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This paper studies the robust bipartite consensus problems for heterogeneous nonlinear nonaffine discrete-time multi-agent systems (MASs) with fixed and switching topologies against data dropout and unknown disturbances. At first, the controlled system's virtual linear data model is developed by employing the pseudo partial derivative technique, and a distributed combined measurement error function is established utilizing a signed graph theory. Then, an input gain compensation scheme is formulated to mitigate the effects of data dropout in both feedback and forward channels. Moreover, a data-driven learning-based robust bipartite consensus control (LRBCC) scheme based on a radial basis function neural network observer is proposed to estimate the unknown disturbance, using the online input/output data without requiring any information on the mathematical dynamics. The stability analysis of the proposed LRBCC approach is given. Simulation and hardware testing also illustrate the correctness and effectiveness of the designed method.

BackgroundAround 30% of cancer survivors suffer from chemotherapy-induced peripheral neuropathy (CIPN) ≥6 months after completion of chemotherapy, which comes with limitations in daily functioning and worsened quality of life(QoL). Treatment options are scarce. Our aim was to develop an online self-help intervention based on Acceptance and Commitment Therapy (ACT) to reduce pain interference in cancer survivors experiencing painful chronic CIPN.Material and methodsThis article applied a patient-centered design process using the Center for eHealth Research (CeHRes) roadmap. User needs were examined using online semi-structured interviews with patients and experts (N = 23). Interviews were transcribed verbatim and analyzed using thematic analysis. Personas were created based on interviews. Intervention content was based on identified user needs and ACT. Content and design were finalized using low-fidelity prototype testing (N = 5), and high-fidelity prototype testing (N = 7).ResultsPatients appreciated and agreed with the elements of ACT, had varying guidance needs, and wanted to have autonomy (e.g., moment and duration of use). Additionally, it was important to be aware that patients have had a life-threatening disease which directly relates to the symptoms they experience. Patients reported to prefer a user-friendly and accessible intervention. Similar points also emerged in the expert interviews. The final intervention, named Embrace Pain, includes six sessions. Session content is based on psychoeducation and all ACT processes. Further interpretation of the intervention (such as quotes, guidance, and multimedia choices) is based on the interviews.ConclusionThis development demonstrated how a patient-centered design process from a theoretical framework can be applied. Theory-driven content was used as the basis of the intervention. Findings show an online ACT intervention designed for cancer survivors with painful chronic CIPN.

OBJECTIVE eHealth has growing potential to enhance access to HIV prevention for hard to reach populations, including young Latino immigrant men who have sex with men (MSM) in the United States. We examined the feasibility and acceptability of using eHealth tools, specifically social media platforms, to facilitate HIV testing and pre-exposure prophylaxis (PrEP) uptake among this population. DESIGN We utilized a community sensitive approach to conduct 30 in-depth interviews and five focus groups with young Latino immigrant MSM in Seattle, WA. Data were analyzed using thematic analysis with both data-driven inductive and a priori deductive approaches. RESULTS Participants were open to receiving HIV information via social media platforms. Participants recommended that social media content be tailored with their language preferences, cultural norms, and beliefs about HIV testing and PrEP in mind. Further, participants emphasized that content avoid stigmatizing HIV or Latino MSM's complex identities. CONCLUSIONS Results have implications for utilizing social media platforms and developing HIV prevention interventions for Latino immigrant MSM. Findings highlight that HIV prevention content should acknowledge how identities as an emerging adult, Latino, immigrant, and MSM, warrant unique consideration.

The development of ehealth applications is a complex task, not only in technological terms, but also in the understanding of both the users' needs, expectations and contexts, and the business models. Therefore, initial conceptual validations might be essential to verify whether the proposed solutions are adequate, sustainable, and worth to be developed. The study reported by this paper applied the nominal group technique to verify the potential suitability and sustainability of a diverse set of ehealth applications to support older adults. The study identified a set of transversal advantages (i.e., promotion of active and healthy, integrated care, and healthcare equity) and barriers (i.e., contextual, personal, and development and deployment barriers. As a conclusion, the nominal group technique was adequate for the conceptual validation of the proposed ehealth solutions and provided comprehensive information about issues that must be carefully considered during the development of these solutions to assure their viability and to reduce research waste. published

In this article, we contrast policy understandings of digital care with older people’s day-to-day digital care. In doing so, we discuss problems relating to deterministic approaches in government policy. Our policy analysis shows that digital care is articulated as an individual practice, and digital technologies as static actors. This bears clear marks of techno-deterministic reasoning. Our ethnographic study demonstrates the ongoing and collective character of older people’s digital care. When policy is not aligned with everyday practice, there is a risk of excluding groups of users. We argue that a socio-technical approach in government policy could contribute to achieving important societal goals.

