Impact of Workplace Bullying on Quiet Quitting in Nurses: The Mediating Effect of Coping Strategies

Workplace bullying is common among nurses and negatively affects several work-related variables, such as job burnout and job satisfaction. However, no study until now has examined the impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data in February 2024. We used the Negative Acts Questionnaire-Revised, the Quiet Quitting Scale, and the Brief COPE to measure workplace bullying, quiet quitting, and coping strategies, respectively. We found that workplace bullying and negative coping strategies were positive predictors of quiet quitting, while positive coping strategies were negative predictors of quiet quitting. Our mediation analysis showed that positive and negative coping strategies partially mediated the relationship between workplace bullying and quiet quitting. In particular, positive coping strategies caused competitive mediation, while negative coping strategies caused complimentary mediation. Nurses' managers and policy makers should improve working conditions by reducing workplace bullying and strengthening positive coping strategies among nurses.

Social Support and Resilience Are Protective Factors against COVID-19 Pandemic Burnout and Job Burnout among Nurses in the Post-COVID-19 Era

Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic, including pandemic burnout and job burnout. The aim of this study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. The study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 Burnout Scale, and Single-Item Burnout Measure, respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support and increased resilience were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout. A similar negative relationship was found between resilience and job burnout. Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses' social support and resilience since they are the backbone of healthcare systems worldwide.

Intensive Care Unit Mortality Trends during the First Two Years of the COVID-19 Pandemic in Greece: A Multi-Center Retrospective Study

Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.

Resilience and Social Support Improve Mental Health and Quality of Life in Patients with Post-COVID-19 Syndrome

Physical and mental health problems among post-COVID-19 patients are common, even a year after infection. As there is no prior study available, we investigated the impacts of resilience and social support on anxiety, depression, and quality of life among patients with post-COVID-19 syndrome. We conducted a cross-sectional study with a convenience sample. The measures included the demographic and clinical characteristics of patients, the Brief Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Patient Health Questionnaire-4 (PHQ-4), and the EuroQol-5D-3L. The mean age of patients was 44.8 years. The total PHQ-4 score suggested that 32.8% of patients with post-COVID-19 syndrome experienced severe psychological distress, 32.8% experienced moderate distress, 23% experienced mild distress, and 11.5% had no distress. Moreover, 60.7% of patients had anxiety scores of ≥3 and 69.7% had depression scores of ≥3, indicating possible major anxiety or depression disorder. The mean EQ-5D-3L index value was 0.36, and the mean EQ-5D-3L VAS was 54.1. Multivariable analysis identified that resilience and social support reduced anxiety and depression among patients. Also, we found a significant positive relationship between resilience and social support, and quality of life. Our findings suggest that resilience and social support can be protective by reducing anxiety and depression and improving quality of life among patients with post-COVID-19 syndrome. Policymakers should develop and implement healthcare management programs to provide psychological support to these patients.

Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services

AIM

To assess the level of quiet quitting among healthcare workers (HCWs) and identify possible differences between nurses, physicians, and other HCWs. We investigated the impact of sociodemographic variables, job burnout, and job satisfaction on quiet quitting levels.

BACKGROUND

The quiet-quitting phenomenon is not new but has been frequently discussed during the COVID-19 pandemic. Interestingly, the level of quiet quitting among HCWs has not been measured yet.

METHODS

We conducted a cross-sectional study with a convenience sample. We measured sociodemographic variables, job burnout, job satisfaction, and quiet quitting. We adhered to STROBE guidelines for cross-sectional studies.

FINDINGS

Among our sample, 67.4% of nurses were quiet quitters, while the prevalence of quiet quitting for physicians and other HCWs was 53.8% and 40.3%, respectively. Multivariable linear regression analysis identified that the levels of quiet quitting were higher among nurses than physicians and other HCWs. Moreover, greater job burnout contributed more to quiet quitting, while less satisfaction implied more quiet quitting. HCWs who work in shifts and those working in the private sector experienced higher levels of quiet quitting.

DISCUSSION

More than half of our HCWs were described as quit quitters. Levels of quiet quitting were higher among nurses. Job burnout and job dissatisfaction were associated with higher levels of quiet quitting.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Measurement of quiet quitting and identification of risk factors are essential to prevent or reduce quiet quitting levels among HCWs. Our study provides information on this field helping managers and organizations to identify quiet quitters within HCWs. Policymakers and managers should develop and implement interventions both at an organizational level and at an individual level.

The Internet of Medical Things: Opportunities, Benefits, Challenges and Concerns

In this narrative review, we investigate the potential opportunities and benefits, as well as the challenges and concerns of integrating the Internet of Things in healthcare. The opportunities include enhanced patient monitoring and management, improved efficiency and resource utilization, personalized and precision medicine, empowering patients and promoting self-management, and data-driven decision-making, while the challenges include security and privacy risks, interoperability and integration, regulatory and compliance issues, ethical considerations and impact on healthcare professionals and patients. These challenges must be carefully weighed against the benefits before deployment of the IoMT-enabled services.

The quiet quitting scale: Development and initial validation

Introduction

COVID-19 pandemic causes drastic changes in workplaces that are likely to increase quite quitting among employees. Although quiet quitting is not a new phenomenon, there is no instrument to measure it.

Objective

To develop and validate an instrument assessing quiet quitting among employees.

Methods

We identified and generated items through an extensive literature review and interviews with employees. We carried out the content validity by content experts and we calculated the content validity ratio. We checked face validity by conducting cognitive interviews with employees and calculating the item-level face validity index. We conducted exploratory and confirmatory factor analysis to investigate the quiet quitting scale (QQS) factorial structure. We checked the concurrent validity of the QQS using four other scales, i.e., Copenhagen burnout inventory (CBI), single item burnout (SIB) measure, job satisfaction survey (JSS) and a single item to measure turnover intention. We estimated the reliability of the QQS measuring Cronbach's alpha, McDonald's omega, Cohen's kappa and intraclass correlation coefficient.

