factorial analysis was performed to test the validity of the construct. Correlation between items and the global scale was assessed using Spearman's correlation coefficient, and the instrument's internal consistency was assessed using Cronbach's alpha coefficient. Results: There were 1,181 respondents evaluating the care received from the TeleCOVID project. A total of 61.6% were female, and 62.4% aged between 30 and 59 years. The correlation coefficients indicated a good correlation between the items present in the instrument. The internal consistency of the global scale was high (Cronbach's alpha = 0.903) and the item-total correlations for the scale ranged from 0.563 to 0.820. The average overall user satisfaction was 4.58, based upon a 5-point Likert scale where 5 is the highest level of satisfaction. Conclusions: The results presented here show how much telehealth can contribute to improving access, resolutibility, and quality of care to the population in general in Public Health Care. In view of the results found, it can be said that the TeleCOVID team offered excellent care and fulfilled its proposed objectives. The scale fulfills its objective of evaluating the quality of teleservice, bringing good results in terms of validity and reliability, in addition to showing high levels of user satisfaction.

Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study

BACKGROUND

The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown.

OBJECTIVE

This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults.

METHODS

The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated.

RESULTS

A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from -0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean -0.0016, 95% HDI -0.0022 to -0.0011), depression (posterior mean -0.006, 95% HDI -0.0079 to -0.004), stigma (posterior mean -0.0052, 95% HDI -0.0068 to -0.0036), and irritability (posterior mean -0.0037, 95% HDI -0.0052 to -0.0022). The moderating effects of eHL varied across the rural and urban subsamples.

CONCLUSIONS

Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19-related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic.

Telemedicine in the Battle with 2019 Novel Coronavirus Disease (COVID-19) in Henan Province, China: A Narrative Study

Background and Objectives: Based on practical services of the Henan Province Telemedicine Center (HTCC), the purpose of this study is to investigate the design, construction, implementation, and application effect of a specific telemedicine system in response to the coronavirus disease 2019 (COVID-19). Methods: Data on COVID-19 cases from December 31, 2019, through October 17, 2022, were collected from official websites. Data and information of telemedicine services related to COVID-19 in HTCC were collected and analyzed, and relevant graphical representations were plotted. Results: All the 147 COVID-19 designated hospitals in the Henan Province were covered by the specific telemedicine system. The cities near to the Hubei Province in the south of Henan tended to be with more COVID-19 cases, where more COVID-19-related telemedicine services were conducted. For the telemedicine system, function modules, including real-time monitoring, command and dispatch, intractable cases transfer, remote guidance, and data sharing, were designed and realized to deal with COVID-19. Through the system, telemedicine services involved COVID-19 such as epidemic surveillance, emergency rescue, case discussion, diagnosis and treatment, remote ward-round, and distance education were performed. During the period between February 2 and March 3, 2020, 646 COVID-19 patients were served by the telemedicine system, with an improvement rate of 73.2%. Conclusions: Telemedicine can improve the diagnosis and treatment of COVID-19 patients, which play a helpful role in curbing the COVID-19 epidemic. Given the current global COVID-19 pandemic and the potential re-emerge of novel zoonotic pathogens in the future, the use of telemedicine would be imperative to fight against the pandemic.

State-of-the-art session key generation on priority-based adaptive neural machine (PANM) in telemedicine

Telemedicine is one of the safest methods to provide healthcare facilities to the remote patients with the help of digitization. In this paper, state-of-the-art session key has been proposed based on the priority oriented neural machines followed by its validation. State-of-the-art technique can be mentioned as newer scientific method. Soft computing has been extensively used and modified here under the ANN domain. Telemedicine facilitates secure data communication between the patients and the doctors regarding their treatments. The best fitted hidden neuron can contribute only in the formation of the neural output. Minimum correlation was taken into consideration under this study. Hebbian learning rule was applied on both the patient’s neural machine and the doctor’s neural machine. Lesser iterations were needed in the patient’s machine and the doctor’s machine for the synchronization. Thus, the key generation time has been shortened here which were 4.011 ms, 4.324 ms, 5.338 ms, 5.691 ms, and 6.105 ms for 56 bits, 128 bits, 256 bits, 512 bits, and 1024 bits of state-of-the-art session keys, respectively. Statistically, different key sizes of the state-of-the-art session keys were tested and accepted. Derived value-based function had yielded successful outcomes too. Partial validations with different mathematical hardness had been imposed here too. Thus, the proposed technique is suitable for the session key generation and authentication in the telemedicine in order to preserve the patients’ data privacy. This proposed method has been highly protective against numerous data attacks inside the public networks. Partial transmission of the state-of-the-art session key disables the intruders to decode the same bit patterns of the proposed set of keys.