The present article throws light on advancement in ICTs. It is an evident that highly intelligent and smart IoT based use cases are possible with the advent in ICTs like Internet of Things, 5G Cellular Technology and Cyber- Physical Systems (CPS). For an instance, people spend considerable amount of their earning towards health in the present scenario. In view of this, there is high- impact- on society use case in Healthcare as IoT enables Ambient Assisted Living (AAL), Mobile Health (mHealth) and Electronic Health (eHealth). The conventional healthcare services are prone to delay, wastage of time and money, besides causing death of people. With intelligence and prediction capabilities of IoT, Remote Patient Monitoring (RPM) on regular basis (home/office/in-hospital), for those who deliberately need it, can be exploited to overcome challenges thrown by conventional healthcare units. IoT based RPM with wearable devices, sensor network and other digital infrastructure form an early warning system for impending emergencies that lead to severe health issues and even death of patients is left untreated or even treatment is delayed. It is proposed that a secure and privacy preserving IoT integration with healthcare units for realizing a reliable, available and secure RPM system at the conclusion. The proposed system provides secure RFID based authentication, end-to-end secure communications and privacy protection. The system includes MOTO 360 watch (biosensor | body sensor) with Android wearable OS, server with REST framework and a smart phone application to monitor and detect fall, blood pressure and heart rate. This motivating scenario is enriched with security and privacy. The empirical evaluation revealed that the proposed RPM has potential to help improve quality of life and healthcare services

Health Informatics (HI) and Information Technology (IT) have enormous potential to improve healthcare quality in countries around the world. A literature review was used to conduct a situational analysis of the use of HI and IT in Botswana's health sector. According to research, there is a significant gap in the available information on the status of HI and the challenges that affect Botswana's healthcare sector. As technology evolves, a frequent situation analysis is required to remedy or improve on challenges encountered during development and implementation, particularly in the health sector. The current study explores present status of HI and IT in Botswana's healthcare system as well as successes, opportunities and challenges faced in the development of e-Health and HI in Botswana. An extensive literature review was carried out to provide a conceptual background of e-Health and HI in Botswana. The paper provides incalculable data on e-Health and HI in Botswana that will be useful in informing future studies, policies and developments in the field of HI and e-Health in Botswana and other developing countries., Sağlık bilişimi ve teknolojisi, küresel düzeyde ülkelerin sağlık hizmetlerinin kalitesini sağlamada büyük bir potansiyele sahiptir. Bu çalışma Botsvana'nın sağlık sektöründe sağlık bilişimi ve bilgi teknolojisi kullanımının durum analizi, literatür taraması yoluyla gerçekleştirilmiştir. Araştırmalar, sağlık bilişiminin durumu ve Botsvana sağlık sektöründe karşılaşılan zorluklar hakkında mevcut bilgilerde büyük bir boşluk olduğunu göstermektedir. Teknoloji geliştikçe, özellikle sağlık sektöründe bu tür uygulamaların geliştirilmesi ve uygulanması sırasında karşılaşılan zorlukların giderilmesi veya iyileştirilmesi için sık sık durum analizi yapılması gerekmektedir. Mevcut çalışma, Botsvana'nın sağlık sisteminde sağlık bilişimi ve e-sağlığın mevcut durumunu ve ayrıca Botsvana'da e-sağlık ve sağlık bilişiminin geliştirilmesinde karşılaşılan başarıları, fırsatları ve zorlukları araştırmaktadır. Botsvana'da e-sağlık ve sağlık bilişiminin kavramsal bir arka planını sağlamak için kapsamlı bir literatür taraması yapılmıştır. Bu makale, Botsvana'da ve diğer gelişmekte olan ülkelerde sağlık bilişimi ve e-sağlık alanındaki gelecekteki çalışmalara ve gelecekteki gelişmelere bilgi vermede faydalı olacak, Botsvana'daki e-sağlık ve sağlık bilişimi hakkında değerli veriler sunmaktadır.

