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Mara T, Barbara T, Lucia P, Giulia S, Cristina T, Greco P, Stefano S. Exploring the impact of integrating telehealth in obstetric care: A scoping review. Eur J Obstet Gynecol Reprod Biol 2024; 302:242-248. [PMID: 39332087 DOI: 10.1016/j.ejogrb.2024.09.031] [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: 08/17/2024] [Revised: 09/14/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND The use of telemedicine has spread to all areas of medicine, including obstetrics, over the last few decades. OBJECTIVE To identify and map the diversity and applicability of telemedicine in the obstetric literature, in the antenatal, intrapartum or postnatal period. To assess patient satisfaction and possible areas for future development. METHODS This scoping review was conducted following the Joanna Briggs Institute (JBI) methodological guidelines for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and its extension for scoping reviews (PRISMA-ScR). We searched the databases PubMed (Medline), CINAHL, CENTRAL (Cochrane Library), EMBASE Ovid and Scopus. We also searched Google Scholar, clinicaltrial.gov, the WHO International Clinical Trials Registry Platform (ICTRP-WHO) and the reference lists of the included studies. We included any primary study design that focused on a population of women in the antenatal, intrapartum or postnatal period. Studies selection and data extraction were performed blindly and independently by two authors. We summarised the results narratively and used graphs and tables to present key concepts thematically. RESULTS We included 66 studies. We categorised the studies according to population, type of intervention, outcomes and user satisfaction. Most of the studies involved pathological (36%) and physiological (30%) pregnancy management, the type of intervention was mainly divided into televisits or video calls with professionals (43%) and the use of specific apps or devices (40%). The maternal outcomes studied were mainly quantitative, i.e., improvement in blood chemistry tests or vital parameters (65%) and treatment adherence (frequency of follow-up visits or keeping appointments, 27%). Patient satisfaction was positive in the majority of cases. CONCLUSIONS There is still little international agreement on the concept and possible applications of telemedicine in obstetrics, although it is increasingly being used in clinical practice. Studies have shown positive results in terms of improved care, particularly in terms of treatment adherence and as an alternative strategy in the management of pregnancy, postpartum and abortion care. Both patients and health professionals were satisfied with it, especially when offered as a complement or alternative to the traditional method of face-to-face visits. Future developments seem to be the time and cost-saving potential of telemedicine and its application to couples' infertility.
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Affiliation(s)
- Tormen Mara
- Maternal and Child Department, Unit of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy; Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44124 Ferrara, Italy.
| | - Toniolo Barbara
- Maternal and Child Department, Unit of Obstetrics and Gynecology, Pietro Cosma Hospital - Ulss 6 Euganea, Camposampiero, Padova, Italy
| | - Pecci Lucia
- Maternal and Child Department, Unit of Obsterics and Gynecology San Daniele del Friuli, "ASUFC", Udine, Italy
| | - Soraci Giulia
- Maternal and Child Department, Unit of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy
| | - Taliento Cristina
- Maternal and Child Department, Unit of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy; Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44124 Ferrara, Italy; Maternal and Child Department, Unit of Obstetrics and Gynecology, Pietro Cosma Hospital - Ulss 6 Euganea, Camposampiero, Padova, Italy; Maternal and Child Department, Unit of Obsterics and Gynecology San Daniele del Friuli, "ASUFC", Udine, Italy; Department of Development and Regeneration - Woman and Child, KU Leuven, Leuven, Belgium
| | - Pantaleo Greco
- Maternal and Child Department, Unit of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy; Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44124 Ferrara, Italy
| | - Salvioli Stefano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa - Campus of Savona, Italy
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Robinson JL, Gatford KL, Clifton VL, Morrison JL, Stark MJ. The impact of maternal asthma on the fetal lung: Outcomes, mechanisms and interventions. Paediatr Respir Rev 2024; 51:38-45. [PMID: 38195368 DOI: 10.1016/j.prrv.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Maternal asthma affects up to 17% of pregnancies and is associated with adverse infant, childhood, and adult respiratory outcomes, including increased risks of neonatal respiratory distress syndrome, childhood wheeze and asthma. In addition to genetics, these poor outcomes are likely due to the mediating influence of maternal asthma on the in-utero environment, altering fetal lung and immune development and predisposing the offspring to later lung disease. Maternal asthma may impair glucocorticoid signalling in the fetus, a process critical for lung maturation, and increase fetal exposure to proinflammatory cytokines. Therefore, interventions to control maternal asthma, increase glucocorticoid signalling in the fetal lung, or Vitamin A, C, and D supplementation to improve alveologenesis and surfactant production may be beneficial for later lung function. This review highlights potential mechanisms underlying maternal asthma and offspring respiratory morbidities and describes how pregnancy interventions can promote optimal fetal lung development in babies of asthmatic mothers.
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Affiliation(s)
- Joshua L Robinson
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
| | - Kathryn L Gatford
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Michael J Stark
- Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Department of Neonatal Medicine, Women's & Children's Hospital, Adelaide, Australia.
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Anderson WC, Baptist AP, Eakin MN, Federman A, Murphy VE. Adherence Challenges and Strategies in Specific Groups With Asthma: Adolescents, Pregnancy, Older Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00819-5. [PMID: 39122111 DOI: 10.1016/j.jaip.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/17/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
Poor adherence to controller therapies is a universal challenge to asthma control. Several high-risk groups, including adolescents, pregnant women, and older adults, have their own unique challenges to adherence. The rates of asthma controller therapy use are low in each of these populations, but secondary to different causes. Adolescents have increased independence and a transition to new self-management responsibilities; pregnant women may be concerned about adverse effects of medications to the fetus; and older adults may have age-related physical and cognitive challenges to effectively taking medication. Only by understanding the nuances of care in these populations can health care professionals develop strategies to address barriers to adherence. Tailored education focused on empowering patients and dispelling misconceptions can serve as tools to improve adherence and ultimately asthma control.
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Affiliation(s)
- William C Anderson
- Allergy and Immunology Section, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, Henry Ford Health + Michigan State University, Detroit, Mich
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Md
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Sanchez-Ramirez DC, Pol M, Loewen H, Choukou MA. Effect of telemonitoring and telerehabilitation on physical activity, exercise capacity, health-related quality of life and healthcare use in patients with chronic lung diseases or COVID-19: A scoping review. J Telemed Telecare 2024; 30:1097-1115. [PMID: 36045633 PMCID: PMC9434200 DOI: 10.1177/1357633x221122124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Telemonitoring and telerehabilitation can support home-based pulmonary rehabilitation (PR) and benefit patients with lung diseases or COVID-19. This study aimed to (1) identify which telemonitoring and telerehabilitation interventions (e.g. videoconferencing) are used to provide telehealth care for people with chronic respiratory conditions or COVID-19, and (2) provide an overview of the effects of telemonitoring and telerehabilitation on exercise capacity, physical activity, health-related QoL (HRQoL), and healthcare use in patients with lung diseases or COVID-19. METHODS A search was performed in the electronic databases of Ovid MEDLINE, EMBASE, and Cinahl through 15 June 2021. Subject heading and keywords were used to reflect the concepts of telemonitoring, telerehabilitation, chronic lung diseases, and COVID-19. Studies that explored the effect of a telerehabilitation and/or telemonitoring intervention, in patients with a chronic lung disease such as asthma, chronic obstructive pulmonary diseases (COPD), or COVID-19, and reported the effect of the intervention in one or more of our outcomes of interest were included. Excluding criteria included evaluation of new technological components, teleconsultation or one-time patient assessment. RESULTS This scoping review included 44 publications reporting the effect of telemonitoring (25 studies), telerehabilitation (8 studies) or both (11 studies) on patients with COPD (35 studies), asthma (5 studies), COPD and asthma (1 study), and COVID-19 (2 studies). Patients who received telemonitoring and/or telerehabilitation had improvements in exercise capacity in 9 out of 11 (82%) articles, better HRQoL in 21 out of 25 (84%), and fewer health care use in 3 out of 3 (100%) articles compared to pre-intervention. Compared to controls, no statistically significant differences were found in the intervention groups' exercise capacity in 5 out 6 (83%) articles, physical activity in 3 out of 3 (100%) articles, HRQoL in 21 out of 25 (84%) articles, and healthcare use in 15 out of 20 (75%) articles. The main limitation of the study was the high variability between the characteristics of the studies, such as the number and age of the patients, the outcome measures, the duration of the intervention, the technological components involved, and the additional elements included in the interventions that may influence the generalization of the results. CONCLUSION Telemonitoring and telerehabilitation interventions had a positive effect on patient outcomes and appeared to be as effective as standard care. Therefore, they are promising alternatives to support remote home-based rehabilitation in patients with chronic lung diseases or COVID-19.
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Affiliation(s)
- Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Margriet Pol
- Department of Occupational Therapy, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, The Netherlands
| | - Hal Loewen
- Neil John Maclean Health Sciences Library, University of Manitoba, Canada
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, Rady Faculty of Health Science, University of Manitoba, Canada
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Bendien SA, de Kruif MD, Feitsma H, van Hoolwerff-Blikkendaal C, Huurne KKT, Kuiterman A, Baranova EV, Wittkamp A, Brons A, Poulissen M, van der Meer AN. Summary of the Dutch Multidisciplinary Practice Guideline on Asthma and Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1751-1762. [PMID: 38513758 DOI: 10.1016/j.jaip.2024.03.025] [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: 01/25/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
Asthma is the most common chronic respiratory disease in women of childbearing age and during pregnancy. This paper presents a summary of the Dutch multidisciplinary guideline on asthma and pregnancy. The aim of this guideline is to provide structured, where possible, evidence-based recommendations to optimize the management of asthma during pregnancy. The main topics covered in this guideline are preconception counseling, the safety of asthma medications during pregnancy and breastfeeding and risk assessment and monitoring of asthma during pregnancy. Because many caregivers are involved and a uniform approach is desirable, this guideline has been developed in collaboration with all relevant health care providers and patient representatives.