Results

After expert panel review and item analysis, nine items with acceptable corrected item-total correlations, inter-item correlations, floor and ceiling effects, skewness and kurtosis were retained. Exploratory factor analysis extracted three factors, namely detachment, lack of initiative and lack of motivation, with a total of nine items. Confirmatory factor analysis confirmed this factorial structure for QQS. We found statistically significant correlations between QQS and CBI, SIB, JSS and turnover intention confirming that the concurrent validity of the QQS was great. Cronbach's alpha and McDonald's omega of the QQS were 0.803 and 0.806 respectively.

Conclusion

QQS, a three-factor nine-item scale, has robust psychometric properties. QQS is an easy-to-administer, brief, reliable and valid tool to measure employees' quiet quitting. We recommend the use of the QQS in different societies and cultures to assess the validity of the instrument.

Persistent Endothelial Lung Damage and Impaired Diffusion Capacity in Long COVID

Since the beginning of the pandemic, both COVID-19-associated coagulopathy biomarkers and a plethora of endothelial biomarkers have been proposed and tested as prognostic tools of severity and mortality prediction. As the pandemic is gradually being controlled, attention is now focusing on the long-term sequelae of COVID-19. In the present study, we investigated the role of endothelial activation/dysfunction in long COVID syndrome. This observational study included 68 consecutive long COVID patients and a healthy age and sex-matched control group. In both groups, we measured 13 endothelial biomarkers. Moreover, in the long COVID patients, we evaluated fatigue and dyspnea severity, lung diffusion capacity (DLCO), and the 6-min walk (6MWT) test as measures of functional capacity. Our results showed that markers of endothelial activation/dysfunction were higher in long COVID patients, and that soluble intracellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) negatively correlated with lung diffusion and functional capacity (sICAM-1 vs. DLCO, r = -0.306, p = 0.018; vs. 6MWT, r = -0.263, p = 0.044; and sVCAM-1 vs. DLCO, r= -0.346, p = 0.008; vs. 6MWT, r = -0.504, p < 0.0001). In conclusion, evaluating endothelial biomarkers alongside clinical tests might yield more specific insights into the pathophysiological mechanisms of long COVID manifestations.

Post-COVID-19 Syndrome and Related Dysautonomia: Reduced Quality of Life, Increased Anxiety and Manifestation of Depressive Symptoms: Evidence from Greece

Background

Post-COVID-19 syndrome affects a significant number of SARS-CoV-2 infected individuals, even in asymptomatic cases causing several neurological and neuropsychiatric symptoms and signs.

Materials and Methods

An online cross-sectional study with a convenience sample was conducted in Greece from November 2022 to January 2023. We measured the demographic and clinical characteristics of patients with post-COVID-19 dysautonomia in terms of the quality of life with the EQ-5D-3L, and anxiety and depressive symptoms by employing Patient Health Questionnaire-4.

Results

The study population included 122 patients with post-COVID-19 syndrome. One out of four patients (27.8%) manifested post-COVID-19 dysautonomia, while the mean duration of COVID-19 symptoms was 11.6 months. Anxiety and depressive symptoms were worse after the post-COVID-19 syndrome (p<0.001 in both cases). A statistically significant reduction in quality of life was observed among patients after the post-COVID-19 syndrome (p<0.001 for both EQ-5D-3L index value and EQ-5D-3L VAS). Post-COVID-19 dysautonomia increased depression symptoms after developing the post-COVID-19 syndrome (p=0.02). We found a negative relationship between the duration of COVID-19 symptoms and the quality of life (p<0.001). Moreover, our results showed that depressive symptoms were more common among females after the post-COVID-19 syndrome (p=0.01). Also, the quality of life was lower among females than males (p=0.004 for EQ-5D-3L index value, and p=0.007 for EQ-5D-3L VAS).

Conclusions

Our results suggest that post-COVID-19 syndrome causes a tremendous impact on the patients' quality of life and mental health. In addition, we found that the groups most psychologically affected were patients with post-COVID-19 dysautonomia, females, and patients with a longer duration of symptoms. Policy makers should assign priority rights to vulnerable groups in future psychiatric planning. Policy measures should focus on the mental health of post-COVID-19 patients who seem to be particularly vulnerable.

Endothelial Glycocalyx Integrity in Treatment-Naïve People Living with HIV before and One Year after Antiretroviral Treatment Initiation

Endothelial glycocalyx (EG) derangement has been associated with cardiovascular disease (CVD). Studies on EG integrity among people living with HIV (PLWH), are lacking. We conducted a prospective cohort study among treatment-naïve PLWH who received emtricitabine/tenofovir alafenamide, combined with either an integrase strand transfer inhibitor (INSTI, dolutegravir, raltegravir or elvitegravir/cobicistat), or a protease inhibitor (PI, darunavir/cobicistat). We assessed EG at baseline, 24 (±4) and 48 (±4) weeks, by measuring the perfused boundary region (PBR, inversely proportional to EG thickness), in sublingual microvessels. In total, 66 consecutive PLWH (60 (90.9%) males) with a median age (interquartile range, IQR) of 37 (12) years, were enrolled. In total, 40(60.6%) received INSTI-based regimens. The mean (standard deviation) PBR decreased significantly from 2.17 (0.29) μm at baseline to 2.04 (0.26) μm (p = 0.019), and then to 1.93 (0.3) μm (p < 0.0001) at 24 (±4) and 48 (±4) weeks, respectively. PBR did not differ among treatment groups. PLWH on INSTIs had a significant PBR reduction at 48 (±4) weeks. Smokers and PLWH with low levels of viremia experienced the greatest PBR reduction. This study is the first to report the benefit of antiretroviral treatment on EG improvement in treatment-naïve PLWH and depicts a potential bedside biomarker and therapeutic target for CVD in PLWH.

Integrating IoT Wearable Devices in Telemonitoring Platforms for Continuous Assisted Living Services

Assisted living services have become increasingly important in recent years as the population ages and the demand for personalized care rises. In this paper, we present the integration of wearable IoT devices in a remote monitoring platform for elderly people that enables seamless data collection, analysis, and visualization while in parallel, alarms and notification functionalities are provided in the context of a personalized monitoring and care plan. The system has been implemented using state-of-the-art technologies and methods to facilitate robust operation, increased usability and real-time communication. The user has the ability to record and visualise their activity, health and alarm data using the tracking devices, and additionally settle an ecosystem of relatives and informal carers to provide assistance daily or support in cases of emergencies.