Objectives: Patients’ experiences are increasingly gaining interest in multiple research fields. Researchers have applied various approaches to studying patient experience (PX); however, there is no commonly agreed-upon definition of PX. This scoping review focuses on PX from an eHealth perspective. Our aim was to: 1) describe how PX has been defined, 2) investigate which factors influencing PX and components of PX have been identified and researched, 3) explore the methods used in studying PX, and 4) find out the recent trends in PX research from an eHealth perspective. Methods: We selected six major journals covering the fields of health informatics, PX, and nursing informatics. Using the search terms “patient experience” and technology-related terms (e.g., digital, eHealth), we searched for articles published between 2019 and 2021. From 426 articles, 44 were included in the analysis. Results: Multiple concepts and meanings are used to refer to PX. Few articles include vague descriptions of the concept. Numerous eHealth factors are influencing PX, as well as components considering PX. The influencing factors were related to eHealth solutions’ type and quality, and care process, when the components of PX were related to communication, remote interaction, risks and concerns, and patients’ attitudes towards telehealth. Surveys were the main method used to study PX, followed by interviews. Conclusions: PX is a complex and multifaceted phenomenon, and it is described as a synonym for patient satisfaction and telehealth experiences. Further multidisciplinary research is needed to understand PX as a phenomenon and to outline a framework for the research.

Health professionals are able to improve the care quality of chronic wounds by monitoring and reporting the wound status. Resorting to visual representations of wound status enhances comprehension by facilitating knowledge transfer to all stakeholders. However, selecting appropriate healthcare data visualisations is a critical challenge and healthcare platforms must be designed to meet their users’ needs and constraints. This article describes the methods used to identify the design requirements and inform the development of a wound monitoring platform through a user-centred approach.

Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other’s professional vocabulary, engaging the older adults, and using technology within the patient’s environment. Further research is needed to integrate IPC components in a technological solution

Background Electronic visits (e-visits) are billable, asynchronous patient-initiated messages that require at least five minutes of medical decision-making by a provider. Unequal use of patient portal tools like e-visits by certain patient populations may worsen health disparities. To date, no study has attempted to qualitatively assess perceptions of e-visits in older adults. Objective In this qualitative study, we aimed to understand patient perceptions of e-visits, including their perceived utility, barriers to use, and care implications, with a focus on vulnerable patient groups. Methods We conducted a qualitative study using in-depth structured individual interviews with patients from diverse backgrounds to assess their knowledge and perceptions surrounding e-visits as compared with unbilled portal messages and other visit types. We used content analysis to analyze interview data. Results We conducted 20 interviews, all in adults older than 65 years. We identified 4 overarching coding categories or themes. First, participants were generally accepting of the concept of e-visits and willing to try them. Second, nearly two-thirds of the participants voiced a preference for synchronous communication. Third, participants had specific concerns about the name “e-visit” and when to choose this type of visit in the patient portal. Fourth, some participants indicated discomfort using or accessing technology for e-visits. Financial barriers to the use of e-visits was not a common theme. Conclusions Our findings suggest that older adults are generally accepting of the concept of e-visits, but uptake may be limited due to their preference for synchronous communication. We identified several opportunities to improve e-visit implementation.

Background A very low–carbohydrate (VLC) nutritional strategy may improve glycemic control and weight loss in adults with type 2 diabetes (T2D). However, the supplementary behavioral strategies that might be able to improve outcomes using this nutritional strategy are uncertain. Objective This study aims to compare the impact of adding 3 different supplementary behavioral strategies to a web-based VLC diet intervention. To our knowledge, this is the first trial to randomize participants to different frequencies of dietary self-monitoring. Methods The study included 112 overweight adults with T2D (hemoglobin A1c ≥6.5%) taking no antiglycemic medications or only metformin. They received a remotely delivered 12-month VLC diet intervention. Participants were randomly assigned through a full factorial 2×2×2 design to supplementary strategies: either daily or monthly dietary self-monitoring, either mindful eating training or not, and either positive affect skills training or not. Our research goal was to determine whether 3 different supplemental strategies had at least a medium effect size (Cohen d=0.5). Results Overall, the VLC intervention led to statistically significant improvements in glycemic control (−0.70%, 95% CI −1.04% to −0.35%; P Conclusions Overall, our results support the use of a VLC diet intervention in adults with T2D. The addition of monthly (not daily) dietary self-monitoring, mindful eating, and positive affect skills training did not show a definitive benefit, but it is worth further testing. Trial Registration ClinicalTrials.gov NCT03037528; https://clinicaltrials.gov/ct2/show/NCT03037528

Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other’s professional vocabulary, engaging the older adults, and using technology within the patient’s environment. Further research is needed to integrate IPC components in a technological solution

Contains fulltext : 290956.pdf (Publisher’s version ) (Open Access) BACKGROUND: Adolescents and young adults (AYAs) diagnosed with cancer fulfill their cancer-related information needs often via the Internet. Healthcare professionals (HCPs) have a crucial role in guiding patients in finding appropriate online information and eHealth sources, a role that is often overlooked. Misperceptions of AYAs' needs by HCPs may lead to suboptimal guidance. We aimed to examine the extent to which AYAs' online information and eHealth needs corresponded with HCPs' perceptions of these needs. METHODS: Two cross-sectional online surveys (AYAs, n = 299; HCP, n = 80) on online information and eHealth needs were conducted. HCPs provided indications of their perceptions of AYA's needs. RESULTS: AYAs reported significantly more online information needs compared with HCPs' perceptions regarding: survival rates (AYA = 69%, HCP = 35%, p

Electronic health (eHealth) is one of the focus areas of the South African Department of Health (DoH), with the ultimate goal being the development of an electronic health record (EHR) for every citizen. A commonly used subset of eHealth data, vaccination records, is still not yet fully digitised in South Africa. This study aimed to determine the perceptions of key stakeholders (doctors, nurses, parents, and school administrators) about a digital system for vaccination records for minors in South Africa’s Gauteng Province. Using a prototype online, cloud-based vaccine records management system created during the research, called e-Vaccination, quantitative and qualitative interaction-related data from 118 participants was collected using a five-point Likert-scale questionnaire. The questionnaire was based on Lund’s (2001) USE user perception framework, which considers usefulness, satisfaction, ease of use, and ease of learning. This study found that the participants supported the use of the digital vaccine records management system, with an emphasis on five identified factors: user friendliness, graphical design, practicality, user experience, and usability. Accordingly, this article recommends that policymakers and system designers carefully consider these factors in the design and development of South Africa’s digital vaccination records management system.

The COVID-19 pandemic has changed the world. Today, the use of Information and Communications Technology (ICT) in support of education, medicine, business and administration has become a reality practically everywhere. In particular, the eHealth (digital Health) sector is on the cusp of a revolution, fueled by the worldwide health emergency due to the spread of the new coronavirus. With a view to developing new sixth generation (6G)-oriented architectures, advanced eHealth services like telemonitoring would benefit from the support of technologies that guarantee secure data access, ultra-low latency and very-high reliability targets, which are hardly achievable by the fifth generation (5G). This is the reason why this work proposes an eHealth system architecture, in which low-latency enabling technologies like Device-to-Device (D2D) communications and Multi-access Edge Computing (MEC) are integrated and supported by security mechanisms for an optimal management of sensitive health data collected by Internet of Medical Things (IoMT) devices. A preliminary evaluation of the proposed framework is provided that shows promising results in terms of data security and latency reduction.

Patient-reported measures are useful in the public interest to improve the quality of care and to assess patients’ needs and priorities by helping to identify existing barriers. A bibliometric analysis was carried out to investigate the use and relevance of patient-reported measures in other countries, which showed the growth of the topic in the scientific literature and allowed the identification of the most important integration processes. Patient-reported measures have been implemented in the information system of Vilnius University Hospital Santaros Clinics and a pilot study with real patients is planned for the future to evaluate the results and propose how this system could be integrated into the Lithuanian eHealth system. Article in Lithuanian. Pacientų įtraukties įrankių integravimas į ligoninės informacinę sistemą: bibliometrinė analizė ir atvejo tyrimas Santrauka Pacientų įtraukties įrankiai yra naudingi viešajam interesui, siekiant gerinti sveikatos priežiūros kokybę ir įvertinti pacientų poreikius bei prioritetus, nes padeda nustatyti esamas kliūtis. Siekiant išsiaiškinti pacientų įtraukties įrankių naudojimą ir aktualumą kitose valstybėse, buvo atlikta bibliometrinė analizė, kuri parodė temos plėtojimąsi mokslinėje literatūroje ir leido identifikuoti svarbiausius integravimo procesus. Vilniaus universiteto ligoninės Santaros klinikų informacinėje sistemoje buvo įdiegti pacientų įtraukties įrankiai ir ateityje planuojama atlikti bandomąjį tyrimą su realiais pacientais, įvertinti rezultatus ir pasiūlyti, kaip ši sistema galėtų būti integruota į Lietuvos e. sveikatos sistemą. Reikšminiai žodžiai: elektroniniai sveikatos įrašai, kokybė, pacientų įtraukties įrankiai, e. sveikata, bibliometrinė analizė.