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Affiliation(s)
- Sarah A Bendien
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
| | | | - Hanneke Feitsma
- Department of Gynaecology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Cathelijn van Hoolwerff-Blikkendaal
- Nederlands huisartsen genootschap (NHG), Utrecht, The Netherlands; Dutch Association of General Practitioners and COPD & Astma Huisartsen Advies Groep (CAHAG), Utrecht, The Netherlands; Dutch COPD & Asthma Advisory Board for Practitioners, Utrecht, The Netherlands
| | | | | | - Ekaterina V Baranova
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arjan Wittkamp
- Department of Respiratory Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Annette Brons
- Lung Foundation Netherlands, Amersfoort, The Netherlands
| | - Marjo Poulissen
- Lung Foundation Netherlands, Amersfoort, The Netherlands, and Patient Organization astma Vereniging Nederland en Davos (VND), Reeuwijk, The Netherlands
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Kurnaz D, Şenoğlu A, Karaçam Z. The impact of antenatal telehealth services on maternal and neonatal outcomes, a comparison of results before and during the COVID-19 pandemic: A systematic review and meta-analysis (The impact of telehealth services on maternal and neonatal outcomes). Midwifery 2024; 134:104017. [PMID: 38714075 DOI: 10.1016/j.midw.2024.104017] [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: 12/16/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE This review was conducted to examine the effectiveness of antenatal follow-up using telehealth in the pre-COVID-19 and active pandemic periods. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Searches were conducted from inception to September 2023 through PubMed, the Cochrane Library, EBSCO, Embase, Web of Science, all via Ovid SP, the National Thesis Center, TR Index, Turkiye Clinics, and DergiPark Academic. Data were combined in the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS The meta-analysis examining the effectiveness of antenatal telehealth services included 35 studies with a total sample size of 16 033. The combined results of the studies revealed that antenatal telehealth services were similar to face-to-face follow-ups for many maternal and newborn health outcomes. Maternal outcomes included abortion, preterm delivery, gestational diabetes, weight gain, hypertensive disorders, maternal hospitalization, number of antenatal follow-ups, use of induction, vaginal and instrumental delivery, planned and emergency cesarean section, shoulder dystocia, episiotomy, perineal laceration, childbirth under the supervision of qualified personnel, breastfeeding problems and postpartum depression. Neonatal outcomes included an APGAR score of <7, neonatal hypoglycemia, hyperbilirubinemia, admission into the neonatal intensive care unit, respiratory distress syndrome, neonatal death, birth weight, low birth weight and macrosomia. However, statistically significant reductions in excessive weight gain (p<0.001) and a 1.23-fold increase in vaccination administration (p=0.001) were observed with telehealth services. Additionally, the effects of telehealth services on preterm and cesarean delivery rates were similar in the pre-pandemic and pandemic periods. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH This review reveals that while antenatal telehealth services are comparable to face-to-face care in terms of multiple pregnancy, delivery, and neonatal outcomes, they contribute to improvements in preventing extreme weight gain and vaccination hesitancy. These findings suggest that the telehealth method can be used as an alternative to face-to-face monitoring in antenatal follow-ups.
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Affiliation(s)
- Döndü Kurnaz
- Assist. Prof. Dr. Döndü Kurnaz, PhD, Marmara University Faculty of Health Sciences Midwifery Department, Istanbul, Turkey.
| | - Ayşe Şenoğlu
- PhD., Ministry of Health Adana Provincial Directorate of Health Emergency Health Services, Adana,Turkey.
| | - Zekiye Karaçam
- Prof. Dr., Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
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Güneş Öztürk G, Akyıldız D, Karaçam Z. The impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancy: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:607-630. [PMID: 35570738 DOI: 10.1177/1357633x221087867] [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: 11/16/2022]
Abstract
INTRODUCTION Telehealth is an applicable, acceptable, cost-effective, easily accessible, and speedy method for pregnant women. This study aimed to examine the impact of telehealth applications on pregnancy outcomes and costs in high-risk pregnancies. METHODS Studies were selected from PubMed, Science Direct, Web of Science, EBSCO, Scopus, and Clinical Key databases according to the inclusion and exclusion criteria from January to February 2021. Cochrane risk-of-bias tools were used in the quality assessment of the studies. RESULTS Four observational and eight randomized controlled studies were included in this meta-analysis (telehealth: 135,875, control: 94,275). It was seen that the number of ultrasound (p < 0.01) and face-to-face visits (p < 0.01), fasting insulin (p < 0.01), hemoglobin A1C before delivery (p < 0.01), and emergency cesarean section rates (p = 0.05) were lower in the telehealth group. In the telehealth group, the women's use of antenatal corticosteroids (p = 0.03) and hypoglycemic medication at delivery (p = 0.03), the total of nursing interventions (p < 0.01), compliance with actual blood glucose measurements (p < 0.01), induction intervention at delivery (p = 0.003), and maternal mortality (p < 0.001) rates were higher. Two groups were similar in terms of the use of medical therapy, total gestational weight gain, health problems related to pregnancy, mode and complications of delivery, maternal intensive care unit admission, fetal-neonatal growth and development, neonatal health problems and mortality, follow-up, and care costs. DISCUSSION Telehealth and routine care yielded similar maternal/neonatal health and cost outcomes. It can be said that telehealth is a safe technique to work with in the management of high-risk pregnancies.
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Affiliation(s)
- Gizem Güneş Öztürk
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
| | - Deniz Akyıldız
- Division of Midwifery, Faculty of Health Science, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Zekiye Karaçam
- Division of Midwifery, Faculty of Health Science, Aydın Adnan Menderes University, Aydın, Turkey
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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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Collins E, Keedle H, Jackson M, Lequertier B, Schmied V, Boyle J, Kildea S, Dahlen HG. Telehealth use in maternity care during a pandemic: A lot of bad, some good and possibility. Women Birth 2024; 37:419-427. [PMID: 38218652 DOI: 10.1016/j.wombi.2023.12.008] [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: 08/05/2023] [Revised: 11/18/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND To reduce transmission risk during the COVID-19 pandemic, 'telehealth' (health care delivered via telephone/video-conferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives' perspectives regarding telehealth use. METHODS A qualitative study was conducted in Australia during 2020-2021 using two data sources from the Birth in the Time of COVID-19 (BITTOC) study: i) interviews and ii) surveys (open-text responses). Content analysis was utilised to analyse the data and explore telehealth from the perspective of midwives and women accessing maternity care services. In-depth interviews were conducted with 20 women and 16 midwives. Survey responses were provided from 687 midwives and 2525 women who were pregnant or gave birth in 2021, generating 212 and 812 comments respectively. FINDINGS Telehealth delivery was variable nationally and undertaken primarily by telephone/videoconferencing. Perceived benefits included: reduced COVID-19 transmission risk, increased flexibility, convenience and cost efficiency. However, women described inadequate assessment, and negative impacts on communication and rapport development. Midwives had similar concerns and also reported technological challenges. CONCLUSION During the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services, but is not a suitable replacement to traditional face-to-face maternity care.
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Affiliation(s)
- Emma Collins
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Melanie Jackson
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Level 11, East Tower, 410 Ann Street, Brisbane, Qld 4000, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia
| | - Jacqueline Boyle
- Monash Centre of Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751 NSW Australia.
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Farzandipour M, Heidarzadeh Arani M, Sharif R, Nabovati E, Akbari H, Anvari S. Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial. Respir Med 2024; 223:107539. [PMID: 38325663 DOI: 10.1016/j.rmed.2024.107539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life. METHODS Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements. RESULTS Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001). CONCLUSION This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Heidarzadeh Arani
- Pediatric Department, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Asthma and Allergy Clinic, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran.
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Biostatistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
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Cabrerizo-Carreño H, Muñoz-Esquerre M, Santos Pérez S, Romero-Ortiz AM, Fabrellas N, Guix-Comellas EM. Impact of the implementation of a telemedicine program on patients diagnosed with asthma. BMC Pulm Med 2024; 24:32. [PMID: 38216971 PMCID: PMC10787462 DOI: 10.1186/s12890-024-02843-y] [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: 12/09/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Asthma is one of the most common respiratory ailments worldwide. Despite broad understanding of the illness and of the available therapeutic options for it, patients with serious asthma suffer poor monitoring of their illness in 50% of cases. AIM To assess the impact of the implementation of a mobile application (ESTOI) to control asthma in patients diagnosed with the illness, their adherence to treatment, and their perceived quality of life. METHODOLOGY Randomized clinical trial with 52 weeks' follow-up of patients with asthma seen in a specialized hospital for their treatment in Spain. Some 108 included patients will be divided into two groups. The intervention group will undergo more exhaustive follow-up than normal, including access to the ESTOI application, which will have various categories of attention: control of symptoms, health recommendations, current treatment and personalized action plan, PEF record, nutritional plan, and chat access with a medical team. The asthma control questionnaire ACT is the main assessment variable. Other variables to be studied include an adherence test for the use of inhalers (TAI), the number of exacerbations, maximum exhalation flow, exhaled nitric oxide test, hospital anxiety and depression scale, asthma quality-of-life questionnaire, forced spirometry parameters (FVC, FEV1, and PBD), and analytic parameters (eosinophilia and IGE). The data will be collected during outpatient visits. TRIAL REGISTRATION This trial has registered at ClinicalTrials.gov (Identifier: NCT06116292).