Prevalence and risk factors of adverse effects after the first COVID-19 booster dose: evidence from Greece

Background

In general, COVID-19 vaccines are safe and effective, but minor adverse effects are common. However, adverse effects have not been measured in several countries including Greece.

Objective

To estimate the prevalence of adverse effects after the first COVID-19 booster dose, and to identify possible risk factors.

Material and methods

We conducted a cross-sectional study with a convenience sample in Greece during November 2022. We measured several adverse effects after the booster dose, such as fatigue, headaches, fever, chills, nausea, etc. We considered gender, age, chronic disease, self-assessment of health status, COVID-19 diagnóstico, and self-assessment of COVID-19 course as possible predictors of adverse effects.

Results

In our sample, 96% developed at least one adverse effect. Half of the participants (50.2%) developed one to five adverse effects, 35.9% developed six to ten adverse effects, and 9.5% developed 11 to 16 adverse effects. Mean number of adverse effects was 5.5. The most frequent adverse effects were pain at the injection site (84.3%), fatigue (70.8%), muscle pain (61%), swelling at the injection site (55.2%), headache (49.8%), fever (42.9%), and chills (41%). Females developed more adverse effects than males (p < 0.001). The prevalence of adverse effects of COVID-19 vaccines was statistically significant and positively associated with the severity of COVID-19 among COVID-recovered individuals (p < 0.05). Moreover, younger age was associated with increased adverse effects (p < 0.001).

Conclusions

Almost all participants in our study developed minor adverse effects after the booster dose. Female gender, COVID-19 patients with worse clinical course, and younger individuals experienced more often adverse effects.

Enriching Remote Monitoring and Care Platforms with Personalized Recommendations to Enhance Gamification and Coaching

Patients' remote monitoring platforms can be enhanced with intelligent recommendations and gamification functionalities to support their adherence to care plans. The current paper aims to present a methodology for creating personalized recommendations, which can be used to improve patient remote monitoring and care platforms. The current pilot system design is aimed to support patients by providing recommendations for Sleep, Physical Activity, BMI, Blood sugar, Mental Health, Heart Health, and Chronic Obstructive Pulmonary Disease aspects. The users, through the application, can select the types of recommendations they are interested in. Thus, personalized recommendations based on data obtained by the patients' records anticipated to be a valuable and a safe approach for patient coaching. The paper discusses the main technical details and provides some initial results.

MedSecurance Project: Advanced Security-for-Safety Assurance for Medical Device IoT (IoMT)

The MedSecurance project focus on identifying new challenges in cyber security with focus on hardware and software medical devices in the context of emerging healthcare architectures. In addition, the project will review best practice and identify gaps in the guidance, particularly the guidance stipulated by the medical device regulation and directives. Finally, the project will develop comprehensive methodology and tooling for the engineering of trustworthy networks of inter-operating medical devices, that shall have security-for-safety by design, with a strategy for device certification and certifiable dynamic network composition, ensuring that patient safety is safeguarded from malicious cyber actors and technology "accidents".

Effect of Different Early Oxygenation Levels on Clinical Outcomes of Patients Presenting in the Emergency Department With Severe Traumatic Brain Injury

STUDY OBJECTIVE

Despite the almost universal administration of supplemental oxygen in patients presenting in the emergency department (ED) with severe traumatic brain injury, optimal early oxygenation levels are unknown. Therefore, we aimed to examine the effect of different early oxygenation levels on the clinical outcomes of patients presenting in the emergency department with severe traumatic brain injury.

METHODS

We performed a secondary analysis of the Resuscitation Outcomes Consortium Traumatic Brain Injury Hypertonic Saline randomized controlled trial by including patients with Glasgow Coma Scale ≤8. Early oxygenation levels were assessed by the worst value of arterial partial pressure of oxygen (PaO₂) during the first 4 hours of presentation in the emergency department. The primary outcome was 6-month neurologic status, as assessed by the Extended Glasgow Outcome Scale. A binary logistic regression was utilized, and an odds ratio (OR) with 95% (95% confidence intervals) was calculated.

RESULTS

A total of 910 patients were included. In unadjusted (crude) analysis, a PaO₂ of 101 to 250 mmHg (OR, 0.59 [0.38 to 0.91]), or 251 to 400 mmHg (OR, 0.53 [0.34 to 0.83]) or ≥401 mmHg (OR, 0.31 [0.20 to 0.49]) was less likely to be associated with poor neurologic status when compared with a PaO₂ of ≤100 mmHg. This was also the case for adjusted analyses (including age, pupillary reactivity, and Revised Trauma Score).

CONCLUSION

High oxygenation levels as early as the first 4 hours of presentation in the emergency department may not be adversely associated with the long-term neurologic status of patients with severe traumatic brain injury. Therefore, during the early phase of trauma, clinicians may focus on stabilizing patients while giving low priority to the titration of oxygenation levels.

Screening for Depression in Cardiovascular Patients in Albania: Findings from the Country Check-Up Program

This is a retrospective study conducted in Vlora from January 2016 to April 2017 and the aim was to report the prevalence of depression in cardiovascular (CVD) patients. Depression assessment was done using the Patient Health Questionnaire (PHQ)-9 (PHQ-9). Data were derived from the patient records and the standard recommended cut-off point of PHQ-9 ≥ 10 was used. In total, data of 300 patients were analyzed. Depressive symptoms (PHQ-9 ≥ 10) were observed at 6% of the participants. Trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy and having little interest or pleasure in doing things were the most common symptoms reported. In multivariate analysis, only family status showed statistical significance. Unmarried (mean rank = 207.22) are more likely to have moderate or severe depression level (OR 3.529; C.I. 95% 1.017-12.238). Future research should focus on the needed actions after depression screening (i.e. referral, treatment etc.).

