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Got Y, Borotikar B, Sandillon-Garétier C, Le Coat A, Dulou R, Garétier M. Use of Instant Messaging Applications by General Practitioners During Overseas Deployment: A Survey of the French Military Health Service. Mil Med 2024; 189:e1745-e1752. [PMID: 38079462 DOI: 10.1093/milmed/usad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 07/05/2024] Open
Abstract
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.
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Affiliation(s)
- Yannis Got
- Val-de-Grâce Military Medical Academy, Paris 75005, France
- 53e AM-4e CMA, Epinal 55400, France
| | - Bhushan Borotikar
- Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra 412115, India
| | | | - Anne Le Coat
- Emergency Department, Military Teaching Hospital Clermont-Tonnerre, Brest 29240, France
| | - Renaud Dulou
- Val-de-Grâce Military Medical Academy, Paris 75005, France
- Military Teaching Hospital Percy, Clamart 92140, France
| | - Marc Garétier
- Radiology Department, Military Teaching Hospital Clermont-Tonnerre, Brest 29240, France
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Amran MM, Bilitzky A, Bar-Yishay M, Adler L. The use of medical health applications by primary care physicians in Israel: a cross-sectional study. BMC Health Serv Res 2024; 24:410. [PMID: 38566059 PMCID: PMC10988819 DOI: 10.1186/s12913-024-10880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated. METHODS From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them. RESULTS From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps. CONCLUSIONS mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.
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Affiliation(s)
- Menashe Meni Amran
- Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.
| | - Avital Bilitzky
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Mattan Bar-Yishay
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li C, Salman M, Esmail T, Matava C. Use of Peer-Led Web-Based Platforms for Peer-Assisted Learning Among Canadian Anesthesia Residents and Fellows: Cross-Sectional Study. JMIR Form Res 2023; 7:e47977. [PMID: 37955954 PMCID: PMC10682924 DOI: 10.2196/47977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/20/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Peer-assisted learning (PAL) using peer-led web-based platforms (PWPs), including social media, can be a highly effective method of supporting medical trainees. PWPs, such as mobile apps for sharing anesthesia resources and social media groups or discussion forums pertaining to anesthesia training, may play a role in facilitating anesthesia trainee-led web-based education. However, there have been many challenges facing anesthesia trainees when it comes to incorporating PWPs, especially social media and mobile apps for PAL. OBJECTIVE The primary objective of this survey was to assess the proportion of trainees that use social media and mobile apps. The secondary objective was to identify the trainees' perceptions on the use of social media and mobile apps for educational purposes, including PAL. METHODS This cross-sectional study was conducted through a survey administered via email at a single large academic center. The survey tool collected data between 2016 and 2017 on the following: demographic data (year of study, field of specialty), use of technology and web-based resources for medicine, use of social media platforms for anesthesia or training, benefits and barriers to future uses of social media for training, and ideas for trainee-led websites. Descriptive statistics were reported. RESULTS In total, 80 anesthesia trainees (51 residents and 29 fellows) responded to the survey (response rate of 33% of out 240 trainees contacted). All trainees reported having a mobile device that most (n=61, 76%) reported using multiple times a day to access medical resources. The highest perceived benefits of PWPs according to residents were that the most valuable information was available on-demand (n=27, 53%), they saved time (n=27, 53%), and they improved their overall learning experience within anesthesia (n=24, 47%). In comparison, fellows thought that PWPs were beneficial because they provided multiple perspectives of a single topic (n=13, 45%) and served as an additional platform to discuss ideas with peers (n=13, 45%). The most popular platforms used by both residents and fellows were Facebook (residents: n=44, 86%; fellows: n=26, 90%) followed by LinkedIn (residents: n=21, 42%; fellows: n=9, 29%). Even though most anesthesia trainees used social media for personal reasons, only 26% (n=21) reported having used resident- or fellow-driven PWP resources. Examples of PWPs that trainees used included anesthesia groups and a resident Dropbox resource folder. CONCLUSIONS There was generally an acceptance for using PWPs for PAL as they provided various benefits for trainees at all levels of learning. PWPs have the potential to garner an increased sense of community and sharing within learning experiences throughout all levels of training. The information gained from this survey will help inform the basis for developing an anesthesia trainee-led e-learning platform.
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Affiliation(s)
- Casey Li
- Faculty of Medicine, University of British Columbia, Vancouver, ON, Canada
| | - Maria Salman
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Termerty Medicine, University of Toronto, Toronto, ON, Canada
| | - Tariq Esmail
- Department of Anesthesiology and Pain Medicine, Termerty Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Management, University Health Network, Toronto, ON, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Termerty Medicine, University of Toronto, Toronto, ON, Canada
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Grasser T, Borges Dario A, Parreira PCS, Correia IMT, Meziat-Filho N. Defining text neck: a scoping review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3463-3484. [PMID: 37405530 DOI: 10.1007/s00586-023-07821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/02/2023] [Accepted: 06/07/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike. PURPOSE To investigate how text neck is defined in peer-reviewed articles. METHODS We conducted a scoping review to identify all articles using the terms "text neck" or "tech neck." Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions. RESULTS Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%). CONCLUSION This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.