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Affiliation(s)
- Héctor Cabrerizo-Carreño
- Bellvitge University Hospital, Department of Pulmonary Medicine, L'Hospitalet de Llobregat, Catalunya, ES, Spain
- Department of Fundamental and Medico-Surgical Nursing, Nursing School, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, ES, Spain
- Pneumology Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, ES, Spain
| | - Mariana Muñoz-Esquerre
- Bellvitge University Hospital, Department of Pulmonary Medicine, L'Hospitalet de Llobregat, Catalunya, ES, Spain.
- Pneumology Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, ES, Spain.
- Facultat de Medicina i Ciències de la Salut, University of Barcelona, L'Hospitalet de Llobregat, Catalunya, ES, Spain.
| | - Salud Santos Pérez
- Bellvitge University Hospital, Department of Pulmonary Medicine, L'Hospitalet de Llobregat, Catalunya, ES, Spain
- Pneumology Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, ES, Spain
- Facultat de Medicina i Ciències de la Salut, University of Barcelona, L'Hospitalet de Llobregat, Catalunya, ES, Spain
| | - Ana Maria Romero-Ortiz
- Bellvitge University Hospital, Department of Pulmonary Medicine, L'Hospitalet de Llobregat, Catalunya, ES, Spain
| | - Núria Fabrellas
- Department of Public Health, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Catalunya, ES, Spain
- Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalunya, ES, Spain
| | - Eva Maria Guix-Comellas
- Department of Fundamental and Medico-Surgical Nursing, Nursing School, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, ES, Spain
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12
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Murphy VE, Gibson PG, Schatz M. Managing Asthma During Pregnancy and the Postpartum Period. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3585-3594. [PMID: 37482082 DOI: 10.1016/j.jaip.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Asthma is one of the most common chronic diseases in pregnancy and is associated with adverse perinatal outcomes. Asthma symptoms worsen in approximately 40% of women, and exacerbations requiring medical intervention occur in at least 20% of women. Factors associated with exacerbation and worsening asthma include multiparity, obesity, Black race, exacerbations before pregnancy, and poor asthma control. Exacerbations are associated with further increased risks for poor perinatal outcomes, including low birth weight, preterm birth, and small for gestational age (SGA) status, as well as an increase in the development of asthma in early childhood. Common medications used for asthma, including short-acting β-agonists and inhaled corticosteroids, are considered safe to use in pregnancy. Whereas guidelines generally suggest traditional step therapy for managing asthma in pregnancy, there are alternative models of care and management approaches that may be effective in pregnancy, but require more research. These include single-inhaler maintenance and reliever therapy, treatment adjustment with FeNO, treatable traits personalized medicine approaches, and telemedicine. Little is known about changes to asthma in the postpartum period. However, low adherence to medication and the potential effects of postpartum depression on asthma exacerbation risk warrant further research.
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Affiliation(s)
- Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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13
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Ugalde IC, Ratigan A, Merriman C, Cui J, Ericson B, Busse P, Carroll JK, Casale T, Celedón JC, Coyne-Beasley T, Fagan M, Fuhlbrigge AL, Villarreal GG, Hernandez PA, Jariwala S, Kruse J, Maher NE, Manning B, Mosnaim G, Nazario S, Pace WD, Phipatanakul W, Pinto-Plata V, Riley I, Rodriguez-Louis J, Salciccioli J, Shenoy K, Shields JB, Tarabichi Y, Sosa BT, Wechsler ME, Wisnivesky J, Yawn B, Israel E, Cardet JC. Preference for and impact of telehealth vs in-person asthma visits among Black and Latinx adults. Ann Allergy Asthma Immunol 2023; 131:614-627.e2. [PMID: 37490981 PMCID: PMC10803643 DOI: 10.1016/j.anai.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Black and Latinx adults experience disproportionate asthma-related morbidity and limited specialty care access. The severe acute respiratory syndrome coronavirus 2 pandemic expanded telehealth use. OBJECTIVE To evaluate visit type (telehealth [TH] vs in-person [IP]) preferences and the impact of visit type on asthma outcomes among Black and Latinx adults with moderate-to-severe asthma. METHODS For this PREPARE trial ancillary study, visit type preference was surveyed by e-mail or telephone post-trial. Emergency medical record data on visit types and asthma outcomes were available for a subset (March 2020 to April 2021). Characteristics associated with visit type preferences, and relationships between visit type and asthma outcomes (control [Asthma Control Test] and asthma-related quality of life [Asthma Symptom Utility Index]), were tested using multivariable regression. RESULTS A total of 866 participants consented to be surveyed, with 847 respondents. Among the participants with asthma care experience with both visit types, 42.0% preferred TH for regular checkups, which associated with employment (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.09-2.39; P = .02), lower asthma medication adherence (OR = 1.06; 95% CI, 1.01-1.11; P = .03), and having more historical emergency department and urgent care asthma visits (OR = 1.10 for each additional visit; 95% CI, 1.02-1.18; P = .02), after adjustment. Emergency medical record data were available for 98 participants (62 TH, 36 IP). Those with TH visits were more likely Latinx, from the Southwest, employed, using inhaled corticosteroid-only controller therapy, with lower body mass index, and lower self-reported asthma medication adherence vs those with IP visits only. Both groups had comparable Asthma Control Test (18.4 vs 18.9, P = .52) and Asthma Symptom Utility Index (0.79 vs 0.84, P = .16) scores after adjustment. CONCLUSION TH may be similarly efficacious as and often preferred over IP among Black and Latinx adults with moderate-to-severe asthma, especially for regular checkups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02995733.
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Affiliation(s)
- Israel C Ugalde
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | | | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Jing Cui
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paula Busse
- Division of Allergy & Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer K Carroll
- CU Anschutz Department of Family Medicine, University of Colorado, Aurora, Colorado; American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Maureen Fagan
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Paulina Arias Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sunit Jariwala
- Division of Allergy & Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jean Kruse
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy E Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Manning
- American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Giselle Mosnaim
- Division of Allergy & Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois
| | - Sylvette Nazario
- Division of Allergy and Immunology, Department of Internal Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Wilson D Pace
- DARTNet Institute, Aurora, Colorado; American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Pinto-Plata
- Division of Pulmonary Critical Care, Department of Medicine, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Isaretta Riley
- Division of Pulmonary, Allergy & Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Justin Salciccioli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Joel B Shields
- American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, Ohio
| | - Bonnie Telon Sosa
- Division of Allergy and Immunology, Department of Internal Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Michael E Wechsler
- Division of Pulmonology, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Juan Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida.
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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15
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Quach S, Michaelchuk W, Benoit A, Oliveira A, Packham TL, Goldstein R, Brooks D. Mobile heath applications for self-management in chronic lung disease: a systematic review. NETWORK MODELING AND ANALYSIS IN HEALTH INFORMATICS AND BIOINFORMATICS 2023; 12:25. [PMID: 37305790 PMCID: PMC10242585 DOI: 10.1007/s13721-023-00419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
Integration of mobile health (mHealth) applications (apps) into chronic lung disease management is becoming increasingly popular. MHealth apps may support adoption of self-management behaviors to assist people in symptoms control and quality of life enhancement. However, mHealth apps' designs, features, and content are inconsistently reported, making it difficult to determine which were the effective components. Therefore, this review aims to summarize the characteristics and features of published mHealth apps for chronic lung diseases. A structured search strategy across five databases (CINAHL, Medline, Embase, Scopus and Cochrane) was performed. Randomized controlled trials investigating interactive mHealth apps in adults with chronic lung disease were included. Screening and full-text reviews were completed by three reviewers using Research Screener and Covidence. Data extraction followed the mHealth Index and Navigation Database (MIND) Evaluation Framework (https://mindapps.org/), a tool designed to help clinicians determine the best mHealth apps to address patients' needs. Over 90,000 articles were screened, with 16 papers included. Fifteen distinct apps were identified, 8 for chronic obstructive pulmonary disease (53%) and 7 for asthma (46%) self-management. Different resources informed app design approaches, accompanied with varying qualities and features across studies. Common reported features included symptom tracking, medication reminders, education, and clinical support. There was insufficient information to answer MIND questions regarding security and privacy, and only five apps had additional publications to support their clinical foundation. Current studies reported designs and features of self-management apps differently. These app design variations create challenges in determining their effectiveness and suitability for chronic lung disease self-management. Registration: PROSPERO (CRD42021260205). Supplementary Information The online version contains supplementary material available at 10.1007/s13721-023-00419-0.
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Affiliation(s)
- Shirley Quach
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
| | - Wade Michaelchuk
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
- Rehabilitation Science Institute, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Adam Benoit
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
| | - Ana Oliveira
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
- Lab3R–Respiratory Research and Rehabilitation Laboratory, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Tara L. Packham
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - Roger Goldstein
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
- Rehabilitation Science Institute, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Respiratory Research, West Park Healthcare Center, Toronto, ON Canada
- Rehabilitation Science Institute, Faculty of Medicine, University of Toronto, Toronto, ON Canada
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16
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Eilayyan OJ, Arafah AM. Acceptance and Dropout Rates of Individuals with Asthma Approached in Self-management Interventions: A Systematic Review and Meta-analysis. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634221150970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Objective The objectives of this systematic review were to assess the acceptability of self-management interventions for people with asthma and identify contributing factors. Methods A systematic literature search was conducted using PubMed, MEDLINE, EMBASE (OVIDWEB), CINAHL and Cochrane databases. Clinical trials design was included if they met specified criteria. A random-effect meta-regression analysis was conducted to estimate the overall acceptance and drop-out rates and to assess the potential factors that may influence the outcomes. Results A total of 64 studies were included and 8,092 participants were recruited and participated in the trials. The estimated acceptance rate was 51.1%, while the estimated drop-out rates in the intervention and control groups were 18.2% and 15.6%, respectively. Lack of interest was the main reported reason for refusing to participate and dropping out from the program. Study-related and program-related factors influenced the acceptance and drop-out rates statistically and clinically. Conclusion The acceptance rate of self-management programs among asthmatic people was not high and the dropout rate was somewhat low. The review suggests optimizing the design of self-management studies and modifying the implemented self-management programs to increase the acceptance rate and decrease the dropout rate.