Telemedicine for Virtual Consultations During COVID-19 Pandemic in a Medically Assisted Reproduction Center: Patients' Perspective

Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in waiting times for other health procedures. During the pandemic, utilization of telemedicine has increased to ensure patient care safely. The aim of this study was to evaluate the perspective of infertile patients who underwent virtual consultations for infertility. Materials and Methods: This was an observational study. A survey was submitted to patients who attended a virtual consultation at a single in vitro fertilization (IVF) unit between March 2020 and July 2021. The survey concerned their experience with telemedicine assessing the experience of video consulting and the software characteristics. Results: The survey response rate was 50.3% (n = 159). In total, 98.8% of patients positively rated the experience of telemedicine. Regarding the software itself, it was defined as intuitive and easy to use by 87.4% of patients. A majority (92.5%) of interviewed patients reported that they were able to receive the information and clear any doubts they had and 85.5% of interviewed patients would repeat the experience of video consultation. Conclusions: The acceptance of telemedicine was very high among infertile patients. However, IVF treatments have a strong emotional component and face-to-face consultation with medical staff might help to create the right climate of trust, and the empathy that can be demonstrated during a vis-à-vis meeting cannot be achieved through a screen. The use of telemedicine should be considered in those situations where it is not possible to attend an in-person consultation or when couples prefer it.

Translation, cultural adaptation and pilot testing of a questionnaire measuring the factors affecting the acceptance of telemedicine by Greek cancer patients

The emergency presented through the COVID-19 pandemic exposed the need to adopt remote, technology-driven solutions and make healthcare services more resilient. To do so, we need technological applications (i.e., telemedicine) that are designed and tailored to the end-users (i.e., chronic patients) needs and the type of healthcare service they get (i.e., cancer care). The requirements above are especially relevant to Greece, being a country with numerous sparsely populated regions (e.g., islands, regions at the borders) and a deteriorating access to healthcare for all citizens. Trying to address such diverse problems and needs, there have been multiple, different telemedicine and telecare projects in Greece in the past years. To support the future design and implementation of such endeavours, in this study we translated a questionnaire measuring the acceptance of telemedicine by patients and adapted it to the Greek context. We continued by running a small-scale pilot with 73 Greek women with breast cancer to assess the adapted instrument for its reliability and construct validity. The created questionnaire had good overall and internal reliability scores for most sub-scales. Factor analysis did not identify the same number of latent dimensions as the original theoretical model. Reverse wording items needing to be recoded were identified, and items that could be omitted in future versions of the questionnaire. Increasing the sample size for the purposes of a longitudinal study, the construct, convergent, and discriminant validity are elements to be further examined in future studies. It is envisaged that the creation of this questionnaire will support the adoption of telemedicine by Greek healthcare services into more routine areas of patient care provision.

Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study

The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.

The behavioral intention to adopt mobile health services: The moderating impact of mobile self-efficacy

This study explored the moderating impact of mobile self-efficacy on the adoption of mobile health services. The UTAUT was used as the theoretical foundation for this study. The results have indicated that mobile self-efficacy was significant in moderating the impact of both performance expectancy (β = -0.005, p < 0.05) and effort expectancy (β = -010, p < 0.05) on the adoption of mobile health services. In addition, it was revealed to our surprise that both performance (β = 0.521, t = 9.311, p > 0.05) and effort expectancy (β = 0.406, t = 7.577, p > 0.05) do not determine the behavioral intention to use mobile health services. Effort expectancy and behavioral intention to use were also, respectively, not significant in influencing performance expectancy (β = 0.702, t = 12.601, p > 0.05) and intention to recommend the adoption of mobile health services (β = 0.866, t = 13.814, p > 0.05). Mobile self-efficacy, however, was found to significantly predict the citizen's intention to recommend the adoption of mobile health services (β = 0.139, t = 2.548, p < 0.05). The implications of these findings on mobile health are discussed.

Multidisciplinary care of patients with narcolepsy during coronavirus disease 2019 pandemic in Italy via televisit: the TElemedicine for NARcolepsy feasibility study

STUDY OBJECTIVES

Narcolepsy is a rare chronic central disorder of hypersomnolence with frequent endocrine-metabolic comorbidities. To address the complex care needs of patients during the COVID-19 emergency, we carried out a feasibility study of the TElemedicine for NARcolepsy (TENAR) protocol with the aim of assessing the feasibility of a multidisciplinary care approach via televisit for patients with narcolepsy.