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Affiliation(s)
- Tatiana Grasser
- Centro Universitário Augusto Motta, UNISUAM, Rua Dona Isabel 94, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-010, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia do Tocantins, Palmas, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia do Paraná, Curitiba, Brazil.
| | - Amabile Borges Dario
- Faculty of Medicine and Health, Sydney School of Health Sciences, University of Sydney, Sydney, Australia
| | | | - Igor Macedo Tavares Correia
- Centro Universitário Augusto Motta, UNISUAM, Rua Dona Isabel 94, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-010, Brazil
| | - Ney Meziat-Filho
- Centro Universitário Augusto Motta, UNISUAM, Rua Dona Isabel 94, Bonsucesso, Rio de Janeiro, RJ, CEP 21041-010, Brazil
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Ncube B, Mars M, Scott RE. Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6718. [PMID: 37754578 PMCID: PMC10530668 DOI: 10.3390/ijerph20186718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
Botswana is developing its eHealth capacity using a National eHealth Strategy. However, that strategy overlooks telemedicine, a potential solution for many healthcare challenges. For telemedicine to benefit Botswana, a telemedicine-specific strategy is required. While establishing a national strategy is a sovereign responsibility, guidance and recommendations can be provided. Using published resources specific to Botswana, key health-related issues were identified. These issues were matched with suitable telemedicine activities and delivery approaches. Recommendations were then derived from these for use in an effective telemedicine-specific strategy for Botswana. From 28 health-related issues, 6 were prioritised. Three telemedicine activities were identified (clinical services, education, and behaviour change), and one delivery approach was chosen (store-and-forward) because they align well with current needs, infrastructure, and mobile phone user capabilities. Since telemedicine has been proven to be effective, efficient, and cost-effective when implemented correctly, this knowledge and experience, plus a recognised strategy development framework, has led to evidence-based recommendations. Specific telemedicine options were identified as examples. As confidence grows, telemedicine options can be expanded to address additional clinical needs and explore alternative activities and delivery options. The recommendations can help the government develop a telemedicine-specific strategy that aligns with the National eHealth Strategy while actively promoting and supporting the adoption and system integration of straightforward telemedicine interventions. This foundation will facilitate the future expansion of telemedicine initiatives for the benefit of all Batswana.
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Affiliation(s)
- Benson Ncube
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
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Yotsu RR, Almamy D, Vagamon B, Ugai K, Itoh S, Koffi YD, Kaloga M, Dizoé LAS, Kouadio K, Aka N, Yeboue LKG, Yao KA, Blanton RE. An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study. JMIR DERMATOLOGY 2023; 6:e46295. [PMID: 37632977 PMCID: PMC10335127 DOI: 10.2196/46295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. OBJECTIVE The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d'Ivoire for diagnosing and managing skin NTDs and other skin diseases. METHODS A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. RESULTS The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a "dermatosis." In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. CONCLUSIONS The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.
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Affiliation(s)
- Rie R Yotsu
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Diabate Almamy
- Department of Dermatology, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Bamba Vagamon
- Department of Dermatology, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
- Raoul Follereau Institute Côte d'Ivoire, Adzopé, Côte d'Ivoire
| | - Kazuko Ugai
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Sakiko Itoh
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yao Didier Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- National Buruli Ulcer Control Program, Ministry of Health of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Mamadou Kaloga
- National Buruli Ulcer Control Program, Ministry of Health of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Ligué Agui Sylvestre Dizoé
- National Control Program for Elimination of Leprosy, Ministry of Health of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | | | | | | | - Ronald E Blanton
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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Eslami Jahromi M, Ayatollahi H. Utilization of telehealth to manage the Covid-19 pandemic in low- and middle-income countries: a scoping review. J Am Med Inform Assoc 2023; 30:738-751. [PMID: 36565464 PMCID: PMC10018263 DOI: 10.1093/jamia/ocac250] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/04/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Recently, the coronavirus disease 2019 (Covid-19) pandemic has led to an increase in the use of telehealth technology. It seems that the application of this technology in low- and middle-income countries (LMICs) has been limited, and few studies have been undertaken to review the current state of knowledge in this area. The aim of the present study was to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs. MATERIALS AND METHODS This scoping review was conducted in 2022. PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest were searched, and all quantitative research, qualitative studies, case reports, and case studies related to the use of telehealth to manage Covid-19 in LMICs and published since 2020 were included in the study. The findings were analyzed and reported narratively. RESULTS In total, 18 articles were included in the research. These studies were conducted in South Asia, sub-Saharan Africa, the Middle East and North Africa, and East Asia and Oceania. Telehealth interventions included teleconsultation, telecoaching, teledermatology, televisit, mhealth applications, telerehabilitation, telepharmacy, and telepsychiatry. WhatsApp was the most common way for service delivery and in most studies, patients and health care providers were satisfied with services. CONCLUSION Although the use of telehealth interventions was limited in LMICs during the Covid-19 pandemic, in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes. A comparison between the characteristics and clinical effectiveness of similar interventions in different countries including LMICs are worth investigation in the future studies.