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Affiliation(s)
- Owis J. Eilayyan
- Physical Therapy Department, Faculty of Allied Medical Sciences, Aqaba University of Technology, Aqaba, Jordan
| | - Alaa M. Arafah
- Faculty of Medical Rehabilitation Sciences, Department of Occupational Therapy, King Abdulaziz University, Jeddah, Saudi Arabia
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17
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Fernandes BA, Alves B, Matosinhos AC, Calácio e Silva BL, Dias R, Hasparyk UG, Damásio J, Bastos FM, Simões e Silva AC. The use and role of telemedicine in maternal fetal medicine around the world: an up-to-date. HEALTH AND TECHNOLOGY 2023; 13:365-372. [PMID: 36846740 PMCID: PMC9942621 DOI: 10.1007/s12553-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Purpose The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM). Methods We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine. Results Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe. Conclusion Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.
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Affiliation(s)
- Bruna Achtschin Fernandes
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Bernardo Alves
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Ana Carolina Matosinhos
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Bárbara Linhares Calácio e Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Raphael Dias
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Ursula Gramiscelli Hasparyk
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Júlia Damásio
- Department of Gynecology and Obstetrics, Service of Fetal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG Brazil
| | - Fernando Macedo Bastos
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
- Department of Gynecology and Obstetrics, Service of Fetal Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG Brazil
| | - Ana Cristina Simões e Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
- Department of Pediatrcs, Faculty of Medicine, UFMG. Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, 30130-100 Belo Horizonte, MG Brazil
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Rivelli A, Fitzpatrick V, Shields M, Erwin K, Delfinado L, Cabiya M, Wennerberg K. The Benefits of Introducing a Pregnancy Support Tool for Low-Income Women During Routine Obstetrics Care. J Prim Care Community Health 2023; 14:21501319231164545. [PMID: 37057337 PMCID: PMC10108416 DOI: 10.1177/21501319231164545] [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: 02/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/15/2023] Open
Abstract
The objective of the CONTINUE (conversations in routine OB care) pilot study was to gather preliminary data on the benefits of integrating a well-designed pregnancy support tool ("CONTINUE Tool") in low-income prenatal care. A total of 184 tools were distributed by 21 OB providers during the study implementation period. Follow-up data were collected from 71 (38.5%) prenatal patients across three community-based midwestern OB clinics serving a diverse prenatal patient population. Early-gestation prenatal patients received the strategically designed CONTINUE Tool during routine prenatal care and later completed a semi-structured interview or electronic survey to report pre-determined individual benefit items experienced due to tool usage. Factor analysis used individual benefit items to identify factors representing common underlying benefits ("factor benefits"). Logistic regression analyses were performed to describe the relative odds of participants with low income (public insurance) experiencing individual and factor benefits of tool use compared to participants of higher income (private insurance). Chi square tests (or Fisher's exact tests) were performed to generate P values reflecting statistically significant differences by income group. More low-income prenatal participants reported experiencing individual benefits as compared to higher-income participants. Among factor benefits, low-income participants were statistically more likely to report experiencing a time-related logistics benefit (OR = 4.00; 95% CI 1.02-15.73; P = .045). Low-income participants reported experiencing an overall logistics factor benefit (OR = 4.29; 95% CI 0.47-38.75), including a cost-related logistics benefit (OR = 3.08; CI 0.59-16.00), as well as an understanding benefit (OR = 1.90; 95% CI 0.72-5.04) and a self-efficacy benefit (OR = 1.30; 95% CI 0.44-3.87). While this study is limited by sample size due to being a pilot study, the findings suggest there may be tangible benefits to introducing the CONTINUE Tool among low-income prenatal patients. Given the staggering inequity in OB care and subsequent health outcomes, any preliminary findings on ways to help combat this are necessary and should lay the groundwork for subsequent randomized trials. Our preliminary findings show that supplementing routine OB care with the CONTINUE Tool can confer benefits to both providers and patients, but particularly for low-income prenatal patients who tend to have more structural barriers to adequate care in the first place.
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Affiliation(s)
- Anne Rivelli
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Veronica Fitzpatrick
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Maureen Shields
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Kim Erwin
- Illinois Institute of Technology Institute of Design, Chicago, IL, USA
| | - Leah Delfinado
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Marie Cabiya
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Karen Wennerberg
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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de Rezende DRB, Neto IA, Iunes DH, Carvalho LC. Analysis of the effectiveness of remote intervention of patients affected by chronic diseases: A systematic review and meta-analysis. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231197316. [PMID: 37781504 PMCID: PMC10540568 DOI: 10.1177/27550834231197316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
Objectives The aim of the study was to verify the effectiveness of telemedicine in randomized controlled trials (RCTs) in terms of its influence on physical conditioning, quality of life, and health conditions in adults/elderly people affected by chronic diseases. Design This was a systematic review and meta-analysis. Methods The search covered RCTs published from 2011 to 2021 and was conducted using the PubMed, Embase, PEDro, Lilacs, and Cochrane Library databases, on volunteers of both sexes, that were rehabilitated, and/or monitored, and/or evaluated, specifically, via remote care. The extraction, quality of studies, and risk of bias were assessed using the RoB2 (risk of bias) tool, for analysis of the strength of evidence, the GRADE (Grading of Recommendations Assessment, Developing, and Evaluation) method was used, and for the preparation of meta-analysis was used at RevMan 5.4 (Review Manager) was used. Results The database search identified 3949 potential articles for screening, 13 of which were eligible for the present systematic review, involving 1469 participants with chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, heart failure, diabetes mellitus, and fibromyalgia). Through the meta-analysis, an advantage was identified for the remote intervention on physical conditioning (p = 0.001), with an estimated effect of 0.29 (0.11, 0.46) and on health conditions (p = 0.0004), -0.30 (-0.47, -0.14), while for quality of life, no significant difference was identified (p = 0.90), 0.01 (-0.13, 0.14). Conclusion Telemedicine has clinical effectiveness for the outcome of physical conditioning and general health conditions in adults with chronic diseases when compared to usual care without face-to-face intervention.
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Affiliation(s)
| | | | - Denise Hollanda Iunes
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Leonardo César Carvalho
- Department of Postgraduate Program in Applied Health Biosciences, Federal University of Alfenas, Alfenas, Brazil
- Physiotherapy Course at the Federal University of Alfenas, Alfenas, Brazil
- Department of Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, Brazil
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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20
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Belanger HG, Toyinbo P, Barrett B, King E, Sayer NA. Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans. Clin Neuropsychol 2022; 36:2093-2119. [PMID: 34184976 DOI: 10.1080/13854046.2021.1936188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.
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Affiliation(s)
- Heather G Belanger
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,United States Special Operations Command (USSOCOM), Tampa, FL, USA.,Department of Psychology and Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,St Michael's Inc, Tampa, FL, USA
| | - Peter Toyinbo
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Blake Barrett
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | - Nina A Sayer
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA
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21
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Cantor AG, Jungbauer RM, Totten AM, Tilden EL, Holmes R, Ahmed A, Wagner J, Hermesch AC, McDonagh MS. Telehealth Strategies for the Delivery of Maternal Health Care : A Rapid Review. Ann Intern Med 2022; 175:1285-1297. [PMID: 35878405 DOI: 10.7326/m22-0737] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes. PURPOSE To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map. DATA SOURCES Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022). STUDY SELECTION Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care. DATA EXTRACTION Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus. DATA SYNTHESIS 28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms. LIMITATIONS Interventions varied, and evidence was inadequate for some clinical outcomes. CONCLUSION Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347).
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Department of Family Medicine, and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.)
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Ellen L Tilden
- Department of Obstetrics and Gynecology and School of Nursing, Oregon Health & Science University, Portland, Oregon (E.L.T.)
| | - Rebecca Holmes
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
| | - Amy C Hermesch
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.C.H.)
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon (R.M.J., A.M.T., R.H., A.A., J.W., M.M.)
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22
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Dhippayom T, Wateemongkollert A, Mueangfa K, Im H, Dilokthornsakul P, Devine B. Comparative Efficacy of Strategies to Support Self-Management in Patients with Asthma: A Systematic Review and Network Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:803-814. [PMID: 34673290 DOI: 10.1016/j.jaip.2021.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is limited evidence about which composite feature of asthma self-management strategies is the best and should be adopted into practice. OBJECTIVE To compare the efficacy of different strategies to support self-management, based on the newly developed framework, in patients with asthma. METHODS We searched PubMed, EMBASE, CENTRAL, CINAHL, and PsycInfo from 1993 to December 2019. We identified randomized controlled trials that explored effects of strategies to support self-management in adult patients with asthma. We conducted network meta-analyses using a random effects model with usual care as the common comparator. Surface under the cumulative ranking curve methods were used to rank different support strategies. RESULTS Thirty-five trials (5195 patients) were included and classified on the basis of our newly created TIP framework: Theme, Intensity, and Provider/Platform. We identified 6 features from the included trials, each represented by 1 element of the TIP framework: (1) behavioral support more than once a month by e-Health; (2) behavioral support more than once a month by health care personnel (HCP); (3) behavioral support less often than or equal to once a month by HCP; (4) education support less often than or equal to once a month by e-Health; (5) education support less often than or equal to once a month by HCP; and (6) psychosocial support less often than or equal to once a month by HCP. Behavioral support more than once a month by e-Health showed significant improvement in asthma control when compared with the other 2 support strategies, which was confirmed by the highest surface under the cumulative ranking of 97.6%. However, the surface under the cumulative ranking for behavioral support less often than or equal to once a month by HCP suggested that it has the potential to be the best intervention to reduce the risk of hospitalization (89.1%) and emergency department visit (84.2%). CONCLUSIONS Different features of asthma self-management support strategies work best on unique outcomes.