Introduction Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information. Methods This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of “eHealth Literacy” and “cancer” were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature. Results Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system. Conclusion With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted.

In cloud-assisted electronic health (eHealth) systems, outsourced electronic health records (EHRs) have attribute-value type formats: an EHR corresponds to an entry with a unique identity and has multiple types of attribute values. Such formatted EHRs form an attribute-value type database, where both the attribute values and unique identities can serve as keywords for searching. Since EHRs are very sensitive, they are always encrypted before being outsourced, which makes retrieval of target EHRs by either identity or attribute value hard. Moreover, the EHRs are encrypted by different doctors, a researcher, who is delegated to research a certain kind of disease, cannot find out all corresponding EHRs due to the difference of encryption keys. In this article, we construct a triple dictionary index structure for the attribute-value type database to allow a researcher to retrieve encrypted EHRs by the identity and attribute value and to perform dynamic operations over them. We employ an identity server to assist doctors in generating encryption keys via an oblivious way. By doing so, the researcher can retrieve encrypted EHRs without leaking any information to the identity server. We analyze the security and evaluate the performance of our scheme to demonstrate that it achieves $L$ -adaptive security and forward security with high efficiency.

With the rapid development of Internet of Things (IoT), it becomes convenient to use mobile devices to remotely monitor the Physiological signals (e.g., Arrhythmia diseases) of patients with chronic diseases (e.g., cardiovascular diseases (CVDs)). High classification accuracy of inter-patient ECGs is extremely important for diagnosing Arrhythmia. The Supraventricular ectopic beat (S) is especially difficult to be classified. It is often misclassified as Normal (N) or Ventricular ectopic beat (V). Class imbalance is another common and important problem in electronic health (eHealth), as abnormal samples (i.e., samples of specific diseases) are usually far less than normal samples. To solve these problems, we propose a sustainable deep learning-based heartbeat classification system, called BeatClass. It contains three main components: two stacked bidirectional Long Short-Term Memory Networks (Bi-LSTMs), called Rist and Morst, and a Generative Adversarial Network (GAN), called MorphGAN. Rist first classifies the heartbeats into five common Arrhythmia classes. The heartbeats classified as S and V by Rist are further classified by Morst to improve the classification accuracy. MorphGAN is used to augment the morphological and contextual knowledge of heartbeats in infrequent classes. In the experiment, BeatClass is compared with several state-of-the-art works for inter-patient arrhythmia classification. The F1-scores of classifying N, S and V heartbeats are 0.6%, 16.0% and 1.8% higher than the best baseline method. The experiment result demonstrates that taking multiple classification models to improve classification results step-by-step may significantly improve the classification performance. We also evaluate the classification sustainability of BeatClass. Based on different physical signal datasets, a trained BeatClass can be updated to classify heartbeats with different sampling rates. At last, an engineering application indicates that BeatClass can promote the sustainable development of IoT-based eHealth.

Background Psychological distress (PD) and fear of cancer recurrence (FCR) are common consequences of surviving cancer. Online self-help training could help many cancer survivors deal with PD and FCR at low costs. Purpose To evaluate the long-term effectiveness of the CAncer REcurrence Self-help Training (CAREST trial) to reduce PD and FCR. Moreover, to evaluate the relation between FCR and PD across time and identify subgroups representing different change trajectories in FCR over time and their predictors. Methods This multicenter randomized controlled trial included 262 female breast cancer survivors, assigned to online self-help training or care as usual. Participants completed questionnaires at baseline and four times during the 24-month follow-up. The primary outcomes were PD and FCR (Fear of Cancer Recurrence Inventory). Latent growth curve modeling (LGCM) and repeated measures latent class analysis (RMLCA) were performed, both according to the intention-to-treat principle. Results LGCM showed no differences between the average latent slope in both groups for both PD and FCR. The correlation between FCR and PD at baseline was moderate for the intervention group and strong for the CAU group and did not significantly decrease over time in both groups. RMLCA revealed five latent classes and several predictors of class membership. Conclusions We did not find a long-term effect of the CBT-based online self-help training in reducing PD or FCR, nor in their relation. Therefore, we recommend adding professional support to online interventions for FCR. Information about FCR classes and predictors may contribute to improvement of FCR interventions.