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Affiliation(s)
- Maryam Eslami Jahromi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Mohammadi M, Rawassizadeh R, Sheikhtaheri A. A consumer-centered security framework for sharing health data in social networks. JOURNAL OF INFORMATION SECURITY AND APPLICATIONS 2022. [DOI: 10.1016/j.jisa.2022.103303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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10
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Yotsu RR, Itoh S, Yao KA, Yeboue LG, Kouadio K, Ugai K, Koffi YD, Almamy D, Vagamon B, Blanton RE. Early Detection and Case Management of Skin Diseases with a Mobile Health Application 'eSkinHealth': Protocol for a Mixed-Methods Pilot Study in Côte d'Ivoire. JMIR Res Protoc 2022; 11:e39867. [PMID: 35922062 PMCID: PMC9536527 DOI: 10.2196/39867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of skin diseases is extremely high in sub-Saharan Africa, among which are skin neglected tropical diseases (skin NTDs) that could lead to life-long disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health application (mHealth app): 'eSkinHealth.' OBJECTIVE This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d'Ivoire. METHODS A mixed-methods pilot trial will be conducted in Côte d'Ivoire and will consist of 3 phases: phase 1, the development and improvement of the eSkinHealth app; phase 2, a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d'Ivoire; and phase 3, a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d'Ivoire. The pilot study will be implemented as a 2-arm trial with local healthcare providers and patients with skin NTDs over a 3-month follow-up period. The local healthcare providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the usage and implementation of the app and diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d'Ivoire by number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the IRB of the Ministry of Health, Côte d'Ivoire and by Tulane University in 2021. RESULTS This study was funded in 2021. We started enrolment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. CONCLUSIONS Our 'eSkinHealth' is a field-adapted platform that could both provide direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d'Ivoire; and further, are expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. CLINICALTRIAL 2020-2054 (Clinicaltrials.gov).
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Affiliation(s)
- Rie R Yotsu
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, US.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, JP.,Department of Dermatology, National Center for Global Health and Medicine, Shinjuku, JP
| | - Sakiko Itoh
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Suita, JP
| | - Koffi Aubin Yao
- Hope Commission International, Abidjan, Côte d'Ivoire, Abidjan, CI
| | | | | | - Kazuko Ugai
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, JP
| | - Yao Didier Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, CI.,National Buruli Ulcer Control Program, Ministry of Health of Côte d'Ivoire, Abidjan, CI
| | - Diabate Almamy
- Department of Dermatology, Universite Alassane Ouattara, Bouaké, CI.,Raoul Follereau Institute Côte d'Ivoire, Adzopé, CI
| | - Bamba Vagamon
- Raoul Follereau Institute Côte d'Ivoire, Adzopé, CI.,Department of Dermatology, Universite Alassane Ouattara, Bouaké, CI
| | - Ronald E Blanton
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, US
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Koh E, Maranga A, Yane T, Ndlovu K, Jereni B, Nwako-Mohamadi MK, Kovarik C, Forrestel A, Williams VL. Evaluation of WhatsApp as a Platform for Teledermatology in Botswana: Retrospective Review and Survey. JMIR DERMATOLOGY 2022. [DOI: 10.2196/35254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
In emerging market countries in sub-Saharan Africa, access to specialty services such as dermatology is limited. Teledermatology is an innovative solution to address this issue; however, many initiatives have been tried without sustained success. Recently, WhatsApp has been used as a store-and-forward telemedicine communication platform for consultation and education in Botswana.
Objective
This study aims to describe the utilization of WhatsApp for teledermatology and the satisfaction levels of participating providers.
Methods
A 2-part pilot study was conducted. First, a retrospective review was performed of WhatsApp communications received by participating dermatologists in Gaborone, Botswana, from January 2016 to December 2019. Sender information, patient demographics and history, response time, diagnoses made, and follow-up recommendations were collected. Second, a 12-question cross-sectional survey was distributed to health care providers who utilized WhatsApp for teledermatology during this period. Descriptive statistics were then performed.