METHODS

A feasibility single open-arm study on the multidisciplinary care of children (>7 y.o.) and adults with narcolepsy who required a follow-up visit was realized during the COVID-19 pandemic emergency period in Italy. The study included a sleep, metabolic, and psychosocial assessment via televisit at baseline, at 6, and at 12 months from the study inclusion period (15th May-26th June 2020).

RESULTS

In total 39 out of 44 eligible patients (89%) entered the study (30 adults, nine children); 37 patients (95%) ended the 12-month follow-up. At baseline, the median Epworth sleepiness scale score (ESS) was 10 (IQR 8-14), and the median body mass index (BMI) was 25.6 (IQR 22.1-30.9). During the follow-up period, the ESS score decreased from the 6th month onward (p = 0.003), and BMI decreased at the 1-year follow-up (p = 0.047), while there were no differences in depressive and anxiety symptoms, quality of life, compliance with treatment, adverse drug reactions, or accidents.

CONCLUSIONS

High response and retention rates, stability of ESS, and lack of side effects indicate that telemedicine is a feasible and safe approach for adults and children with narcolepsy.

Telemedicine solutions for clinical care delivery during COVID-19 pandemic: A scoping review

Background:

The unexpected emergence of coronavirus disease 2019 (COVID-19) has changed mindsets about the healthcare system and medical practice in many fields, forcing physicians to reconsider their approaches to healthcare provision. It is necessary to add new, unique, and efficient solutions to traditional methods to overcome this critical challenge. In this regard, telemedicine offers a solution to this problem. Remote medical activities could diminish unnecessary visits and provide prompt medical services in a timely manner.

Objective

This scoping review aimed to provide a map of the existing evidence on the use of telemedicine during the COVID-19 pandemic by focusing on delineation functions and technologies, analyzing settings, and identifying related outcomes.

Methods

This review was conducted following the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed and Scopus databases were systematically searched based on specific eligibility criteria. The English publications included in this study focused on telemedicine systems implemented during the COVID-19 pandemic to provide clinical care services. Two independent reviewers screened the articles based on predefined inclusion and exclusion criteria. The relevant features of telemedicine systems were summarized and presented into the following four domains and their subcategories, including functionality, technology, context, and outcomes.

Results

Out of a total of 1,602 retrieved papers, 66 studies met the inclusion criteria. The most common function implemented was counseling, and telemedicine was used for diagnosis in seven studies. In addition, in 12 studies, tele-monitoring of patients was performed by phone, designed platforms, social media, Bluetooth, and video calls. Telemedicine systems were predominantly implemented synchronously (50 studies). Moreover, 10 studies used both synchronous and asynchronous technologies. Although most studies were performed in outpatient clinics or centers, three studies implemented a system for hospitalized patients, and four studies applied telemedicine for emergency care. Telemedicine was effective in improving 87.5% of health resource utilization outcomes, 85% of patient outcomes, and 100% of provider outcomes.

Conclusion

The benefits of using telemedicine in medical care delivery systems in pandemic conditions have been well–documented, especially for outpatient care. It could potentially improve patient, provider, and healthcare outcomes. This review suggests that telemedicine could support outpatient and emergency care in pandemic situations. However, further studies using interventional methods are required to increase the generalizability of the findings.

Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis

Background

Patients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality.

Objective

This study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS).

Methods

The German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user.

Results

In total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app “CED Dokumentation und Tipps” had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values.

Conclusions

The MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care.

Mobile Health Apps Providing Information on Drugs for Adult Emergency Care: Systematic Search on App Stores and Content Analysis

Background

Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs.

Objective

This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics.

Methods

We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost.

Results

Overall, 49 apps were identified. Of these 49 apps, 32 (65%) were found on both digital platforms; 11 (22%) were available only for Android, and 6 (12%) were available only for iOS. In total, 41% (20/49) of the apps required payment (ranging from €0.59 [US $0.64] to €179.99 [US $196.10]) and 22% (11/49) of the apps were developed by non–health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45% (22/49) of the apps focused on emergency drugs, and 55% (27/49) focused on emergency medicine. More than half (29/47, 62%) did not include bibliographic references or had not been updated for more than a year (29/49, 59%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55%) and adverse reactions (24/47, 51%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32%), interactions (10/47, 21%), and use during pregnancy and breastfeeding (15/47, 32%). Only 6% (3/47) identified high-alert medications, and 2% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively).

Conclusions

We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content.

STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus

Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.