Exploiting Augmented Reality and Computer Vision for Healthcare Education: The Case of Pharmaceutical Substances Visualization and Information Retrieval

Augmented Reality (AR) is already used as the primary visualization and user interaction tool in several scientific and business areas. At the same time new AR technologies and frameworks considerably facilitate both the development of innovative applications and also their wide adoption in different domains of everyday life. In the area of healthcare AR solutions make use of mobile or wearable devices and glasses to support, among others, education and healthcare professionals training. The aim of this paper is to present a prototype mHealth app for education, which uses AR and computer vision technologies for pharmaceutical substances recognition on drug packaging. The conceptual design of the system includes three main components which are responsible for a) Text recognition, b) Drug identification and c) AR operations for interactivity. The prototype application is available in Android or iOS platforms and has been evaluated in real-world scenarios. Camera and screen of the mobile phones fulfill the text recognition and AR operations, which eliminates the need for special equipment, while PubChem and 3D Model databases provide assets required for the drug identification and AR visualizations. The results highlight the value of AR for educational purposes, especially when combined with advanced image recognition technologies to build interactive AR encyclopedias.

Investigating Diabetes Mellitus Patients' Experiences with Self Monitoring Blood Glucose Methods

Diabetes mellitus (DM) is a common metabolic disease characterized by high blood glucose levels, and it is considered as a modern global threat. Glucose monitoring is an important component of modern therapy for diabetes mellitus. Self-monitoring blood glucose (SMBG) by finger pricking or flash glucose monitoring (FGM) allows individual planning of treatment. The aim of this study was to investigate patients' experiences with self-monitoring blood glucose methods.

METHODS

A cross-sectional study was conducted using the Glucose Monitoring Experiences Questionnaire (GME-Q), consisted of 22 items with an overall score ranging from 1 to 5 (higher score indicates better experiences). The study included adult patients with diabetes mellitus type 1 (DM 1) or type 2 (DM 2).

RESULTS

Out of 253 participants (mean age, 56.4 years), 65.6% were suffering from DM type 2 and 34.4% from DM type 1, whereas 48.6% were using SMBG and 49.8% FGM. The mean score of convenience and effectiveness were higher in the group of patients using FGM, while SMBG found to be more discreet. The results of the analysis suggested that there was no relation between gender and effectiveness, discreetness or convenience of the method used for glucose monitoring. Furthermore, participants with diabetes type 2 reported higher "convenient" and "discreetness" score than patients with diabetes type 1. The analysis also indicated that there was no relation between the age of the participants and the effectiveness, discreetness and convenience of any glucose monitoring method.

CONCLUSIONS

Improved self-glucose monitoring experiences are an essential component to achieve effective management of patients suffering from both DM 1 and DM 2. More research should be conducted on the field of glucose monitoring experiences, related to the cost of the methods, the user's training and the ability to support insulin/diet calculations.

Investigating Diabetes Mellittus Impact on Various Aspects of Patients' Quality of Life

The aim of the study was to evaluate the quality of life (QoL) of patients with diabetes mellitus (DM) Methods: A cross-sectional study was conducted using the Audit of Diabetes-Depended Quality of Life (ADDQoL) questionnaire. The study included adult patients with diabetes mellitus type 1 (DM 1) or type 2 (DM 2). Results: A total of 253 patients were enrolled in the study. Despite the fact that the majority of participants stated a good QoL, DM has a negative impact on all 19 domains of ADDQoL. The greater negative impact referred to the domain "freedom to eat". There was no relation between overall score of QoL and age, gender or type of DM. On the contrary, we found statistically significant relation between age, gender, type of DM, presence of comorbidities and specific domains of Qol. Conclusions: Our findings, which are in accordance with the literature, highlight the great negative impact of DM on QoL of diabetics and they could be used by health professionals and policy makers to improve patients' well-being.

Intelligent Pervasive Monitoring Solution of COVID-19 Patients

The COVID-19 pandemic transforms the healthcare delivery models and accelerates the implementation and the adoption of telemedicine solutions at all levels of the healthcare system. Telehealth services ensure the continuity of care and treatment of both inpatients and outpatients during this pandemic, while reducing the spread of the virus through hospitals. The aim of this paper is to present an intelligent remote monitoring system with innovative data analytics features for COVID-19 patients. The i-COVID platform provides remote COVID-19 patients monitoring. The presented solution is addressed to patients with mild COVID-19 symptoms, as well as it can be used for post intensive-care monitoring. The platform offers advanced analytic capabilities using Proactive AI, to detect health condition deterioration, and automatically trigger personalized support workflows. Remote monitoring of COVID-19 patients using bio-sensors, seems to be an effective tool against the COVID-19 pandemic, as reduces the number of visits to patient screening centres and hospital admissions.

Using an Extended Technology Acceptance Model to Evaluate Digital Health Services

The evaluation of digital health services is concerned with assessing user satisfaction, improving the quality of health services and drawing useful conclusions regarding the factors that affect citizens' acceptance and intention to use digital health services. This paper proposes a model for evaluating a health digital service, that of, the Personal Health Insurance Record (PHIR), delivered by the Greek Organization for the Health Care Provision. The proposed model is based on the Technology Acceptance Model (TAM), enhanced with two additional factors: a) user satisfaction and b) safety-privacy. The analysis of the results highlighted that the intention to use is significantly affected by perceived usefulness, perceived ease of use, user satisfaction and safety-privacy. Parameters such as age and familiarity with the use of e-services also seem to determine the intention to use.

Open Source Web Application: An Application on Health Tourism in Greece

The purpose of this work is to enhance health tourism services for thermal sources in Greece. Within this research work, a website was developed to assist all interested people in searching for the appropriate thermal source for them. The content of the website is related to the health tourism ideas approach the historical foundation of health tourism and the alternative forms. The website was implemented based on the open-source CMS of Joomla. The server hosted by the CMS is based on open-source solutions such as Apache, MariaDB, and PHP.

3D Digital Printing in Healthcare: Technologies, Applications and Health Issues

3D Printing has a wide range of technologies and applications used in healthcare. In this work, a thorough literature review, concerning the last decade, was conducted in major bibliographic databases. The aim is to report the main applications and materials used in healthcare. In addition, this work tries to identify possible health issues due to particles emissions made by the 3D printing materials.