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Affiliation(s)
- Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash.
| | | | - Kanchana Mueangfa
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Haerin Im
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash
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Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir 2022; 39:241-257. [DOI: 10.1016/j.rmr.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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25
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Helou A, Stewart K, Ryan K, George J. Pregnant women's experiences with the management of hypertensive disorders of pregnancy: a qualitative study. BMC Health Serv Res 2021; 21:1292. [PMID: 34856992 PMCID: PMC8638107 DOI: 10.1186/s12913-021-07320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management. Methods A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Results Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition. Conclusions The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia
| | - Kath Ryan
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Melbourne, Victoria, Australia.
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Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials. NPJ Digit Med 2021; 4:144. [PMID: 34611287 PMCID: PMC8492762 DOI: 10.1038/s41746-021-00517-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
COVID-19 pandemic challenges have accelerated the reliance on digital health fuelling the expanded incorporation of mobile apps into healthcare services, particularly for the management of long-term conditions such as chronic diseases (CDs). However, the impact of health apps on outcomes for CD remains unclear, potentially owing to both the poor adoption of formal development standards in the design process and the methodological quality of studies. A systematic search of randomised trials was performed on Medline, ScienceDirect, the Cochrane Library and Scopus to provide a comprehensive outlook and review the impact of health apps on CD. We identified 69 studies on diabetes (n = 29), cardiovascular diseases (n = 13), chronic respiratory diseases (n = 13), cancer (n = 10) or their combinations (n = 4). The apps rarely adopted developmental factors in the design stage, with only around one-third of studies reporting user or healthcare professional engagement. Apps differed significantly in content, with a median of eight behaviour change techniques adopted, most frequently pertaining to the ‘Feedback and monitoring’ (91%) and ‘Shaping knowledge’ (72%) categories. As for the study methodologies, all studies adopted a traditional randomised control trial (RCT) design, with relatively short follow-ups and limited sample sizes. Findings were not significant for the majority of studies across all CD, with most RCTs revealing a high risk of bias. To support the adoption of apps for CD management, this review reinforces the need for more robust development and appropriate study characteristics to sustain evidence generation and elucidate whether study results reflect the true benefits of apps or a biased estimate due to unsuitable designs.
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Zairina E, Nugraheni G, Achmad GNV, Sulistyarini A, Nita Y, Bakhtiar A, Amin M. The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients. J Basic Clin Physiol Pharmacol 2021; 32:453-458. [PMID: 34214370 DOI: 10.1515/jbcpp-2020-0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. METHODS The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper's Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper's Asthma Quality of Life Questionnaire (AQLQ) were used. RESULTS A total of 82 adults with asthma were recruited in the study. Male participants' mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had "uncontrolled asthma" and more than 85% participants both showed "non adherence" to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. CONCLUSIONS The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.
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Affiliation(s)
- Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia.,Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
| | - Gesnita Nugraheni
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Gusti Noorrizka Veronika Achmad
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Arie Sulistyarini
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Yunita Nita
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.,Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
| | - Arief Bakhtiar
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Muhammad Amin
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology, Universitas Airlangga Hospital, Surabaya, Indonesia
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Stoup T, Chenivesse C. [Management of asthma during pregnancy]. Rev Mal Respir 2021; 38:626-637. [PMID: 34052060 DOI: 10.1016/j.rmr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Asthma is the most common chronic condition in pregnant women. The risks of complications associated with asthma for the mother, the foetus and the pregnancy are mainly due to uncontrolled asthma and the occurrence of exacerbations. These events are promoted by the patient's difficulty in complying with treatment or by prescription insufficiency for an unjustified fear of teratogenicity. The challenge of the management of asthma during pregnancy is to ensure optimal maternal asthma control in order to prevent foetal hypoxia and thus, reduce the risk of complications. Preventing the occurrence of asthma symptoms and exacerbations, ensuring optimal lung function and managing the risk factors of poor asthma outcomes and comorbidities are the principles necessary to achieve this goal. Because of the low or non-existent risks of the main treatments of asthma for the foetus and the mother, it is widely recommended that all therapies initiated before conception are continued, in particular inhaled corticosteroids, and to adjust the dosage to the minimum effective dose. During the preconception period and throughout pregnancy, coordination of the different healthcare professionals (general practitioner, respiratory specialist and gynecologist) is essential, with the mother-to-be playing a central role in the management of her asthma.
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Affiliation(s)
- T Stoup
- CHU Lille, université Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, 59000 Lille, France
| | - C Chenivesse
- CHU Lille, université Lille, CNRS, Inserm, institut Pasteur de Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), CRISALIS, F-CRIN Inserm network, 59000 Lille, France.
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Improving Asthma Symptoms Among Inner-City Women During Pregnancy: A Prospective Cohort Intervention. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3672-3678. [PMID: 34033982 DOI: 10.1016/j.jaip.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is unknown how active asthma management influences symptom control among inner-city pregnant women who have unique exposures and socioeconomic limitations affecting their care. OBJECTIVE To assess the impact of an integrated subspecialty intervention composed of education and monitoring on asthma control among underserved women in an antenatal clinic setting. METHODS We conducted a prospective cohort study of pregnant asthmatic patients participating in a subspecialty clinic integrated into routine prenatal care. We compared baseline characteristics and objective measurements of asthma control between women at an initial visit and those who were evaluated in at least one follow-up. For follow-up, we measured symptom control at successive visits and the incidence of asthma-related complications. RESULTS Among 85 women enrolled, 53 (62.4%) returned for at least one follow-up visit. Mean baseline Asthma Control Test scores were similarly low (≤19) between groups (one or more follow-up and no follow-up), as were self-administered Asthma Quality of Life Questionnaire scores (<4.7). A total of 72 women had inadequate asthma control resulting in step-up therapy after the initial visit (84.7%). There was a significant increase in ACT scores between the initial and first follow-up visits. For those with an intervening self-administered Asthma Quality of Life Questionnaire, there was also a significant increase by 1.39 ± 0.67 (P = .0003). CONCLUSIONS We found that uncontrolled asthma is common among urban women seeking routine obstetric care. Our results suggest that even one interventional visit can result in significant improvement in asthma control. Further investigation into mechanisms for optimizing treatment strategies may improve the quality of asthma care during pregnancy in this underserved population.
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Examining ultrasound diagnostic performance improvement with utilization of maternal-fetal medicine tele-interpretation. Am J Obstet Gynecol MFM 2021; 3:100389. [PMID: 33957316 DOI: 10.1016/j.ajogmf.2021.100389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Telemedicine can extend essential health services to under-resourced settings and improve the quality of obstetrical care. Specifically, the evaluation and management of fetal anomalies require perinatal subspecialists, rendering prenatal diagnosis essential, and may benefit from telemedicine platforms to improve access to care. OBJECTIVE This study aimed to evaluate the impact of a maternal-fetal medicine telemedicine ultrasound program on the diagnostic accuracy of fetal anomalies when used within practices where ultrasounds are interpreted by general obstetricians or family medicine physicians. STUDY DESIGN This was a cross-sectional study of all patients receiving care at 11 private obstetrical practices and imaging centers who had obstetrical ultrasounds performed from January 1, 2020, to July 6, 2020. All ultrasounds were performed by sonographers remotely trained under a standardized protocol and interpreted by maternal-fetal medicine physicians via telemedicine. Ultrasound characteristics and interpretation were extracted from ultrasound reports. Before the introduction of maternal-fetal medicine telemedicine, all ultrasound interpretations were reviewed by general obstetricians and family medicine physicians with reliance predominantly on the sonographer's impression. The primary outcome was potential missed diagnosis of a fetal anomaly, defined as an ultrasound designated as normal by a sonographer but diagnosed with an anomaly by a maternal-fetal medicine physician via telemedicine. This outcome serves as a proxy measure for anomaly diagnoses that would likely be missed without the supervision of a maternal-fetal medicine physician. The characteristics of the potential missed diagnoses were compared by type of scan and fetal organ system in univariable analysis. Moreover, a survey was conducted for sonographers and obstetrical providers to assess their perceptions of ultrasound interpretation via telemedicine. RESULTS Overall, 6403 ultrasound examinations were evaluated, 310 of which had a diagnosis of fetal anomaly by a maternal-fetal medicine physician (4.8%). Of the fetal anomalies, 43 were diagnosed on an anatomic survey (13.9%), and 89 were diagnosed as cardiac anomalies (28.7%). The overall rate of the potential missed diagnoses was 34.5% and varied significantly by type of ultrasound (anatomy scans vs other first-, second-, and third-trimester ultrasounds) (P<.01). Moreover, there were significant differences in the rate of the potential missed diagnoses by organ system, with the highest rate for cardiac anomalies (P<.01). CONCLUSION Expertise in maternal-fetal medicine telemedicine improves the diagnostic performance of antenatal ultrasound throughout pregnancy. However, there are implications for improving the quality of antenatal care, such as ensuring appropriate referrals and site of delivery, particularly for cardiac anomalies.