Impact on Mental Well-Being and Resilience of Patients with Multiple Chronic Conditions in Different Periods during the Coronavirus Disease 2019 Outbreak in Taiwan

Concerns over the coronavirus disease 2019 (COVID-19) pandemic and control measures have affected the routine outpatient visits of individuals with comorbidities and their mental well-being. From October 2019 to August 2020, this cross-sectional study enrolled 135 patients who sought medical attention at a medical center in Taiwan. This period covered the early (October to December 2019), peak (January to April 2020), and late (May to August 2020) periods of the COVID-19 outbreak in Taiwan. The demographic data, social support data, activities of daily living (ADL), resilience scale scores, and mental well-being scale scores of the participants were compared. There were no statistically significant differences in the participation rate, demographic data, and social support data between the three periods. The correlation analysis confirmed significant negative relationships between the number of COVID-19 cases and outpatient department visits per month (r = −0.764, p < 0.001), emergency department visits per month (r = −0.023, p < 0.001), ADL (r = −0.257, p = 0.03), resilience scale (r = −0.390, p < 0.001), and mental well-being scale (r = −0.475, p < 0.001). In conclusion, the severity of the COVID-19 outbreak in Taiwan was associated with declines in the ADL, mental well-being, and resilience of patients who sought medical attention.

The Development of Electronic Health and Artificial Intelligence in Surgery after the SARS-CoV-2 Pandemic-A Scoping Review

BACKGROUND

SARS-CoV-2 has significantly transformed the healthcare environment, and it has triggered the development of electronic health and artificial intelligence mechanisms, for instance. In this overview, we concentrated on enhancing the two concepts in surgery after the pandemic, and we examined the factors on a global scale.

OBJECTIVE

The primary goal of this scoping review is to elaborate on how surgeons have used eHealth and AI before; during; and after the current global pandemic. More specifically, this review focuses on the empowerment of the concepts of electronic health and artificial intelligence after the pandemic; which mainly depend on the efforts of countries to advance the notions of surgery.

DESIGN

The use of an online search engine was the most applied method. The publication years of all the studies included in the study ranged from 2013 to 2021. Out of the reviewed studies; forty-four qualified for inclusion in the review.

DISCUSSION

We evaluated the prevalence of the concepts in different continents such as the United States; Europe; Asia; the Middle East; and Africa. Our research reveals that the success of eHealth and artificial intelligence adoption primarily depends on the efforts of countries to advance the notions in surgery.

CONCLUSIONS

The study's primary limitation is insufficient information on eHealth and artificial intelligence concepts; particularly in developing nations. Future research should focus on establishing methods of handling eHealth and AI challenges around confidentiality and data security.

Machine Learning in Medical Emergencies: a Systematic Review and Analysis

Despite the increasing demand for artificial intelligence research in medicine, the functionalities of his methods in health emergency remain unclear. Therefore, the authors have conducted this systematic review and a global overview study which aims to identify, analyse, and evaluate the research available on different platforms, and its implementations in healthcare emergencies. The methodology applied for the identification and selection of the scientific studies and the different applications consist of two methods. On the one hand, the PRISMA methodology was carried out in Google Scholar, IEEE Xplore, PubMed ScienceDirect, and Scopus. On the other hand, a review of commercial applications found in the best-known commercial platforms (Android and iOS). A total of 20 studies were included in this review. Most of the included studies were of clinical decisions (n = 4, 20%) or medical services or emergency services (n = 4, 20%). Only 2 were focused on m-health (n = 2, 10%). On the other hand, 12 apps were chosen for full testing on different devices. These apps dealt with pre-hospital medical care (n = 3, 25%) or clinical decision support (n = 3, 25%). In total, half of these apps are based on machine learning based on natural language processing. Machine learning is increasingly applicable to healthcare and offers solutions to improve the efficiency and quality of healthcare. With the emergence of mobile health devices and applications that can use data and assess a patient's real-time health, machine learning is a growing trend in the healthcare industry.

Wearable devices as a valid support for diagnostic excellence: lessons from a pandemic going forward

Today, the use of wearable devices is continuously increasing with many different application fields. Their low-cost and wide availability make these devices proper instruments for long-term monitoring, potentially useful to detect physiological changes related to influenza or other viruses. The relevance of this aspect and the impact of such technology have become evident particularly in the last year, during COVID-19 emergency; (big) data from wearable devices (already worn by many citizens) together with artificial intelligence techniques gave birth to specific studies dedicated to quickly identify patterns discriminating between healthy and infected people. These evaluations are made on the basis of parameters measured by these devices, among which heart rate, physical activity, and sleep seem to play a dominant role. This could be extremely significant in terms of early detection and limit of contagion risk. However, there is still a lot of research to be conducted in terms of measurement accuracy, data management (privacy and security issues), and results exploitation, in order to reach an accurate and reliable solution helping the whole healthcare system particularly in epidemic events, such as the SARS-CoV-2 pandemic.