Results
There were 811 communication threads over the study period. The majority (503/811, 62%) of communications were consultations from providers inquiring about a specific patient, followed by multidisciplinary care coordination communications (90/811, 11%). Our in-depth analysis focused on the former. In 323 (64%) provider consultations, dermatologists responded within 1 hour. A diagnosis was made in 274 (55%) consultations. Dermatologists gave treatment recommendations remotely in 281 (56%) consultations and recommended an in-person dermatology visit in 163 (32%). Of the 150 health care providers surveyed, 23 (15%) responded. All respondents (100%) felt that there was a need for teledermatology and improved teledermatology education in Botswana. Moreover, 17 (74%) respondents strongly felt that the guidance received via WhatsApp was high quality, and 22 (96%) were satisfied with WhatsApp as a platform for teledermatology.
Conclusions
This retrospective review and survey demonstrated that WhatsApp is a quick, well-received, and sustainable method of communication between dermatologists and providers across Botswana. The app may offer a solution to the challenges providers face in accessing specialty referral systems, point-of-care education, and medical decision-making support for complex dermatologic cases in Botswana. The information gained from this pilot study can serve as the basis for future telemedicine studies to improve the implementation of teledermatology in Botswana and other resource-limited countries.
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An Audit and Survey of Informal Use of Instant Messaging for Dermatology in District Hospitals in KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127462. [PMID: 35742708 PMCID: PMC9223770 DOI: 10.3390/ijerph19127462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Background. In KwaZulu-Natal (KZ-N), South Africa, recent reports have indicated that spontaneous use of smartphones has occurred, providing access to specialist dermatological care to remote areas. This informal use has raised a number of practical, legal, regulatory, and ethical concerns. Aim. To assess the nature and content of WhatsApp messages sent to dermatologists, to determine the referring doctors’ reasons for, and satisfaction with, their interactions, as well as their knowledge of legal, regulatory, and ethical requirements. Methods. A retrospective study of WhatsApp messages between referring doctors and dermatologists, as well as a cross-sectional survey of doctors working at district hospitals in KZ-N who used IM for teledermatology. Results. Use of IM (primarily WhatsApp) for teledermatology was almost universal, but often not considered ‘telemedicine’. Few referring doctors were aware of South Africa’s ethical guidelines and their requirements, and few of those who did followed them, e.g., the stipulated and onerous consent process and existing privacy and security legislations. No secure methods for record keeping or data storage of WhatsApp content were used. A desire to formalize the service existed. Conclusions. Based upon these findings, it was proposed that a number of described steps be followed in order to formalize the use of IM for teledermatology.
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Gebbia V, Piazza D, Valerio MR, Firenze A. WhatsApp Messenger use in oncology: a narrative review on pros and contras of a flexible and practical, non-specific communication tool. Ecancermedicalscience 2022; 15:1334. [PMID: 35211203 PMCID: PMC8816506 DOI: 10.3332/ecancer.2021.1334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Palermo, Italy.,Department of Internal Medicine 'Promise', University of Palermo, Palermo, Italy
| | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinic 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Alberto Firenze
- Department of Internal Medicine 'Promise', University of Palermo, Palermo, Italy.,Risk Management Unit, Policlinic 'P. Giaccone', University of Palermo, Palermo, Italy
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WhatsApp in Clinical Practice-The Challenges of Record Keeping and Storage. A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413426. [PMID: 34949033 PMCID: PMC8708459 DOI: 10.3390/ijerph182413426] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
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.
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Ndlovu K, Mars M, Scott RE. Development of a conceptual framework for linking mHealth applications to eRecord systems in Botswana. BMC Health Serv Res 2021; 21:1103. [PMID: 34654432 PMCID: PMC8518885 DOI: 10.1186/s12913-021-07134-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The proliferation of mHealth solutions and eRecord systems is inevitable in developing countries, and ensuring their bi-directional interoperability is essential. Interoperability has been described as the ability for two or more systems or components to exchange information and use the information that has been exchanged. Given the importance of linking mHealth solutions to eRecord systems in the developing world, a suitable interoperability framework is required to provide an agreed approach to interoperability and specify common elements. Although eHealth interoperability frameworks exist in the literature, none meet all the requirements for linking mHealth solutions to eRecord systems in developing countries. The aim of this paper was to describe the design and development of a conceptual framework for linking mHealth solutions to eRecord systems in Botswana, as an exemplar. METHODS An iterative and reflective process was adopted, supported by existing literature and research including consultations with eHealth experts, and guidance from existing frameworks. These collectively identified key elements, concepts, and standards relevant and essential for framework design and development. RESULTS The mHealth-eRecord Interoperability Framework (mHeRIF) was developed which highlights the need for: governance and regulation of mHealth and eRecord systems, a national health information exchange, and which interoperability levels to achieve. Each of these are supported by integral themes and concepts. It also addresses the need for regular review, accreditation, and alignment of framework concepts and themes with a National eHealth Strategy Interoperability Development Process. To demonstrate the framework's applicability, a proposed architecture for the Kgonafalo mobile telemedicine programme is presented. CONCLUSION Interoperable mHealth solutions and eRecords systems have the potential to strengthen health systems. This paper reports the design and development of an evidence-based mHeRIF to align with, build upon, and expand National eHealth Strategies by guiding the linking of mHealth solutions to eRecord systems in Botswana and other developing countries facing similar circumstances.
