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Rometsch C, Festl-Wietek T, Bäuerle A, Schweda A, Skoda EM, Schäffeler N, Stengel A, Zipfel S, Teufel M, Herrmann-Werner A. Anxiety and Somatoform Syndromes Predict Transplant-Focused Internet Use in the Course of an Organ Transplantation. Telemed J E Health 2024; 30:e1172-e1179. [PMID: 37902962 DOI: 10.1089/tmj.2023.0137] [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] [Indexed: 11/01/2023] Open
Abstract
Background: e-Health interventions are increasing in the field of organ transplantations; however, the literature lacks evidence regarding needs, attitudes, and preferences of organ recipients and donors during the course of an organ transplantation. Methods: In a cross-sectional study, 70 subjects were assessed using self-rated and validated questionnaires, such as the PRIME MD Patient Health Questionnaire (PHQ-D) and the Essen Resource Inventory (ERI). Group differences and a multiple linear regression were also applied. Results: Organ recipients had significantly higher scores for depression (U = 245.00, z = -2.65, p = 0.008, Cohen's d = 0.32), somatoform (U = 224.50, z = -2.99, p = 0.003, Cohen's d = 0.37), and stress syndromes (U = 266.00, z = -2.25, p = 0.008, Cohen's d = 0.27). They also named the internet and apps as resources to find information regarding organ transplants (U = 177.50, z = -2.07, p = 0.017, Cohen's d = 0.28; Z = -2.308, p = 0.021) and preferred to use apps to monitor the physical condition (Z = -2.12, p = 0.034) significantly more than organ donors. Anxiety and somatoform syndromes were significant predictors to search for information regarding the transplant process (F[6,38] = 3.98, p < 0.001; R2 = 0.386). Conclusions: e-Health interventions are promising in accompanying the course of an organ transplant for patients to be informed and educated. Predominantly, potential organ recipients might benefit from apps to record physical parameters. However, anxiety syndromes might hinder patients from searching for information about the transplant process, while somatoform syndromes might enable patients who are searching for such information.
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Affiliation(s)
- Caroline Rometsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Teresa Festl-Wietek
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Eva Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Anne Herrmann-Werner
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
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2
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Burghall A, Ruhl M, Rosaasen N, Groot B, Flood K, Davis K, Minakakis N, Wichart J, Mansell H. A scoping review of pediatric transplant education. Pediatr Transplant 2023; 27:e14578. [PMID: 37528694 DOI: 10.1111/petr.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Education is crucial for pediatric patients and caregivers throughout the transplant continuum, yet data are lacking around which interventions are effective and in what circumstances. METHODS We undertook a scoping review with the objectives of (a) describing the types, effects, and outcomes of patient-focused educational interventions before and after pediatric transplant and (b) understanding the educational experiences of patients and caregivers. Five scientific databases were explored for relevant literature using the JBI methodology. Educational interventions published in English, targeting pediatric solid organ transplant patients (0-25 years) and their caregivers were included. Relevant data from eligible articles (n = 27) were extracted and summarized. RESULTS Eighteen articles describing 17 educational interventions were identified for objective A, and nine articles qualitatively assessing patient or parental learning needs were identified for objective B. Most interventions were directed toward teenage patients and their caregivers post kidney transplant, primarily focusing on medication self-management and adherence, or providing general information on transplant using multicomponent delivery formats. Most interventions achieved statistically significant improvements in knowledge (n = 8/9) and patients or caregivers expressed satisfaction with the intervention (n = 7/7) but health-related outcomes such as medication adherence (n = 2/6) or behavior change (n = 1/3) rarely achieved statistically significant results. In objective B, patients and caregivers described the transplant process as overwhelming, but indicated that social supports and education helped them cope. Participants consistently wanted more information than they received. CONCLUSION Caregivers and pediatric patients value transplant education, but high-quality studies are limited. Since education is a fundamental part of the transplant process, future research in this area should be prioritized.