Using mHealth Technologies to Promote Public Health and Well-Being in Urban Areas with Blue-Green Solutions

European and International cities face crucial global geopolitical, economic, environmental, and other changes. All these intensify threats to and inequalities in citizens' health. The implementation of Blue-Green Solutions in urban and rural areas have been broadly used to tackle the above challenges. The Mobile health (mHealth) technologies contribution in people's well-being has found to be significant. In addition, several mHealth applications have been used to support patients with mental health or cardiovascular diseases with very promising results. The patients' remote monitoring can be a valuable asset in chronic diseases management for patients suffering from diabetes, hypertension or arrhythmia, depression, asthma, allergies and others. The scope of this paper is to present the specifications, the design and the development of a mobile application which collects health-related and location data of users visiting areas with Blue-Green Solutions. The mobile application has been developed to record the citizens' and patients' physical activity and vital signs using wearable devices. The proposed application can also monitor patients physical, physiological, and emotional status as well as motivate them to engage in social and self-caring activities. Additional features include the analysis of the patients' behavior to improve self-management. The "HEART by BioAsssist" application could be used as a health and other data collection tool as well as an "intelligent assistant" to monitor and promote patient's physical activity.

Gamification and Coaching in Remote Monitoring and Care Platforms

Nowadays, several e-health systems are equipped with advanced features for patients monitoring and care. Among these features, gamification and operations supporting the patients' adherence to therapeutic and care plans have been found to be quite useful and valuable. Among others, the introduction of intelligent patient coaching and the provisions of recommendations are very popular. The aim of this paper is to present specific gamification and coaching approaches that could be employed in the context of an existing eHealth system for remote monitoring and care for elders. The "Points, Badges and Leaderboards" gamification approach was followed. Specifically, parameters related to the application usage (daily points), the physical activity (number of daily steps), the sleep quality (sleep score) and other measurements (i.e. weight) were utilized to accommodate elders needs for motivation and engagement. Regarding the coaching, motivational messages and notification for the mobile devices were selected to deliver the relative information to the elders. A prototype health information system with a corresponding mobile application was adapted to include gamification and coaching features to motivate elders in order to achieve the maximum adherence on their monitoring and care health plans. The paper presents the design issues and summarizes the technical details.

Pervasive Monitoring of Public Health and Well-Being in Urban Areas with Blue-Green Solutions

The urban environment seems to affect the citizens' health. The implementation of Blue-Green Solutions (BGS) in urban areas have been used to promote public health and citizens well-being. The aim of this paper is to present the development of an mHealth app for monitoring patients and citizens health status in areas where BGS will be applied. The "HEART by BioAsssist" application could be used as a health and other data collection tool as well as an "intelligent assistant" to monitor and promote patient's physical activity in areas with Blue-Green Solutions.

Lactate and Lactate-to-Pyruvate Ratio in Critically Ill COVID-19 Patients: A Pilot Study

A limited number of coronavirus disease-19 (COVID-19) cases may require treatment in an intensive care unit (ICU). Arterial blood lactate levels are routinely measured in the ICU to estimate disease severity, predict poor outcomes, and monitor therapeutic handlings. A number of studies have suggested that, simultaneously with lactate, pyruvate should also be measured, providing augmented prognostic ability, and a better understanding of the underlying metabolic alterations in ICU patients. Hence, the aim of the present study was to elucidate the relationship between lactate levels and the lactate-to-pyruvate (LP) ratio with the clinical outcome in mechanically ventilated COVID-19 patients. Lactate and pyruvate were serially measured during the first 24 h of ICU stay. A group of ICU non-COVID-19 patients was used as a comparison group. The majority of COVID-19 patients (82.5%) had normal lactate levels and a normal LP ratio on ICU admission (normal metabolic pattern). A small, yet significant, percentage of patients had either elevated lactate levels or a high LP ratio (abnormal metabolic pattern); these patients exhibited a significantly higher risk of ICU mortality compared to the patients with a normal metabolic pattern (72.7% vs. 34.6%, p = 0.04). In our critically ill COVID-19 patients, elevated lactate levels or high LP ratios on admission to the ICU could be associated with poor clinical outcome.

Quantifying Citizens' Well-Being in Areas with Natural Based Solutions Using Mobile Computing

Urban planners, architects and civil engineers are integrating Nature-Based Solutions (NBS) to address contemporary environmental, social, health and economic challenges. Many studies claim that NBS are poised to improve citizens' well-being in urban areas. NBS can also benefit Public Health, as they can contribute to optimising environmental parameters (such as urban heat island effects, floods, etc.), as well as to the reduction of diseases, as for example cardiovascular ones and the overall mortality rate. In addition, the usage of mobile health (mHealth) solutions has been broadly applied to support citizens' well-being as they can offer monitoring of their physical and physiological status and promote a healthier lifestyle. The aim of this paper is to present the specifications, the design and the development of a mobile app for monitoring citizens' well-being in areas where NBS have been applied. The users' physical activity and vital signs are recorded by wearable devices and the users' locations are recorded by the proposed mobile application. All collected data are transferred to the cloud platform where data management mechanisms aggregate data from different sources for combined analysis. The mobile application is currently available for Android and iOS devices and it is compatible with most smart devices and wearables. The "euPOLIS by BioAssist" application can be used as a health and other data collection tool to investigate citizen's well-being improvement in areas with NBS.

Chios Hospital Information System Assessment

A very important aspect for organizations that provide healthcare services is to have fully functional and successful information systems. A successful hospital information system can contribute to high quality healthcare services provided to the patients of the hospital. In this paper, is presented the evaluation of the information system of Chios Hospital, "Skylitsio". The survey was conducted using a questionnaire which consists demographic questions and questions that measure the factors of the DeLone & McLean success model. The participants of the survey were 71 users of the clinical information system. Cronbach's alpha reliability test, descriptive statistics, and further data analyses to investigate the relations between the factors of the DeLone & McLean success model were performed. Based on the results, the users of the information system are satisfied with it, as well as they find the system useful and easy to use. The average value of the "information quality" is 3.78 out of 5, the "system quality" is 3.61, the "service quality" is 3.45, the "use" is 3.83, the "user satisfaction" is 3.46, and the "user benefit" is 3.76. The research concludes with a validation of the DeLone & McLean success model and it seems that the information system of the General Hospital of Chios is successful based on the users' opinions.