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Affiliation(s)
- Kagiso Ndlovu
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Department of Computer Science, University of Botswana, Gaborone, Botswana.
| | - Maurice Mars
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard E Scott
- Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Demirel Öğüt N, Öğüt Ç, Eşme P. The role of online consultation requests to personal social media accounts and instant messaging services of dermatologists in occupational burnout: An emerging problem. J Cosmet Dermatol 2021; 21:2542-2549. [PMID: 34449960 DOI: 10.1111/jocd.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Burnout affects all physicians, including dermatologists. Long working hours, high workload, and work-related activities outside working hours are common risk factors for burnout that disrupt the work-life balance. This study aimed to evaluate dermatologists' approach to online consultation requests via social media (SM) and instant messaging services (IMS), the psychological effects of these consultations on dermatologists, and their relationship with burnout syndrome. MATERIALS AND METHODS A cross-sectional, descriptive research was conducted as an online survey using Google Forms. The survey consisted of 55 items and was sent to dermatologists through a closed Facebook group of the Turkish Society of Dermatology. The burnout levels of dermatologists were evaluated using three subscales of the Maslach Burnout Inventory (MBI): emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). RESULTS Out of the total 270 participants, 268 (99.3%) participants reported using SM and IMS, whereas 263 (98.1%) received personal consultation requests on these applications. Among all IMS, WhatsApp (n=258, 98.1%) was the most common IMS for online consultation requests. Median (IQR) scores for EE, DP, and PA subscales were 18 (11), 6 (5), and 21 (6), respectively. A positive correlation was observed between the frequency of online consultation requests and MBI-EE subscale scores (r = 0.136; 95% CI, 0.013-0.254; p = 0.026). Fatigue (95.1%), anger (66.6%), and unhappiness (45.2%) were among the most common adverse effects of online consultations on dermatologists. CONCLUSION Online consultation requests to dermatologists' personal IMS and SM accounts can lead to burnout. The current study findings raise the awareness of the risks of burnout among dermatologists. There is an implicit need for further research, mobile apps other than frequently used IMS and SM apps, and regulations to avoid problems related to the consequences of online dermatology consultations through IMS and SM.
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Affiliation(s)
- Neslihan Demirel Öğüt
- Department of Dermatology and Venereology, Uşak University Training and Research Hospital, Uşak, Turkey
| | - Çağrı Öğüt
- Department of Psychiatry, Uşak University Training and Research Hospital, Uşak, Turkey
| | - Pelin Eşme
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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Giansanti D, Maccioni G. Health in the palm of your hand-part 2: design and application of an educational module for young people on the risks from smartphone abuse and the opportunities of telemedicine and e-Health. Mhealth 2021; 7:48. [PMID: 34345625 PMCID: PMC8326954 DOI: 10.21037/mhealth-20-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/06/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The evolution of mHealth is strictly related to the evolution of the mobile-technology and in particular of the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of emerging risks and in particular (I) the text neck, (II) the addiction, (III) the use of deceptive Apps in mHealth and today telemedicine and e-Health solutions to face this are strongly needed. What young people need is a package of solutions that allow them to tackle all three of these problems at the same time through dedicated tools and specific material on these topics. However up to now this is lacking. The purpose of the study was the design and application of a teaching package focused in this field and specific for young people, the target population for the emerging risks. METHODS A teaching package was developed in a school-work alternation program for the secondary schools at the Italian National Institute of Health, according the Italian Law. It was available on the basis of proposals offered publically. It provided a two weeks stage on the topics: the risks from smartphone abuse and Telemedicine and e-Health solutions. RESULTS A specific electronic survey in this field was available at the end of the stage. The survey was submitted to 500 young subjects (50% male; 50% females; mean age 15.9 y; std-dev 1.2 y) at school and/or in meeting initiatives. The outcome demonstrated: (I) that the knowledge on the postural risk (text neck) was very poor, while the desiderata of Apps for correcting the posture was very high; (II) the feasibility to obtain feedback on the risk of addiction through a cyber-psychology approach; (III) a worrying position in relation to non-medical Apps confused with the medical ones. CONCLUSIONS The study demonstrated how the young people mBorn can familiarize with some aspects of telemedicine and e-Health and be at the same time a kind of spreader of a correct vision of the ratio between user and smartphone and the knowledge on both the mTech and the related problems.