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Vieira AC, Pité H, Morais-Almeida M. Asthma and pregnancy in the 2020 decade: still a matter of concern. J Matern Fetal Neonatal Med 2021; 35:6498-6504. [PMID: 33926358 DOI: 10.1080/14767058.2021.1916462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Asthma is a fairly common health problem for pregnant women and a potentially serious medical condition that may complicate pregnancy. Most complications are related to lack of disease control, which can adversely affect both maternal quality of life and perinatal outcomes. In this article, we review recent literature concerning asthma in pregnancy, describing the course of the disease and associated complications. Furthermore, we review and discuss asthma monitoring and management during pregnancy, labor and post-partum. The course of asthma symptoms during pregnancy is unpredictable but exacerbations are more common during the second trimester. The causes are multifactorial and asthma phenotype may have a role. It has been proposed that combined use of CARAT (Control of Allergic Rhinitis and Asthma Test) and lung function tests can be used to monitor and adjust therapy during pregnancy in patients with asthma. As a complement, an approach that considers airway inflammation assessment using fractional exhaled nitric oxide (FeNO), a noninvasive marker of inflammation, may improve asthma control during pregnancy. It is important to consider a few but relevant differences in asthma management and treatment regarding pregnancy and the peri-partum period to safely achieve optimal management of asthma during all these phases for both mother and offsprings.
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Affiliation(s)
- Ana Cláudia Vieira
- Pulmonology Department, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Helena Pité
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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Snoswell CL, Rahja M, Lalor AF. A Systematic Review and Meta-Analysis of Change in Health-Related Quality of Life for Interactive Telehealth Interventions for Patients With Asthma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:291-302. [PMID: 33518036 DOI: 10.1016/j.jval.2020.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/23/2020] [Accepted: 09/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Asthma is one of the most common major noncommunicable diseases in the world and affects individuals of all ages. Medication is used to achieve and maintain quality of life (QOL) for people with asthma. Telehealth interventions offer optimized and personalized symptom monitoring with timely treatment adjustment and the potential to increase medication adherence for individuals with asthma. This study examines and synthesizes the available data on the change in the QOL for patients with asthma who use interactive telehealth interventions, and identifies the most effective telehealth modalities used for intervention in this area. METHODS Literature searches were conducted in 5 databases in November 2018 for studies measuring a change in QOL for patients with asthma. Study QOL outcomes, where possible, were pooled in a meta-analysis. RESULTS Seventeen publications (describing 16 studies) comprising 2015 patients were included. Based on a meta-analysis, interactive telehealth interventions can improve QOL outcomes for people living with asthma, although the improved effects may be small: web portals (0.51, 95% confidence interval [CI] -0.00 to 1.03), interactive smartphone apps (0.30, 95% CI -0.16 to 0.76) and remote monitoring (standardized mean difference 0.20, 95% CI -0.11 to 0.52). Intervention delivery modalities identified include interactive web portals, smartphone apps, and remote monitoring programs. CONCLUSIONS The findings provide a comprehensive overview of the available literature on interactive telehealth interventions, including interactive web portals, smartphone apps, and remote monitoring programs. These findings demonstrated that a positive change in QOL can be attributed to these interventions and provide evidence for the implementation of telehealth interventions for individuals with asthma.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia; Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia.
| | - Miia Rahja
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Aislinn F Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
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Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol 2021; 59:19-37. [PMID: 32215784 DOI: 10.1007/s12016-020-08782-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.
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Affiliation(s)
- Pavadee Poowuttikul
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA.
| | - Divya Seth
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA
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35
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Mayoral K, Garin O, Caballero-Rabasco MA, Praena-Crespo M, Bercedo A, Hernandez G, Castillo J, Lizano Barrantes C, Pardo Y, Ferrer M. Smartphone App for monitoring Asthma in children and adolescents. Qual Life Res 2021; 30:3127-3144. [PMID: 33387290 DOI: 10.1007/s11136-020-02706-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The asthma stepwise treatment approach recommended is based on monitoring patients' symptoms. The Asthma Research in Children and Adolescents (ARCA) cohort was created to provide evidence about the evolution of persistent asthma. This manuscript describes the development of an electronic health tool, comprising a mobile health application for patients with asthma and its associated online platform for pediatricians to monitor them. METHODS The development process followed 7 phases: the first 5 (Conceptualization, Preparation, Assessment scheduling, Image and user interface, and Technical development) defined and designed the tool, followed by a testing phase (functionality assessment and pilot test with ARCA patients), and a last phase which evaluated usability. Since the target population was aged 6-16 years, three versions were designed within the same smartphone application: parents/proxy, children, and adolescents. The online platform for pediatricians provides real-time information from the application: patients' responses over time with color-coded charts (red/amber/green, as in traffic lights). RESULTS The pilot test through semi-structured phone interviews of the first 50 participants included in the ARCA study (n = 53) detected their misunderstandings. Pediatricians were trained to emphasize that the application is free of charge and requires monthly answers. Median of the System Usability Scale scores (n = 85), ranging 0 (negative)-100 (positive), was > 93 in the three age versions of the application. CONCLUSIONS Technology has the capability of transforming the use of patient-reported outcomes. Describing all the development phases of a mobile health application for monitoring children and adolescents with asthma may increase the knowledge on how to design applications for young patients.
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Affiliation(s)
- K Mayoral
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - O Garin
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain. .,Pompeu Fabra University UPF, Barcelona, Spain.
| | - M A Caballero-Rabasco
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Pediatric Allergy and Pulmonology Unit, Pediatric Service, Hospital del Mar, Barcelona, Spain
| | - M Praena-Crespo
- Centro de Salud la Candelaria, Servicio Andaluz de Salud, Seville, Spain.,Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain
| | - A Bercedo
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,Centro de Salud Dobra, Servicio Cántabro de Salud, Cantabria, Spain
| | - G Hernandez
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,CAP Vila Olimpica, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - J Castillo
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,Pediatric Pneumology Unit, Pediatric Service, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
| | - C Lizano Barrantes
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pompeu Fabra University UPF, Barcelona, Spain.,University of Costa Rica, San José, Costa Rica
| | - Y Pardo
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. .,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.
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Abstract
Telemedicine is an important modality of care delivery in the twenty-first century and has many applications for the obstetric population. Existing research has shown the clinical efficacy and improved patient satisfaction of many telemedicine platforms in obstetrics. Telemedicine has the potential to reduce racial and geographic disparities in pregnancy care, but more research is necessary to inform best practices. Developing cost-effective telemedicine programs and establishing health care policy that standardizes insurance reimbursement are some of the most important steps toward scaling up telemedicine offerings for obstetric patients in the United States.
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Affiliation(s)
- Adina R Kern-Goldberger
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor Silverstein Building, Philadelphia, PA 19146, USA
| | - Sindhu K Srinivas
- Department of Obstetrics & Gynecology, Maternal Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor Silverstein Building, Philadelphia, PA 19146, USA.
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Persaud YK, Portnoy JM. Ten Rules for Implementation of a Telemedicine Program to Care for Patients with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:13-21. [PMID: 33039648 PMCID: PMC7543924 DOI: 10.1016/j.jaip.2020.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the use of telemedicine changed from being an optional way to see patients to becoming a necessity. It has transformed primary, specialty, and mental health services by becoming incorporating into everyday practice. Because allergists have adapted to patient care using telemedicine, use of this technology is likely to continue after COVID-19. In the process of using telemedicine, lessons have been learned. We now offer 10 rules for creating a successful telemedicine practice while also ensuring that quality asthma care is provided.
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Affiliation(s)
- Yudy K Persaud
- Division of Allergy, BronxCare Health Systems, Bronx, NY
| | - Jay M Portnoy
- Section of Allergy, Asthma and Immunology, Children's Mercy Hospital, Kansas City, Mo.
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Ngo E, Truong MBT, Nordeng H. Use of Decision Support Tools to Empower Pregnant Women: Systematic Review. J Med Internet Res 2020; 22:e19436. [PMID: 32924961 PMCID: PMC7522732 DOI: 10.2196/19436] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023] Open
Abstract
Background Women face many health-related decisions during pregnancy. Digitalization, new technology, and a greater focus on empowering patients have driven the development of patient-centered decision support tools. Objective This systematic review provides an overview of studies investigating the effect of patient-centered decision support tools for pregnant women. Methods We searched 5 online databases, MEDLINE, EMBASE, Web of Science, PsycINFO, and Scopus, from inception to December 1, 2019. Two independent researchers screened titles, abstracts, and full-texts against the inclusion criteria. All studies investigating the effect of patient-centered decision support tools for health-related issues among pregnant women were included. Study characteristics and results were extracted using the review management tool Rayyan and analyzed according to topic, type of decision support tools, control group, outcome measurements, and results. Results The 25 eligible studies covered a range of health topics, including prenatal screening (n=10), gestational diabetes and weight gain (n=7), lifestyle (n=3), blood pressure and preeclampsia (n=2), depression (n=1), asthma (n=1), and psychological well-being (n=1). In general, the use of decision support tools increased women's knowledge, and recording symptoms enhanced satisfaction with maternity care. Conclusions The opportunities created by digitalization and technology should be used to develop innovative patient-centered decision support tools tailored to support pregnant women. Effect on clinical outcomes should be documented.