The digital transformation of our health care system will require not only digitization of existing tools but also a redesign of our care delivery system and collaboration with digital partners. Traditional patient journeys are reactive to symptom presentation and delayed by health care system–centric scheduling, leading to poor experience and avoidable adverse outcomes. Patient journeys will be reimagined to a digital health pathway that seamlessly integrates various care experiences from telemedicine, remote monitoring, to in-person clinic visits. Through centering the care delivery around the patients, they can have more delightful experiences and enjoy the quality of standardized condition pathways and outcomes. To design and implement digital health pathways at scale, enterprise health care systems need to develop capabilities and partnerships in human-centered design, operational workflow, clinical content management, communication channels and mechanisms, reporting and analytics, standards-based integration, security and data management, and scalability. Using a human-centered design methodology, care pathways will be built upon an understanding of the unmet needs of the patients to have a more enjoyable experience of care with improved clinical outcomes. To power this digital care pathway, enterprises will choose to build or partner for clinical content management to operationalize up-to-date, best-in-class pathways. With this clinical engine, this digital solution will engage with patients through multimodal communication modalities, including written, audio, photo, or video, throughout the patient journey. Leadership teams will review reporting and analytics functions to track that the digital care pathways will be iterated to improve patient experience, clinical metrics, and operational efficiency. On the backend, standards-based integration will allow this system to be built in conjunction with the electronic medical record and other data systems to provide safe and efficient use of the digital care solution. For protecting patient information and compliance, a security and data management strategy is critical to derisking breeches and preserving privacy. Finally, a framework of technical scalability will allow digital care pathways to proliferate throughout the enterprise and support the entire patient population. This framework empowers enterprise health care systems to avoid collecting a fragmented series of one-off solutions but develop a sustainable concerted roadmap to the future of proactive intelligent patient care.

Aim: Health care professionals are tasked with the role of supporting patients in using eHealth services in their personal care and counselling competence in digital environments to ensure appropriate patient care. Our aim was to describe health care professionals’ experiences of counselling competence in Digital Care Pathways. Design: A descriptive qualitative study. Methods: Interviews with semi-structured questions were conducted. Twelve healthcare professionals were interviewed. The data were analysed using inductive content analysis. The results were reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: The analysis revealed eight distinct areas of competence related to counselling in Digital Care Pathways, namely, counselling competences related to the use of Digital Care Pathways, supporting patients’ self-care, information technology competence, competence in creating an interactive counselling relationship on the Digital Care Pathway, information management, ethical competence related to counselling in Digital Care Pathways, competence to developing Digital Care Pathways services, and change competence. No Public or Patient Contribution: Due to the complex and unpredictable circumstances of COVID, people’s strict confinement in the hospital prohibited free access to them and the study environment. Therefore, the professionals involved in the study were interviewed through online systems.

For people with chronic kidney disease (CKD), adhering to a range of self-management tasks—such as healthy eating, frequent physical activity, and non-smoking—is crucial. However, changing health behaviors is difficult. To support patients in doing so, an eHealth care pathway was developed and evaluated. The results provide different insights into patients' priorities and care needs. Many individuals with CKD experience problems in self-management, which can be hindered by many different barriers of which a common one is psychological distress. Therefore, personalized interventions are needed with screening and treatment of both psychological distress and suboptimal self-management, tailored to the specific barriers and needs of the individual patient. The E-GOAL eHealth care pathway is an example of such a personalized intervention, combining cognitive behavioral therapy with self-management support. Patients were enthusiastic about the eHealth care pathway. However, in a randomized study, the intervention was not effective in reducing psychological distress compared with regular care only. Patients did experience improvements in areas of functioning and self-management that they prioritized themselves. These mixed results show that interventions could be implemented that are person-tailored, with personalized outcomes that reflect individually meaningful treatment goals and improvements for every patient.

Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory-autonomy, relatedness, and competence-at the outset. Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-based information. However, the second generation of e-patients also produce their own health data, which they learn from and share. They also engage in the innovation of digital tools to meet health-related needs. Utilizing technological developments comes naturally to the second generation of e-patients, even if the health care system is not prepared to support them under these new circumstances

Background: Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. Objective: To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. Methods:This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). Results: Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. Discussion: Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.