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Giansanti D, Maccioni G. Health in the palm of your hand-part 1: the risks from smartphone abuse and the role of telemedicine and e-Health. Mhealth 2021; 7:49. [PMID: 34345626 PMCID: PMC8326943 DOI: 10.21037/mhealth-20-150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/06/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The evolution of the Telemedicine and e-Health is strictly related to the evolution of the mobile-technology. If today it is possible to successfully use a wide range of mHealth applications, playing an important role in Telemedicine and e-Health, health care has surely a gratitude debt with the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of risks and it is therefore necessary to tackle the various gaps and/or the role that Telemedicine and e-Health itself has in this field. METHODS Through an overview to literature, Web and App stores the study faced the implications for health from the excessive use of the smartphone and therefore the various gaps and/or the role that Telemedicine and e-Health itself has in this area both in the prevention and in the monitoring with particular regard to the three components: eHealth, mHealth and eLearning. RESULTS The study found (I) as emerging risks: the text neck, the risk of addiction and the risk in the use of deceptive Apps in mHealth; (II) as Telemedicine and e-Health useful approach: the design of Apps for the text neck prevention and the relevant acceptance and effectiveness assessment; the design and application of electronic surveys for tele-assessment of the addiction risk; the design and application of information and training path on the deceptive Apps in mHealth. CONCLUSIONS The key role of Telemedicine and e-Health in the prevention and monitoring of the risks from smartphone abuse has been clearly identified and the young people has been identified as target population and the relevant need to design specific teaching packages in this field focused on them.
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Barayev E, Shental O, Yaari D, Zloczower E, Shemesh I, Shapiro M, Glassberg E, Magnezi R. WhatsApp Tele-Medicine - usage patterns and physicians views on the platform. Isr J Health Policy Res 2021; 10:34. [PMID: 34074319 PMCID: PMC8167384 DOI: 10.1186/s13584-021-00468-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/25/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp - a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations. METHODS A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019. RESULTS Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week. CONCLUSIONS In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients' medical records, while providing adequate compensation for those providing the service during and after work hours.
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Affiliation(s)
- Edward Barayev
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel.
- Israel Defense Forces Medical Corps, Tel Aviv, Israel.
| | - Omri Shental
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Dotan Yaari
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Elchanan Zloczower
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | - Itai Shemesh
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| | | | | | - Racheli Magnezi
- Department of Public Health and Health Systems Management Program, Bar Ilan University, 52900, Ramat Gan, Israel
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Sund G, Lipnick M, Law T, Wollner E, Rwibuka G. Anaesthesia facility evaluation : a Whatsapp survey of hospitals in Burundi. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.2.2456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hampshire K, Mwase-Vuma T, Alemu K, Abane A, Munthali A, Awoke T, Mariwah S, Chamdimba E, Owusu SA, Robson E, Castelli M, Shkedy Z, Shawa N, Abel J, Kasim A. Informal mhealth at scale in Africa: Opportunities and challenges. WORLD DEVELOPMENT 2021; 140:105257. [PMID: 33814676 PMCID: PMC7903241 DOI: 10.1016/j.worlddev.2020.105257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with 'mobile health' (mhealth) being a key component of this. However, while 'formal' (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers' (CHWs') 'informal mhealth' practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of 'formal' compared with 'informal' mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this 'informal health' usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
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Affiliation(s)
- Kate Hampshire
- Department of Anthropology, Durham University, Durham DH1 3LE, UK
- Corresponding author.
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Abstract
The first cases of coronavirus disease 2019 (COVID-19) in Iran were detected on February 19, 2020. Soon the entire country was hit with the virus. Although dermatologists were not immediately the frontline health care workers, all aspects of their practice were drastically affected. Adapting to this unprecedented crisis required urgent appropriate responses. With preventive measures and conserving health care resources being the most essential priorities, dermatologists, as an integral part of the health system, needed to adapt their practices according to the latest guidelines. The spectrum of the challenges encompassed education, teledermatology, lasers, and other dermatologic procedures, as well as management of patients who were immunosuppressed or developed drug reactions and, most importantly, the newly revealed cutaneous signs of COVID-19. These challenges have paved the way for new horizons in dermatology.
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Affiliation(s)
- Maryam Daneshpazhooh
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - HamidReza Mahmoudi
- Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Giansanti D, Cosentino L. WhatsApp in mHealth: design and evaluation of an mHealth tool to share dynamic images in hemodynamics. Mhealth 2021; 7:9. [PMID: 33634192 PMCID: PMC7882277 DOI: 10.21037/mhealth-19-187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/11/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND WhatsApp, like many other messaging Apps, enables messages, documents, and multimedia elements to be exchanged through a chat-based tool. Among the many potentialities of WhatsApp are: (I) the possibility to create groups (WhatsApp Groups) and (II) the possibility to install the app on a personal computer using the WhatsApp Web application. METHODS The two functionalities (I, II) were used to set-up an mHealth environment for teleconsultation in telecardiology which will support the exchange of the dynamic images in hemodynamics. A proper client/server architecture was proposed to supply the mHealth environment. The files related to the dynamic study were preliminarily converted [using picture archiving and communication system (PACS) functions] into an audio-video interleave (AVI) format, which is compatible with mobile technology. RESULTS The mHealth environment was configured. Five dynamic images were extracted from the PACS in the format AVI. The images were exchanged using WhatsApp Web on the server side and WhatsApp on the client side (smartphones). An acceptance analysis of five observers showed high satisfaction with the methodology. CONCLUSIONS From a global perspective, our contribution aligns with those of scholars in the field concerning the use of WhatsApp in medical imaging. Furthermore, this study suggests that research in the telecardiology field can be strengthened through the use of dynamic images and WhatsApp.