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Affiliation(s)
- Elin Ngo
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Maria Bich-Thuy Truong
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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An opportunity for patient-centered care: Results from a secondary analysis of sex- and gender-based data in mobile health trials for chronic medical conditions. Maturitas 2020; 138:1-7. [PMID: 32631583 DOI: 10.1016/j.maturitas.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/27/2020] [Accepted: 05/06/2020] [Indexed: 01/12/2023]
Abstract
Traditional medical practice has suffered from male bias, which can lead to sub-optimal treatment options for female patients and increase the incidence of severe side-effects in this population. Mobile health applications, mHealth apps, represent one essential component of the shift towards consumer-centered self-administered individualized health. To prevent sex-specific bias it is important that trials consider sex and gender when developing mHealth apps. We evaluated the inclusion and reporting of sex and gender at all levels in mHealth randomized controlled trials (RCTs). To this end, we conducted a secondary analysis of a large study database addressing the effectiveness of app interventions on clinical outcomes in patients with chronic medical conditions. We followed the 5 steps described in the framework by Arksey and O'Malley and the guidelines of the PRISMA-ScR. Of the 72 app-based RCTs which reported information about sex overall, 62 included individuals of both sexes. The concept of gender was not addressed in any of the studies. The consideration of sex aspects in the design, execution and reporting of mHealth RCTs was minimal or absent. To adequately address the health and preventative needs of the mHealth user population, sex and gender should be systematically included in the research, development and evaluation of mHealth applications.
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Abstract
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. OBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
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Munteanu LA, Frandes M, Timar B, Tudorache E, Fildan AP, Oancea C, Tofolean DE. The efficacy of a mobile phone application to improve adherence to treatment and self-management in people with chronic respiratory disease in Romanian population - a pilot study. BMC Health Serv Res 2020; 20:475. [PMID: 32460752 PMCID: PMC7254754 DOI: 10.1186/s12913-020-05340-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies assessed the effect of mobile phone applications on self-management outcomes in patients with asthma, but all of them presented variable results. In this paper. we examined the effect of a mobile phone application on self-management and disease control in Romanian population. METHODS This study included 93 patients diagnosed with asthma that were recalled every three months for a year for assessment and treatment. Patients were divided into two groups. The first group included patients that received treatment, and the second group received treatment and also used the smartphone application. Number of exacerbations and asthma control test (ACT) were recorded. RESULTS The ACT score was significantly higher for asthma patients using also the mobile application than for the patients using the treatment alone, for all the evaluation moments (Mann-Whitney U test, p < 0.001). Also, we found significant differences between the ACT score with-in each group, observing a significant improvement of the score between evaluations and baseline (related-samples Friedman's test with Bonferroni correction, p < 0.001). When considering the exacerbations rate, significantly less patients using the application presented exacerbations, 10.30% vs. 46.30% (Pearson Chi-square test, X2 (1) = 13.707, p < 0.001). CONCLUSION Our study indicates that smartphone applications are an effective way to improve asthma control and self-management when used continually in our population. We found significant positive effects in disease control and exacerbation frequency.
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Affiliation(s)
- Laura Adela Munteanu
- Department of Pulmonology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Mirela Frandes
- Department of Biostatistics and Medical Informatics, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu, 30041, Timișoara, Romania.
| | - Bogdan Timar
- Department of Biostatistics and Medical Informatics, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu, 30041, Timișoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Ariadna Petronela Fildan
- Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta, Faculty of Medicine, Constanta, Romania
| | - Cristian Oancea
- Department of Pulmonology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Doina Ecaterina Tofolean
- Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta, Faculty of Medicine, Constanta, Romania
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Gyselaers W, Lanssens D, Perry H, Khalil A. Mobile Health Applications for Prenatal Assessment and Monitoring. Curr Pharm Des 2020; 25:615-623. [PMID: 30894100 DOI: 10.2174/1381612825666190320140659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND A mobile health application is an exciting, fast-paced domain that is likely to improve prenatal care. METHODS In this narrative review, we summarise the use of mobile health applications in this setting with a special emphasis on both the benefits of remote monitoring devices and the potential pitfalls of their use, highlighting the need for robust regulations and guidelines before their widespread introduction into prenatal care. RESULTS Remote monitoring devices for four areas of prenatal care are reported: (1) cardio-tocography; (2) blood glucose levels; (3) blood pressure; and (4) prenatal ultrasound. The majority of publications are pilot projects on remote consultation, education, coaching, screening, monitoring and selective booking, mostly reporting potential medical and/or economic benefits by mobile health applications over conventional care for very specific situations, indications and locations, but not always generalizable. CONCLUSIONS Despite the potential advantages of these devices, some caution must be taken when implementing this technology into routine daily practice. To date, the majority of published research on mobile health in the prenatal setting consists of observational studies and there is a need for high-quality randomized controlled trials to confirm the reported clinical and economic benefits as well as the safety of this technology. There is also a need for guidance and governance on the development and validation of new apps and devices and for the implementation of mobile health technology into healthcare systems in both high and low-income settings. Finally, digital communication technologies offer perspectives towards exploration and development of the very new domain of tele-pharmacology.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Belgium; 2Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Mobile Health Unit, Facultiy of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Helen Perry
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.,Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, United Kingdom
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Farzandipour M, Nabovati E, Heidarzadeh Arani M, Akbari H, Sharif R, Anvari S. Enhancing Asthma Patients' Self-Management through Smartphone-Based Application: Design, Usability Evaluation, and Educational Intervention. Appl Clin Inform 2019; 10:870-878. [PMID: 31724144 DOI: 10.1055/s-0039-1700866] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The aim of this study was to design and evaluate a smartphone-based application for improving self-management in patients with asthma and evaluate its effects on their knowledge. METHODS In this applied research, based on the Clinical Practice Guideline and a systematic review, a questionnaire was designed to determine the application information content and functionality requirements by 15 pediatric and adult asthma and allergy specialist. Then the application was designed and developed using Adobe Air software on the Android operating system. Usability evaluation of the mobile application was performed using the standard questionnaire for user interaction satisfaction (QUIS), which completed by 30 patients with asthma, 8 information technology (IT) specialists, and 2 asthma and allergy specialists. Self-management knowledge of 30 asthma patients was measured using a researcher-made questionnaire before and after using the application. RESULTS The number of specialists in the both Delphi rounds was 15 and the mean work experiences were 17.6 years. The most important elements for asthma self-management were avoiding exposure to allergen and triggers (96%), drug treatment (94.6%), and how to use the therapeutic tools (92.4%), and the most important functionalities were alerting the patients when they did not control asthma (92%), setting reminders for timely drug use (85.4%) and therapeutic tools (82.6%), recording prescription drugs (82.6%), and peak flow meter values (82%). Usability evaluation showed that 30 patients with asthma, 8 IT specialists, and 2 physicians evaluated the application at a "good" level. The mean score of the patients' knowledge before intervention was 2.43 ± 0.95 which after intervention was significantly increased to 4.3 ± 0.56 (p < 0.001). CONCLUSION Considering the desirable outcomes of application evaluation and a positive impact of this educational intervention on asthma patients' knowledge, it is possible to use mobile-based self-management programs to help these patients to manage illness and gain knowledge and self-management skills.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Hossein Akbari
- Department of Biostatistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Department of Health Information Management and Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
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Portnoy JM, Wu AC. Is Telemedicine as Effective as Usual Care? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:217-218. [PMID: 30598177 DOI: 10.1016/j.jaip.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jay M Portnoy
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
| | - Ann Chen Wu
- Center for Health Care Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
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Alves DS, Times VC, da Silva ÉMA, Melo PSA, Novaes MDA. Advances in obstetric telemonitoring: a systematic review. Int J Med Inform 2019; 134:104004. [PMID: 31816495 DOI: 10.1016/j.ijmedinf.2019.104004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/12/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and prevention of intercurrences, providing local intervention before hospitalization. OBJECTIVE This paper aims to identify advances, contributions and limitations of obstetric telemonitoring using mobile technologies. METHODS A systematic review was performed on the Pubmed, Medline, LILACS, Cochrane, Scielo, Embase, ACM Surveys, and IEEE databases, from 2008 to 2018. PRISMA and CASP were used to analyze methodological rigour. RESULTS 26 papers were included. The majority of the studies related to pregnant women, prenatal care, high-risk pregnancies and homecare. Only 2 articles related to postpartum and none related to delivery. Among the technological resources, the articles presented smartphone applications, which interact with external telemonitoring devices (such as electrodes attached to the body and thermometers) or request information about maternal and / or fetal health status. Based on those devices, decision-making by health professionals is more reliable, since data is obtained by digital devices that have a greater accuracy. The variety of studies is enormous and achieve promising results. However, there are still important gaps to be addressed. Many studies only cover isolated aspects of maternal health, e.g. blood pressure, which somehow limits clinical decision-making. All authors have described concerns about usability, but not all of them had actually performed usability tests. Interventions through obstetric telemonitoring can be applied to a wide range of domains, at various levels of healthcare complexity. There are still few investments in studies in developing countries, where maternal and fetal morbidity and mortality are higher. CONCLUSION The area of obstetrical telemonitoring has a great potential for contributing with better gestational outcomes, early detection of complications, prevention of intercurrences, providing local intervention even before hospitalization. Development of obstetric telemonitoring systems wich collect complete obstetric parameter integrated with the periods of childbirth and postpartum is recommended.
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Affiliation(s)
- Danielle Santos Alves
- Department of Nursing, Federal University of Pernambuco, UFPE, Brazil; Post-Graduation Program in Computer Science, Federal University of Pernambuco, UFPE, Brazil; Telehealth Center, Clinical Hospital, Federal University of Pernambuco, UFPE, Brazil.
| | - Valéria Cesário Times
- Post-Graduation Program in Computer Science, Federal University of Pernambuco, UFPE, Brazil; Center for Informatics, Federal University of Pernambuco, UFPE, Brazil.
| | - Érika Maria Alves da Silva
- Department of Nursing, Federal University of Pernambuco, UFPE, Brazil; Telehealth Center, Clinical Hospital, Federal University of Pernambuco, UFPE, Brazil.
| | - Priscila Santos Alves Melo
- Department of Nursing, Federal University of Pernambuco, UFPE, Brazil; Telehealth Center, Clinical Hospital, Federal University of Pernambuco, UFPE, Brazil.
| | - Magdala de Araújo Novaes
- Center of Medical Sciences, Federal University of Pernambuco, UFPE, Brazil; Telehealth Center, Clinical Hospital, Federal University of Pernambuco, UFPE, Brazil.