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) Could Provide Better Accuracy Than Creatinine in Predicting Acute Kidney Injury Development in Critically Ill Patients

Acute kidney injury (AKI) is one of the most common complications in critically ill patients. In recent years, studies have focused on exploring new biomarkers for the early diagnosis and prognosis of AKI. The aim of this study was to investigate serum prognostic biomarkers (neutrophil gelatinase-associated lipocalin, NGAL, and creatinine) of AKI in critically ill patients. The study included 266 critically ill, initially nonseptic, patients admitted to a multidisciplinary ICU. Serum levels of NGAL and creatinine were measured at ICU admission. ROC curves were generated to estimate the prognostic value of the biomarkers, while a logistic regression analysis was performed to assess their association with an increased AKI risk. Patients were divided in two groups based on the development (n = 98) or not (n = 168) of AKI during their ICU stay. Serum NGAL levels at ICU admission were significantly higher in those who subsequently developed AKI compared to those who did not (p < 0.0001). NGAL was shown to be more accurate in predicting AKI development than creatinine; furthermore, NGAL levels were associated with an increased risk of AKI development (1.005 (1.002–1.008), p < 0.0001). In the present study, we were able to demonstrate that increased serum NGAL levels at ICU admission might be predictive of AKI development during ICU hospitalization. Further studies are needed to support NGAL as a prognostic marker of acute kidney injury.

An Online Information Tool for Diabetic Retinopathy

Regardless of the type of diabetes, patients with diabetes are 25 times more likely to develop vision problems or even blindness than non-diabetics. Diabetic Retinopathy is the most common cause of new cases of blindness in adults. The aim of this paper is to present a pilot online tool to provide information regarding the Diabetic Retinopathy. The tool was developed using a Content Management System. To compile the content of the website, a literature review was conducted. The online information tool is addressed to all potential stakeholders on this subject, for the provision of knowledge and targeted information according to their information needs. The online tool also aims to raise the public awareness about the Diabetic Retinopathy and health promotion.

Could Soluble Endothelial Protein C Receptor Levels Recognize SARS-CoV2-Positive Patients Requiring Hospitalization?

INTRODUCTION

The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in COVID-19 has not been explored. In this study, we investigated whether sEPCR levels were related to COVID-19 patients' requirement for hospitalization.

METHODS

Plasma sEPCR levels were measured on hospital admission in 84 COVID-19 patients, and in 11 non-hospitalized SARS-CoV2-positive patients approximately 6 days after reported manifestation of their symptoms. Multiple logistic regression analysis was performed to identify potential risk factors for hospitalization and receiver operating characteristic (ROC) curves were generated to assess their value.

RESULTS

In our cohort, hospitalized patients had considerably higher sEPCR levels upon admission compared with outpatients [107.5 (76.7-156.3) vs. 44.6 (12.1-84.4) ng/mL; P < 0.0001)]. The ROC curve using hospitalization as the classification variable and sEPCR levels as the prognostic variable generated an area under the curve at 0.845 (95% CI = 0.710-0.981, P < 0.001). Additionally, we investigated the predictive value of sEPCR combined with BMI, age, or D-dimers.

CONCLUSIONS

In our cohort, sEPCR levels in COVID-19 patients upon hospital admission appear considerably elevated compared with outpatients; this could lead to impaired APC activities and might contribute to the pro-coagulant phenotype reported in such patients. sEPCR measurement might be useful as a point-of-care test in SARS-CoV2-positive patients.

Evaluating the Role of the Interleukin-23/17 Axis in Critically Ill COVID-19 Patients

Studies have hypothesized a potential role of the interleukin (IL)-23/17 axis in coronavirus disease 2019 (COVID-19). However, to date, levels of IL-23 and 17 have not been compared between critically ill COVID-19 patients and critically ill non-COVID-19 patients. IL-23 and 17 were measured on admission to the intensive care unit (ICU) in critically ill COVID-19 (N = 38) and critically ill non-COVID-19 (N = 34) patients with an equal critical illness severity. Critically ill non-COVID-19 patients did not have sepsis or septic shock on ICU admission. None of the enrolled patients had previously received corticosteroids. In our study, circulating IL-17 levels were higher in the COVID-19 patients. More specifically, critically ill COVID-19 patients had levels of 0.78 (0.05-1.8) pg/mL compared to 0.11 (0.05-0.9) pg/mL in the critically ill non-COVID-19 patients (p = 0.04). In contrast, IL-23 levels were comparable between groups. A group of patients hospitalized in the specialized COVID-19 clinic (N = 16) was also used to evaluate IL-17 and IL-23 levels with respect to COVID-19 severity. Non-critically ill COVID-19 patients had undetectable levels of both cytokines. Our results support the notion of inhibiting IL-17 in critical COVID-19 infection.

Soluble Angiotensin Converting Enzyme 2 (ACE2) Is Upregulated and Soluble Endothelial Nitric Oxide Synthase (eNOS) Is Downregulated in COVID-19-induced Acute Respiratory Distress Syndrome (ARDS)

A damaged endothelium is an underlying condition of the many complications of COVID-19 patients. The increased mortality risk associated with diseases that have underlying endothelial dysfunction, such as acute respiratory distress syndrome (ARDS), suggests that endothelial (e) nitric oxide synthase (NOS)-derived nitric oxide could be an important defense mechanism. Additionally, intravenous recombinant angiotensin converting enzyme 2 (ACE2) was recently reported as an effective therapy in severe COVID-19, by blocking viral entry, and thus reducing lung injury. Very few studies exist on the prognostic value of endothelium-related protective molecules in severe COVID-19 disease. To this end, serum levels of eNOS, inducible (i) NOS, adrenomedullin (ADM), soluble (s) ACE2 levels, and serum (s) ACE activity were measured on hospital admission in 89 COVID-19 patients, hospitalized either in a ward or ICU, of whom 68 had ARDS, while 21 did not. In our cohort, the COVID-19-ARDS patients had considerably lower eNOS levels compared to the COVID-19 non-ARDS patients. On the other hand, sACE2 was significantly higher in the ARDS patients. iNOS, ADM and sACE activity did not differ. Our results might support the notion of two distinct defense mechanisms in COVID-19-derived ARDS; eNOS-derived nitric oxide could be one of them, while the dramatic rise in sACE2 may also represent an endogenous mechanism involved in severe COVID-19 complications, such as ARDS. These results could provide insight to therapeutical applications in COVID-19.