Applied to health field, Internet of Things (IoT) systems provides continuous and ubiquitous monitoring and assistance, allowing the creation of valuable tools for diag nosis, health empowerment, and personalized treatment, among others. Advances in these systems follow different approaches, such as the integration of new protocols and standards, combination with artificial intelligence algorithms, application of big data processing methodologies, among others. These new systems and applications also should face different challenges when applying this kind of technology into health areas, such as the management of personal data sensed, integration with electronic health records, make sensing devices comfortable to wear, and achieve an accurate acquisition of the sensed data. The objective of this chapter is to present the state of the art, indicating the most current IoT trends applied to the health field, their contribu tions, technologies applied, and challenges faced. Junta de Andalucía US-1263715

Background The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. Objective The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. Methods This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. Results A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. Conclusions Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.

The population of older adults globally increased during the last couple of decades. Due to these demographic changes, the need for medical care has also significantly increased. Despite the age-related disabilities and chronic diseases, most older adults prefer independent living in their home environment. Technology-enhanced systems and eHealth applications seem to provide some promising solutions for older adults’ well-being and independent living. However, the adoption and acceptance of these applications for older adults are unclear and further research is needed in this area. This study was carried out as a literature review, to meet the aim of identifying and discussing important factors in the Human-computer interaction of eHealth for older adults. The overall research question for this study was: What are the critical factors to consider for an improved human-computer interaction in technology-enhanced health care systems for older adults? Findings indicate some important factors to address: personal integrity, trust, technology acceptance, accessibility of ICT and eHealth literacy. If the presented factors are considered and addressed, it would be easier to achieve the desired aim of independent living. The authors recommend a human-computer interaction that is older adults centred, with the involvement of older adults users in the design process. Proper education and training on the use of eHealth services are also of great importance. Finally, the technology-enhanced system should also provide good social and technological support to the users.

Aims: To evaluate the long-term effect of the Tät®II app for treatment of urgency (UUI) and mixed urinary incontinence (MUI). Methods: Long-term follow-up of a randomized controlled trial, including 123 women ≥18 years old with UUI or MUI, without red-flag symptoms, and ≥2 leakages per week. All participants, regardless of group, had received the intervention, a treatment app, at the long-term follow-up. Long-term data were collected through web-based questionnaires 15 months after participants received the intervention. The app included pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, an exercise log, reminders, reinforcement messages, and tailored advice. The primary outcome was a change in incontinence symptoms (International Consultation on Incontinence Questionnaire [ICIQ]—Urinary Incontinence Short Form [ICIQ-UI SF]), from baseline to follow-up. Other outcomes were urgency symptoms (ICIQ—Overactive Bladder Module (ICIQ-OAB)), quality of life (ICIQ—Lower Urinary Tract Symptoms Quality of Life Module [ICIQ-LUTSqol]), and improvement (Patient's Global Impression of Improvement [PGI-I]). Results: Of the 123 women, 102 (83%) completed the long-term follow-up. The ICIQ-UI SF mean score improved from 11.5 to 7.6 (mean difference 4.0, 95% CI 3.2–4.7). The ICIQ-OAB improved from 6.7 to 5.5 (mean difference 1.3, 95% CI 0.9–1.6) and the ICIQ-LUTSqol improved from 38.0 to 30.9 (mean difference 7.1, 95% CI 5.7–8.5). Of the 102 women, 74 (73%) reported improvement. Conclusions: Self-management with the Tät®II app for UUI and MUI had a significant effect across all outcome measures also long-term and might serve as an alternative first-line treatment for these conditions.

Purpose: The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. Method: Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the categories of goals, questions, and challenges. Results: Emergent themes revealed that parent goals were focused on self-efficacy, routines, device care, and child development. Emergent themes for questions revealed that parents asked questions related to the device care, audiology appointments, confirmation of learning, and child development. For challenges, emergent themes revealed parents' own struggles (e.g., with emotions), issues related to working with their audiologist, child factors, and anticipated challenges. Conclusions: The eHealth intervention allowed parents to raise questions and discuss their challenges in a supportive environment. Supportive accountability helped participants identify and address barriers to hearing aid management based on their priorities and current challenges. Providing supplemental learning support, in addition to routine audiology visits, can help parents develop more effective hearing aid management routines.