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Taylor L, Waller M, Portnoy JM. Telemedicine for Allergy Services to Rural Communities. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2554-2559. [PMID: 31238163 DOI: 10.1016/j.jaip.2019.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 01/25/2023]
Abstract
Telemedicine (TM) involves the use of technology to provide medical services to patients who live at a distance. It can be used asynchronously for interpretation of test results (spirometry, skin tests imaging studies), and for communication of information when the simultaneous presence of provider and patient is unnecessary. Synchronous encounters can either be unscheduled and initiated on demand by patients or be facilitated substitutes for in-person visits. The latter results in asthma outcomes that are as good as those for in-person visits while reducing the cost and inconvenience of travel from rural communities to urban centers. Facilitated visits can be done in the ambulatory and emergency department settings, and they can be used for inpatient consults when allergy specialists are not readily available. Both patients and providers experience high degrees of satisfaction with this type of visit. In addition, virtual visits performed using TM are cost-effective. TM offers a solution to the shortage of specialty care that is present in rural communities.
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Affiliation(s)
- Luisa Taylor
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
| | - Morgan Waller
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
| | - Jay M Portnoy
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo.
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Whalen OM, Campbell LE, Murphy VE, Lane AE, Gibson PG, Mattes J, Collison A, Mallise CA, Woolard A, Karayanidis F. Observational study of mental health in asthmatic women during the prenatal and postnatal periods. J Asthma 2019; 57:829-841. [PMID: 31148493 DOI: 10.1080/02770903.2019.1621888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: We aimed to examine the prevalence and severity of psychological distress of women with asthma in both the prenatal and postnatal periods, and to determine whether asthmatic women with and without mental health problems differ in self-management, medications knowledge, and asthma symptoms.Methods: We assessed spirometry performance and asthma symptoms in 120 women (mean age 29.8 years) before 23 weeks gestation, as part of the Breathing for Life Trial (Trial ID: ACTRN12613000202763). Prenatal depression data was obtained from medical records. At 6 weeks postpartum, we assessed general health, self-reported asthma control, depression symptoms (with the Edinburgh Postnatal Depression Scale) and adaptive functioning (with the Achenbach System of Empirically Based Assessment scales).Results: Twenty percent of our sample reported having a current mental health diagnosis, 14% reported currently receiving mental health care, while 47% reported having received mental health care in the past (and may/may not have received a diagnosis). The sample scored high on the Aggressive Behavior, Avoidant Personality, and Attention Deficit/Hyperactivity scales. Poorer self-reported postnatal asthma control was strongly correlated with elevated somatic complaints, externalizing problems, antisocial personality problems, and greater withdrawal. Prenatal spirometry or asthma severity and control were largely not associated with measures of psychopathology.Conclusions: These findings indicate that pregnant women with asthma frequently report issues with psychopathology during the prenatal and postnatal periods, and that the subjective perception of asthma control may be more related to psychopathology than objective asthma measures. However, due to sample bias, these findings are likely to be understated.
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Affiliation(s)
- Olivia M Whalen
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alison E Lane
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carly A Mallise
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Woolard
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Frini Karayanidis
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
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Yang Q, Van Stee SK. The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review. JMIR Mhealth Uhealth 2019; 7:e11244. [PMID: 30942695 PMCID: PMC6468337 DOI: 10.2196/11244] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/01/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background As mobile technology continues expanding, researchers have been using mobile phones to conduct health interventions (mobile health—mHealth—interventions). The multiple features of mobile phones offer great opportunities to disseminate large-scale, cost-efficient, and tailored messages to participants. However, the interventions to date have shown mixed results, with a large variance of effect sizes (Cohen d=−0.62 to 1.65). Objective The study aimed to generate cumulative knowledge that informs mHealth intervention research. The aims were twofold: (1) to calculate an overall effect magnitude for mHealth interventions compared with alternative interventions or conditions, and (2) to analyze potential moderators of mHealth interventions’ comparative efficacy. Methods Comprehensive searches of the Communication & Mass Media Complete, PsycINFO, Web of Knowledge, Academic Search Premier, PubMed and MEDLINE databases were conducted to identify potentially eligible studies in peer-reviewed journals, conference proceedings, and dissertations and theses. Search queries were formulated using a combination of search terms: “intervention” (Title or Abstract) AND “health” (Title or Abstract) AND “*phone*” OR “black-berr*” (OR mHealth OR “application*” OR app* OR mobile OR cellular OR “short messag*” OR palm* OR iPhone* OR MP3* OR MP4* OR iPod*) (Title or Abstract). Cohen d was computed as the basic unit of analysis, and the variance-weighted analysis was implemented to compute the overall effect size under a random-effects model. Analysis of variance–like and meta-regression models were conducted to analyze categorical and continuous moderators, respectively. Results The search resulted in 3424 potential studies, the abstracts (and full text, as necessary) of which were reviewed for relevance. Studies were screened in multiple stages using explicit inclusion and exclusion criteria, and citations were evaluated for inclusion of qualified studies. A total of 64 studies were included in the current meta-analysis. Results showed that mHealth interventions are relatively more effective than comparison interventions or conditions, with a small but significant overall weighted effect size (Cohen d=0.31). In addition, the effects of interventions are moderated by theoretical paradigm, 3 engagement types (ie, changing personal environment, reinforcement tracking, social presentation), mobile use type, intervention channel, and length of follow-up. Conclusions To the best of our knowledge, this is the most comprehensive meta-analysis to date that examined the overall effectiveness of mHealth interventions across health topics and is the first study that statistically tested moderators. Our findings not only shed light on intervention design using mobile phones, but also provide new directions for research in health communication and promotion using new media. Future research scholarship is needed to examine the effectiveness of mHealth interventions across various health issues, especially those that have not yet been investigated (eg, substance use, sexual health), engaging participants using social features on mobile phones, and designing tailored mHealth interventions for diverse subpopulations to maximize effects.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University, Fort Worth, TX, United States
| | - Stephanie K Van Stee
- Department of Communication and Media, University of Missouri-St. Louis, St. Louis, MO, United States
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Chan KL, Chen M. Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis. JMIR Mhealth Uhealth 2019; 7:e11836. [PMID: 30698533 PMCID: PMC6372934 DOI: 10.2196/11836] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background The use of social media and mobile health (mHealth) apps has been increasing in pregnancy care. However, the effectiveness of these interventions is still unclear. Objectives We conducted a meta-analysis to examine the effectiveness of these interventions with regard to different health outcomes in pregnant and postpartum women and investigate the characteristics and components of interventions that may affect program effectiveness. Method We performed a comprehensive literature search of major electronic databases and reference sections of related reviews and eligible studies. A random effects model was used to calculate the effect size. Results Fifteen randomized controlled trial studies published in and before June 2018 that met the inclusion criteria were included in the meta-analysis. The interventions were effective in promoting maternal physical health including weight management, gestational diabetes mellitus control, and asthma control with a moderate to large effect size (d=0.72). Large effect sizes were also found for improving maternal mental health (d=0.84) and knowledge about pregnancy (d=0.80). Weight control interventions using wearable devices were more effective. Conclusion Social media and mHealth apps have the potential to be widely used in improving maternal well-being. More large-scale clinical trials focusing on different health outcomes are suggested for future studies.
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Affiliation(s)
- Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Mengtong Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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50
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Hossain I, Ang YN, Chng HT, Wong PS. Patients' attitudes towards mobile health in Singapore: a cross-sectional study. Mhealth 2019; 5:34. [PMID: 31620461 PMCID: PMC6789194 DOI: 10.21037/mhealth.2019.08.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smartphone-mediated mobile health (mHealth) has the potential to assist patients with medication adherence and disease monitoring. This study aimed to describe the awareness and usage of, and attitudes towards, mHealth among smartphone-owning patients in a tertiary hospital in Singapore. METHODS A self-administered cross-sectional survey was systematically offered to patients at the Singapore General Hospital from August to September 2018. Participants were included if they were at least 18 years old, owned a smartphone, and could speak and read simple English. No identifiable data was collected. Responses were summarized using descriptive statistics. Multiple logistic regression analysis was used to identify factors associated with awareness and usage of, and attitudes towards, mHealth. RESULTS Four-hundred and two eligible responses were received, with most participants reporting having completed tertiary education (63.7%) and having chronic medical conditions (71.1%), with a mean age of about 43 years. On average, participants were aware of 3.7 out of 7 mHealth functions and used 1.9 functions. Most patients were aware that smartphones could be used for general health/fitness tracking, obtaining health information, and appointment management. Most (76.3%) participants were keen to learn to use mHealth in future, and 63.2% agreed that mHealth could help them better manage their health. CONCLUSIONS Although mHealth usage among patients was low, most patients held positive attitudes towards mHealth. For mHealth to fulfill its potential, strategies to improve the awareness and usage among patients need to be explored.
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Affiliation(s)
- Ihtimam Hossain
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Ying Na Ang
- Department of Pharmacy, National University of Singapore, Singapore
| | - Hui Ting Chng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Pei Shieen Wong
- Department of Pharmacy, Singapore General Hospital, Singapore
- Department of Pharmacy, National University of Singapore, Singapore
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