Endothelial, Immunothrombotic, and Inflammatory Biomarkers in the Risk of Mortality in Critically Ill COVID-19 Patients: The Role of Dexamethasone

Endothelial dysfunction, coagulation and inflammation biomarkers are increasingly emerging as prognostic markers of poor outcomes and mortality in severe and critical COVID-19. However, the effect of dexamethasone has not been investigated on these biomarkers. Hence, we studied potential prognostic biomarkers of mortality in critically ill COVID-19 patients who had either received or not dexamethasone. Biomarker serum levels were measured on intensive care unit (ICU) admission (within 24 h) in 37 dexamethasone-free and 29 COVID-19 patients who had received the first dose (6 mg) of dexamethasone. Receiver operating characteristic (ROC) curves were generated to assess their value in ICU mortality prediction, while Kaplan-Meier analysis was used to explore associations between biomarkers and survival. In the dexamethasone-free COVID-19 ICU patients, non-survivors had considerably higher levels of various endothelial, immunothrombotic and inflammatory biomarkers. In the cohort who had received one dexamethasone dose, non-survivors had higher ICU admission levels of only soluble (s) vascular cell adhesion molecule-1 (VCAM-1), soluble urokinase-type plasminogen activator receptor (suPAR) and presepsin. As determined from the generated ROC curves, sVCAM-1, suPAR and presepsin could still be reliable prognostic ICU mortality biomarkers, following dexamethasone administration (0.7 < AUC < 0.9). Moreover, the Kaplan-Meier survival analysis showed that patients with higher than the median values for sVCAM-1 or suPAR exhibited a greater mortality risk than patients with lower values (Log-Rank test, p < 0.01). In our single-center study, sVCAM-1, suPAR and presepsin appear to be valuable prognostic biomarkers in assessing ICU mortality risk in COVID-19 patients, even following dexamethasone administration.

Knowledge and Perceptions of Undergraduate and Postgraduate Nursing Students About the Use of 3D Digital Printing in Healthcare

3D printing is applicable in various fields. The purpose of this study was to explore the knowledge and perceptions of undergraduate and postgraduate nursing students in relation to the use of 3D printing. A questionnaire was developed including questions about demographics, the students' knowledge about, and the student's attitude towards the 3D printing technology. Descriptive statistics and correlations were examined. The average knowledge score was 2.6 out of 6 and the perception score was 7.7 out of 10. Only gender was found to be related with 3D printing knowledge. Gender, age, and educational level were related with students' attitude towards 3D printing.

ICU Admission Levels of Endothelial Biomarkers as Predictors of Mortality in Critically Ill COVID-19 Patients

Endotheliopathy is suggested to be an important feature of COVID-19 in hospitalized patients. To determine whether endotheliopathy is involved in COVID-19-associated mortality, markers of endothelial damage were assessed in critically ill COVID-19 patients upon intensive care unit (ICU) admission. Thirty-eight critically ill COVID-19 patients were included in this observational study, 10 of whom died in the ICU. Endothelial biomarkers, including soluble (s)E-selectin, sP-selectin, angiopoietin 1 and 2 (Ang-1 and Ang-2, respectively), soluble intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF), soluble vascular endothelial (VE)-cadherin, and von Willebrand factor (vWf), were measured upon ICU admission. The ICU cohort was subsequently divided into survivors and non-survivors; Kaplan-Meier analysis was used to explore associations between biomarkers and survival, while receiver operating characteristic (ROC) curves were generated to determine their potential prognostic value. sE-selectin, sP-selectin, Ang-2, and sICAM-1 were significantly elevated in ICU non-survivors compared to survivors, and also associated with a higher mortality probability in the Kaplan-Meier analysis. The prognostic values of sE-selectin, Ang-2, and sICAM-1 from the generated ROC curves were greater than 0.85. Hence, we conclude that in our cohort, ICU non-survivors had higher levels of specific endothelial markers compared to survivors. Elevated levels of these markers upon ICU admission could possibly predict mortality in COVID-19.

Citizens' Opinions About a Digital Health Insurance Record

An Electronic Health Insurance Record (EHIR) could give all the information needed to the insured citizens, informing them about the history of benefits and the health expenses. The aim of this work is to evaluate a Digital Health Insurance Record system as well as to explore the benefits of using this system, both for society and for each citizen individually. A quantitative survey was carried out using a questionnaire shared among 180 people in Greece in 2019. The questionnaire consisted of 25 closed-ended questions, 3 of which related to demographics and the remaining 22 related to the use and benefits of use of the EHIR system. Most of all people who took part in this study believe that EHIR can contribute positively giving both social benefits and benefits for the patients. An important finding of the study is the concern expressed by respondents about the security of the system in the management of sensitive personal data. Based on citizens' opinions a Digital Health Insurance Record can provide a lot of benefits to citizens and to the society as well as to the national health insurance system.

The Drug Addicts' Usage of Information and Communication Technologies

Information and Communication Technologies (ICT) are broadly used to support people's daily needs. Individuals addicted to psychoactive drugs sometimes present social exclusion as well as, limitations to the usage of ICT such as Internet, devices and applications. The aim of this paper is to present the findings of a pilot study related to the use of Information and Communication Technologies by Drug Addicts. A survey was conducted on 204 users of psychoactive substances. According to the results, the majority of the drug addicts seem to use ICT on a daily basis, showing their preference on Smartphones compared to other devices. The Internet access and the usage of Social Media and Communication Networks by addicted individuals is quite high, probably because they are willing to reintegrate into the society through Social Networks. Age is often related to the usage of ICT on Drug Addicts.

The Dissemination and Communication Plan and Activities of the CrowdHEALTH Project: "Collective Wisdom Driving Public Health Policies"

Determining the dissemination and communication plans and activities of research projects is an important part for transferring research outputs to the target audience. This paper presents the dissemination and communication plans and activities of the CrowdHEALTH project. Towards this end, the methodology and results are presented in this paper.