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Affiliation(s)
- Ashley Burghall
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michelle Ruhl
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
| | - Brianna Groot
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kayla Flood
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Keefe Davis
- Division of Pediatric Nephrology, Department of Pediatrics, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jenny Wichart
- Canadian Donation and Transplantation Research Program, Canada
- Department of Pharmacy, Alberta Health Services, Edmonton, Alberta, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Donation and Transplantation Research Program, Canada
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3
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Steinberg Christofferson E, Ruzicka EB, Bolt M, Lyons E, Wachs M, Buchanan CL, Schmiege SJ, Monnin K. Understanding disparities and barriers associated with pediatric transplant evaluation and time to listing: Moving toward a more comprehensive picture. Pediatr Transplant 2022; 26:e14182. [PMID: 34738706 DOI: 10.1111/petr.14182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/25/2021] [Accepted: 10/14/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Delayed time to listing (TTL) for pediatric transplant patients is associated with increased risks of mortality and morbidity. The full range of health disparities, sociodemographic factors, and other barriers associated with delays in listing in the pediatric transplant candidate evaluation process has not been fully examined. METHODS Retrospective chart reviews were conducted for 183 kidney, liver, and heart transplant candidates ages 0-18 who were referred for evaluation during 2012-2015. Demographic information and potential barriers (e g., social/medical factors, financial concerns) were gathered from pre-transplant evaluations and included in a comprehensive model to evaluate mechanisms that explain differences in TTL. Descriptive statistics, logistic regression models, Cox proportional hazards models, and path analysis were used for analyses. RESULTS Candidates included 26.8% heart, 33.3% liver, and 39.9% kidney patients. The most common barrier to listing was financial (71.6%), followed by caregiver psychological or substance use (57.9%), and medical problems (49.7%). Higher age, kidney, and liver organ type (relative to the heart), and presence of social, medical, administrative/motivation, and financial barriers were all directly associated with longer TTL. Public insurance was indirectly associated with TTL through social, administrative/motivation, and financial barriers. Organ type was indirectly associated with TTL through financial barriers. CONCLUSIONS Results suggest social problems, administrative issues, and financial issues act as mechanisms through which insurance type and liver transplant candidates face increased risk of delays in transplant listing time. There are numerous clinical implications and interventions that are warranted to reduce TTL among pediatric transplant candidates with co-occurring barriers.
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Affiliation(s)
- Elizabeth Steinberg Christofferson
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Elizabeth B Ruzicka
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Matthew Bolt
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emma Lyons
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Michael Wachs
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kara Monnin
- Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio, USA
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4
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Campagna BR, Tutino R, Stevanovic K, Flood J, Halevi G, Shemesh E, Annunziato RA. Acceleration of mobile health for monitoring post-transplant in the COVID-19 era: Applications for pediatric settings. Pediatr Transplant 2022; 26:e14152. [PMID: 34661316 PMCID: PMC8646582 DOI: 10.1111/petr.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Since the start of the COVID-19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone-based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in-person care. METHODS The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo® and PubMed® . RESULTS We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long-term use. CONCLUSIONS The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi-center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer-term follow-up before telehealth interventions should be fully embraced.
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Affiliation(s)
- Bianca R. Campagna
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rebecca Tutino
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Julia Flood
- Department of PsychologyFordham UniversityBronxNew YorkUSA
| | - Gali Halevi
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eyal Shemesh
- Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rachel A. Annunziato
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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5
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Dolcini MM, Canchola JA, Catania JA, Song Mayeda MM, Dietz EL, Cotto-Negrón C, Narayanan V. National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey. J Med Internet Res 2021; 23:e27723. [PMID: 34636728 PMCID: PMC8548978 DOI: 10.2196/27723] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/18/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.
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Affiliation(s)
- M Margaret Dolcini
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | | | - Joseph A Catania
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Marissa M Song Mayeda
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Erin L Dietz
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Coral Cotto-Negrón
- Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
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6
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Pruette CS, Amaral S. Empowering patients to adhere to their treatment regimens: A multifaceted approach. Pediatr Transplant 2021; 25:e13849. [PMID: 33073474 DOI: 10.1111/petr.13849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
It is well-recognized that adolescence and early adulthood are a high-risk period for non-adherence with treatment regimens in solid organ transplant recipients, leading to high rates of rejection and graft loss (Transplantation, 92, 2011, 1237; Pediatr Transplant, 9, 2005, 381; Transplantation, 77, 2004, 769). Preventing medication non-adherence is the holy grail of transplant adolescent care. If we can determine how best to support our patients in taking their daily medications as prescribed, we can improve long-term health, reduce need for re-transplantation, and reduce healthcare costs. In the last few years, several studies have provided us with additional insights into potentially effective interventions and have highlighted existing gaps in knowledge. This article reviews recent literature published over the last 5 years on the topic of adherence in transplant recipients, highlighting insights and opportunities to promote adherence at the individual patient level, family level, healthcare system level, and community level. Above all, the recent work that is highlighted suggests that adherence interventions for prevention and treatment must be multifaceted, individualized, and longitudinal to be effective.