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Islam SMS, Maddison R. Digital health approaches for cardiovascular diseases prevention and management: lessons from preliminary studies. Mhealth 2021; 7:41. [PMID: 34345618 PMCID: PMC8326947 DOI: 10.21037/mhealth-2020-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/28/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Ncube B, Mars M, Scott RE. The need for a telemedicine strategy for Botswana? A scoping review and situational assessment. BMC Health Serv Res 2020; 20:794. [PMID: 32843017 PMCID: PMC7448978 DOI: 10.1186/s12913-020-05653-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Health, healthcare, and healthcare system problems within the developing world are well recognised. eHealth, the use of Information and Communications Technologies (ICT) for health, is frequently suggested as one means by which to ameliorate such problems. However, to identify and implement the most appropriate ehealth solutions requires development of a thoughtful and broadly evidence-informed strategy. Most published strategies focus on health informatics solutions, neglecting the potential for other aspects of ehealth (telehealth, telemedicine, elearning, and ecommerce). This study examined the setting in Botswana to determine the need for a telemedicine-specific strategy. Methods A situational assessment of ehealth activities in Botswana was performed through a scoping review of the scientific and grey literature using specified search terms to July 2018; an interview with an official from the major mhealth stakeholder; and benchtop review of policies and other relevant Government documents including the country’s current draft eHealth Strategy. Results Thirty-nine papers were reviewed. Various ehealth technologies have been applied within Botswana. These include Skype for educational activities, instant messaging (WhatsApp for telepathology; SMS for transmission of laboratory test results, patient appointment reminders, and invoicing and bill payment), and robotics for dermatopathology. In addition health informatics technologies have been used for surveillance, monitoring, and access to information by healthcare workers. The number of distinct health information systems has been reduced from 37 to 12, and 9 discrete EMRs remain active within the public health institutions. Many infrastructural issues were identified. A critical assessment of the current draft ehealth strategy document for Botswana showed limitations. Many telemedicine services have been introduced over the years (addressing cervical cancer screening, teledermatology, teleradiology, oral medicine and eye screening), but only one project was confirmed to be active and being scaled up with the intervention of the Government. Conclusions Botswana’s draft ‘ehealth’ strategy will not, in and of itself, nurture innovative growth in the application of telemedicine initiatives, which currently are fragmented and stalled. This lack of focus is preventing telemedicine’s recognised potential from being leveraged. A specific Telemedicine Strategy, aligned with and supportive of the pre-existing ehealth strategy, would provide the necessary focus, stimulus, and guidance.
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Affiliation(s)
- B Ncube
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Dynamics Research & Development Institute, Gaborone, Botswana.
| | - M Mars
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R E Scott
- Department of TeleHealth, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Knapp AP, Rehmus W, Chang AY. Skin diseases in displaced populations: a review of contributing factors, challenges, and approaches to care. Int J Dermatol 2020; 59:1299-1311. [PMID: 32686140 DOI: 10.1111/ijd.15063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
There are 70.8 million persons displaced worldwide due to war, persecution, and violence. Eighty percent of displaced persons reside in low- and middle-income countries with limited healthcare resources. Cutaneous diseases are commonly reported among displaced persons owing to numerous interrelated factors such as inadequate housing, overcrowding, food insecurity, environmental exposures, violence including torture, and breakdown of healthcare infrastructure. Diagnosis and management of these conditions, as well as an understanding of the context in which they present, is crucial to providing dermatologic care for displaced populations worldwide. Herein, we define displaced populations and, within this context, review the epidemiology of skin diseases, discuss pertinent skin conditions, examine challenges to care provision, and present approaches for improving dermatologic care. Inflammatory and communicable infectious disorders are the most common skin diseases seen in displaced populations. Other relevant conditions include skin manifestations of heat injuries, cold injuries, immersion foot syndromes, macronutrient and micronutrient deficiencies, torture, and sexual and gender-based violence. Provision of dermatologic care to displaced populations is hampered by limited diagnostic and therapeutic resources and specialist expertise. Medical screening for cutaneous disorders, context-relevant dermatology training, and telemedicine are potential tools to improve diagnosis and management of skin diseases in displaced populations.