Sun4Patients Web Platform: Facilitating Long-Term Monitoring of Stroke Patients

SUN4Patients is an observational study for the monitoring of patients with first ever acute stroke. For the support of this study, an online platform has been developed which facilitates the collection of various information related to hospital discharge, health services utilization and loss of productivity of the patients. This paper presents the main characteristics of the platform and the methodology followed for its design and implementation.

Determining and Evaluating the Dissemination and Exploitation Plans and Activities for the CrowdHEALTH Project: The Role of the Impact Creation Board

Determining and evaluating the dissemination and exploitation plans and activities of research projects can be a challenging task. This paper presents an overview of the role of the Impact Creation Board in the identification and assessment of the dissemination and exploitation plan and activities for the CrowdHEALTH project "Collective wisdom driving public health policies". Towards this end, a stepwise methodology was applied and the feedback from the Impact Creation Board members, and results of each step were analyzed and shared with the consortium.

An Online Prevention Tool for Ophthalmological Disorders

The information of the general population regarding the prevention of eye diseases is crucial. This work presents the design and development of an online prevention tool for the information and education of the general population about ophthalmological diseases. A literature review was conducted for the collection of all necessary and up-to-date information regarding the diseases selected. The phases of requirement analysis, design, development and evaluation were followed. The online tool developed, proved to accomplish the aims of usability and usefulness in the prevention of eye diseases and their complications.

Physicians' and Pharmacists' Opinions Regarding the e-Prescription Systems

The e-Prescription systems are modern and efficient prescribing tools which can affect the quality of the healthcare services. The aim of this study is to evaluate the e-Prescription systems in Greece based the users' opinions. The survey was conducted in 2019 among 157 randomly selected healthcare profesionals through an on-line survey tool. The 51.2% of the sample were pharmacists and 48.8% physicians. 80.7% believe that the e-Prescription systems are reliable. More than the half of the professionals has the view that the e-Prescription systems are useful. Regarding to the ease of use, the e-Prescription systems, seem to can not fulfill sufficiently the participants' requirements.

How to Extract and Explore Big Data for Fraud Detection in the Healthcare Sector: The EOPYY Case Study

Big Data technologies can contribute to medical fraud detection. The aim of this paper is to present the methodological approach of the Hellenic National Organization for the Provision of Health Services (EOPYY) in data analysis to detect financial or medical fraud. To analyze the data for fraud detection, a selection of prescription data from the year 2018 were examined. The Local Correlation Integral algorithm was applied to detect any outliers on the dataset. The results revealed that 7 out of 879 cases could be characterized as outliers. These outliers must be further investigated to determine if they have been associated with fraud. According to the results of this study, this outliers' detection approach can support and help the fraud detection process conducted by the auditing services in Healthcare sector.

Health in All Policy Making Utilizing Big Data

INTRODUCTION

Health in all Policies (HiAP) is a valuable method for effective Healthcare policy development. Big data analysis can be useful to both individuals and clinicians so that the full potential of big data is employed.

AIM

The present paper deals with Health in All Policies, and how the use of Big Data can lead and support the development of new policies.

METHODS

To this end, in the context of the CrowdHEALTH project, data from heterogeneous sources will be exploited and the Policy Development Toolkit (PDT) model will be used. In order to facilitate new insights to healthcare by exploiting all available data sources.

RESULTS

In the case study that is being proposed, the NOHS Story Board (inpatient and outpatient health care) utilizing data from reimbursement of disease-related groups (DRGs), as well as medical costs for outpatient data, will be analyzed by the PDT.

CONCLUSION

PDT seems promising as an efficient decision support system for policymakers to align with HiAP as it offers Causal Analysis by calculating the total cost (expenses) per ICD-10, Forecasting Information by measuring the clinical effectiveness of reimbursement cost per medical condition, per gender and per age for outpatient healthcare, and Risk Stratification by investigating Screening Parameters, Indexes (Indicators) and other factors related to healthcare management. Thus, PDT could also support HiAP by helping policymakers to tailor various policies according to their needs, such as reduction of healthcare cost, improvement of clinical effectiveness and restriction of fraud.

Disseminating Research Outputs: The CrowdHEALTH Project

INTRODUCTION

Dissemination benefits come from the outputs integration and implementation by the key audience, who will also determine the relevance and usability of the disseminated content.

AIM

One of the CrowdHEALTH project's objectives is the transition from patient health records towards the Holistic Health Records (HHRs) and Social HHR. The CrowdHEALTH project aims at integrating high volumes of health-related data collected from various sources to support policy-making decisions.

METHODS

The European Federation for Medical Informatics (EFMI) supports the development of an effective Communication and Collaboration Plan identifying the messages, the tools and channels in disseminating the project and its outcomes to the target audience based on the McGuire approach.

RESULTS

The process for defining the dissemination strategy is a cyclic one as shown in the following figure involving review of each step periodically The next step was to define the four dimension dissemination approach based on McGuire attributes of persuasive communication. The objectives, target groups, key messages, the tools and channels where defined at this stage.

CONCLUSION

The CrowdHEALTH project and its outcomes were disseminated with a variety of tools and channels such as scientific journals, conferences, exhibitions and social media communication.

Disseminating Research Findings: The Crowdhealth Paradigm

The CrowdHEALTH project intends to integrate high volumes of health-related heterogeneous data from multiple sources with the aim of supporting policy making decisions. The European Federation of Medical Informatics supports the development of an effective Communication and Collaboration Plan.A dissemination strategy has been applied for this purpose considering appropriate messages, target audience, tools, and channels to achieve the highest impact and the first results of social media dissemination are presented here.

Measuring the Intention of Using Augmented Reality Technology in the Health Domain

Augmented Reality technology can provide useful tools and devices to support healthcare services. The aim of this study is to investigate the intention of IT and health care scientists' to use Augmented Reality technology in Healthcare. A survey was conducted using a questionnaire based on a theoretical research model. According to the results, the participants seem to have positive perception about using the Augmented Reality technology in health domain, and they intend to use it.