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Affiliation(s)
| | - Sandra Amaral
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
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7
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Mace RA, Doorley JD, Popok PJ, Vranceanu AM. Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study. JMIR Res Protoc 2021; 10:e25351. [PMID: 33208301 PMCID: PMC7813630 DOI: 10.2196/25351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic pain (CP) and cognitive decline (CD) are costly, challenging to treat, prevalent among older adults, and worsen each other over time. We are iteratively developing Active Brains-Fitbit (AB-F), a live video program for older adults with CP and CD that teaches mind-body skills and gradual increases in step count. AB-F has demonstrated feasibility; acceptability; and signs of improvement in emotional, physical, and cognitive functions when delivered in person to older adults. OBJECTIVE We are conducting a feasibility randomized controlled trial (RCT) of AB-F versus a time- and dose-matched educational control (health enhancement program [HEP]) in older adults with CP and CD. Here, we describe virtual adaptions to our study protocol, manualized treatments, evaluation plan, and study design in response to feedback from former participants and COVID-19. We will evaluate the feasibility benchmarks and the potential of AB-F to improve physical, emotional, and cognitive functions. METHODS This is a single-blind pilot RCT. Participants are randomized to AB-F or HEP. Patients are recruited through pain clinic referrals, institutional registries, and flyers. Interested participants are screened for eligibility via telephone and provide electronic informed consent. After randomization, participants are mailed all study documents, including their treatment manual, an ActiGraph accelerometer, and a Fitbit (separate envelope for AB-F only). Both conditions are manualized and delivered over 8 weekly sessions via Zoom. Participants complete self-report and performance-based (6-min walk test and Montreal Cognitive Assessment) outcome measures via Zoom at baseline and post intervention. Primary outcomes are a priori set feasibility (recruitment, quantitative measures, and adherence), acceptability, credibility, expectancy, and satisfaction benchmarks. Secondary outcomes are physical, cognitive, and emotional functions as well as intervention targets (social function, pain intensity, pain-specific coping, and mindfulness). RESULTS The trial is ongoing. We have recruited 21 participants (10 AB-F and 11 HEP) across 2 rounds. Only 2 participants have withdrawn (1 before baseline and 1 before the first session). All 19 remaining participants have completed the baseline assessment. In the first round, attendance is high (11 out of 12 participants completed all 4 sessions so far), and AB-F participants are adherent to their Fitbit and step goals (5 out of 6 participants). CONCLUSIONS Preliminary findings are promising for the feasibility of our completely virtual AB-F intervention. However, these findings need to be confirmed at the trial conclusion. This study will answer important questions about the feasibility of delivering a completely virtual mind-body activity program to older adults with comorbid CP and CD, which, to our knowledge, is unprecedented. Details on integrating multiple digital platforms for virtual assessments and intervention delivery will inform treatment development for older adults and those with comorbid CP and CD, which is crucial during the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov NCT04044183; https://clinicaltrials.gov/ct2/show/NCT04044183. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25351.
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Affiliation(s)
- Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - James D Doorley
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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8
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Duettmann W, Naik MG, Zukunft B, Osmonodja B, Bachmann F, Choi M, Roller R, Mayrdorfer M, Halleck F, Schmidt D, Budde K. eHealth in transplantation. Transpl Int 2020; 34:16-26. [DOI: 10.1111/tri.13778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/17/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Wiebke Duettmann
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marcel G. Naik
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Bianca Zukunft
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Bilgin Osmonodja
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Friederike Bachmann
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Roland Roller
- German Research Center for Artificial Intelligence Berlin Germany
| | - Manuel Mayrdorfer
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Danilo Schmidt
- Business Division IT Department of Research and Teaching Charité—Universitätsmedizin Berlin Berlin Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
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9
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Badawy SM, Radovic A. Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research. JMIR Pediatr Parent 2020; 3:e20049. [PMID: 32540841 PMCID: PMC7318926 DOI: 10.2196/20049] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ana Radovic
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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10
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Campagna BR, Weatherley K, Shemesh E, Annunziato RA. Adherence to Medication During Transition to Adult Services. Paediatr Drugs 2020; 22:501-509. [PMID: 32889685 PMCID: PMC7474320 DOI: 10.1007/s40272-020-00414-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The transition from childhood and adolescence to adulthood is often tumultuous. For individuals with a chronic medical condition, this progression also includes a gradual transition to independence in healthcare management as well as a transfer in care location at some set point. As adolescents navigate these sometimes challenging processes, there is a significant risk for a decline in adequate health behaviors, which can have dire consequences. One of the most vital components of the transfer to adult care is medication adherence. Poor medication adherence puts patients at risk for worse outcomes, with the most profound being increased mortality for many conditions. In recent years, acknowledgment of the need to create evidence-based methods to aid patients during the transition period has been growing. This paper seeks to provide an overview of current research and recommendations for interventions to increase adherence to medication regimens during this period.
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Affiliation(s)
- Bianca R. Campagna
- grid.256023.0000000008755302XDepartment of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458 USA ,grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children’s Hospital, New York, NY USA
| | - Kristen Weatherley
- grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children’s Hospital, New York, NY USA
| | - Eyal Shemesh
- grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children’s Hospital, New York, NY USA
| | - Rachel A. Annunziato
- grid.256023.0000000008755302XDepartment of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458 USA ,grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children’s Hospital, New York, NY USA
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