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Affiliation(s)
- Alexia P Knapp
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, HealthPartners Institute, Saint Paul, Minnesota, USA
| | - Wingfield Rehmus
- Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC, Canada
| | - Aileen Y Chang
- Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, University of California, San Francisco, USA
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Giansanti D. WhatsApp in mHealth: an overview on the potentialities and the opportunities in medical imaging. Mhealth 2020; 6:19. [PMID: 32270011 PMCID: PMC7136653 DOI: 10.21037/mhealth.2019.11.01] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022] Open
Abstract
WhatsApp as many other Messaging Apps or "Messengers" enables messaging and exchanging documents and/or multimedia element (images, movies, music) through chat like tools; these last characteristics makes WhatsApp useful for the remote-image exchanging in mHealth for teleconsulting. Among the other potentialities of this App there are (I) the possibility to create groups, the so called WhatsApp Groups and (II) the possibility of this App to be installed into a platform based on a personal computer through the version for pc named WhatsApp Web; these potentialities allow both the creation of protected groups for cooperative teleconsulting and the creation of client-server architectures in telemedicine and e-Health. Scholars have recently shown the usefulness of WhatsApp in several mHealth applications. Recent important studies are highlighting, for example, the wide-range opportunities of WhatsApp as an adjunctive tool in mHealth in medical imaging or in specific applications such as in oral medicine in orthopedics and tele-education. In this contribution we share our alignment with these scholars and presents our polarities of research in the use of WhatsApp. These polarities range from the institutional surveillance of the spontaneous phenomena of WhatsApp groups in the families for the monitoring of the fragile patient up to the test of use of WhatsApp in digital-pathology and digital-radiology static imaging and recently in cardiologic dynamic imaging.
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Affiliation(s)
- Daniele Giansanti
- Technology and Health Department, National Institute of Health, Rome, Italy
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28
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Peracca SB, Jackson GL, Weinstock MA, Oh DH. Implementation of Teledermatology: Theory and Practice. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
There is an almost innate urge in human beings to represent reality in a visual form. From rock art in the Paleolithic to images of galaxies, the quotidian and the extraordinary have been visually represented through the ages. Medical and scientific disciplines are no exception. Accurate representation of the human body structures and anatomy based on cadaver dissections was almost not possible up to the Renaissance due to ethical, social, and religious beliefs and objections. The works of Leonardo da Vinci (1452-1519) and others and, later, Andreas Vesalius (1514-1564), who produced De Humanis Corporis Fabrica, are considered landmarks in the history of medicine. During the following centuries medical and scientific illustration relied upon the expertise of physician-artists and scientist-artists until a new paradigm appeared in the realm of scientific (medical) illustration: the invention of photography in the 19th century. Two of the medical disciplines most rapidly influenced by photography were dermatology and pathology, both macro- and microscopic. Physicians rapidly started to use photographs as a tool for consultation, documentation, and education, and large collections of images were amassed by individuals and institutions for these purposes. Photographic images are produced by visible light impressing a light-sensitive material such as a silver halide plate, and nowadays a silicon chip. But photons are reflected by nontransparent objects, including the human skin. Developments in science and technology allowed the use of other types of radiation to reveal internal structures in the human body and, most interestingly, noninvasively. Thus today much of the medical diagnosis and treatment is guided by the so-called medical imaging with the use of these techniques, that is, medical photography, endoscopy, x-ray radiography, computer-aided tomography, magnetic resonance imaging, ultrasonography, thermography, and nuclear medicine functional imaging techniques as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some of these techniques are being applied at the microscopic level to study cell structure and even functional changes in real time. All these advancements in science and technology applied to medicine and other disciplines pose the question as to what extent physicians are trading their capabilities as clinicians. Ethics issues add to the complexity of this new era governed by constant changes in scientific paradigms.
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Affiliation(s)
- Fabian Michelangeli
- Biophysics and Biochemistry, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
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30
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Hogan SC, van Hees C, Asiedu KB, Fuller LC. WhatsApp platforms in tropical public health resource-poor settings. Int J Dermatol 2018; 58:228-230. [DOI: 10.1111/ijd.14237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/26/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah C. Hogan
- Dermatology Department; The Royal London Hospital; Barts Health NHS Trust; Whitechapel London England
| | - Colette van Hees
- Consultant Dermatologist; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Kingsley B. Asiedu
- Public Health Specialist and Medical Officer; World Health Organisation; Geneva Switzerland
| | - L. Claire Fuller
- Consultant Dermatologist; Chelsea and Westminster Hospital; London England
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Williams V, Kovarik C. Long-Range Diagnosis of and Support for Skin Conditions in Field Settings. Trop Med Infect Dis 2018; 3:E84. [PMID: 30274480 PMCID: PMC6160944 DOI: 10.3390/tropicalmed3030084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs.
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Affiliation(s)
- Victoria Williams
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Carrie Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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