Contains fulltext : 248781.pdf (Publisher’s version ) (Open Access) BACKGROUND: For patients with chronic myeloid leukemia, a web-based platform CMyLife was developed. Its aim is to enhance patient empowerment, by adequate information provision, among others. Before evaluating its effect, information provision and needs in current care were assessed. OBJECTIVE: To assess patients' evaluation of received information and information needs before CMyLife utilization and whether this information source is used correspondingly. Additionally, we explored predicting patient factors in information perception. PATIENT INVOLVEMENT: CMyLife platform was developed with active patient participation. METHODS: We conducted a cross-sectional survey among 203 CML patients before launch of the CMyLife platform, using validated questionnaires on information provision and predictive factors. We focused on website utilization during the first 3 years, using Google Analytics. Regression analyses were performed to determine influence of patient factors on information perception. RESULTS: Global perceived information provision was scored 42.8 (0-100). Information on other services such as rehabilitation and psychological support, and effects of treatment on sexuality showed room for improvement. One out of 3 knew where to find useful health information online. But more information was desired by 36% of them. Age ≥65 years, time since diagnosis and low education were positively associated with this need. Pages on medication and side effects were visited the most. DISCUSSION: To fill the gap in perceived provision and needs, information should be adjusted more to the individual in content, manner and timing. Age, time since diagnosis, and educational level are of influence in perceived information, and specific needs within these groups should be further explored. PRACTICAL VALUE: CMyLife provides reliable and up-to-date information for low eHealth literacy skilled patients concerning multiple topics indicated by patients.

Purpose In this correspondence, we highlight general and domain-specific caveats in the development and validation of prediction models. Methods Development and use of the “QUiPP” application, a tool for preterm birth prediction which is supported by the United Kingdom National Health Service, is scrutinised and commented on. Results We highlight and elaborate ten points which may be perceived to be unclear or potentially misleading. Conclusion While the QUiPP application has high potential, it lacks transparency (on certain aspects related to model development) and proper validation. This precludes transportability to settings with other treatment policies and to other countries where the app has been made publicly available. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-022-06418-2.

Peak oxygen uptake (˙VO2peak) is an important factor contributing to running performance. Wearable technology may allow the assessment of ˙VO2peak more frequently and on a larger scale. We aim to i) validate the ˙VO2peak assessed by a smartwatch (Garmin Forerunner 245), and ii) discuss how this parameter may assist to evaluate and guide training procedures. A total of 23 runners (12 female, 11 male; ˙VO2peak: 48.6±6.8 ml∙min−1∙kg−1) visited the laboratory twice to determine their ˙VO2peak during a treadmill ramp test. Between laboratory visits, participants wore a smartwatch and performed three outdoor runs to obtain ˙VO2peak values provided by the smartwatch. The ˙VO2peak obtained by the criterion measure ranged from 38 to 61 ml∙min−1∙kg−1. The mean absolute percentage error (MAPE) between the smartwatch and the criterion ˙VO2peak was 5.7%. The criterion measure revealed a coefficient of variation of 4.0% over the VO2peak range from 38–61 ml∙min−1∙kg−1. MAPE between the smartwatch and criterion measure was 7.1, 4.1 and −6.2% when analyzing ˙VO2peak ranging from 39–45 ml∙min−1∙kg−1, 45–55 ml∙min−1∙kg−1 or 55–61 ml∙min−1∙kg−1, respectively.

Licensed Clinical Social Workers (LCSWs) have been integrating technology into psychotherapy practice for at least two decades, but the COVID-19 pandemic dramatically shifted the primary method of service delivery for diagnostic assessment and therapy to telebehavioral health. By developing telebehavioral health competencies, the 250,000 + LCSWs in the US can ensure and enhance the quality of care both during and after the COVID public health emergency (PHE). This article applies an evidence- and consensus-based, interprofessional telebehavioral health (TBH) competency framework to the field of social work. This framework was developed by the Coalition for Technology in Behavioral Science (CTiBS), initially published in 2017. It has seven competency domains: (1) clinical evaluation and care; (2) virtual environment and telepresence; (3) technology; (4) legal and regulatory issues; (5) evidence-based and ethical practice (comprised of Standards and Guidelines and Social Media); (6) mobile health and apps; and (7) telepractice development. The framework outlines three competency levels (novice, proficient, and authority) covering 49 specific objectives and 146 measurable competencies or practices. The TBH competencies support existing in-person clinical practices and are intended for trainees and practitioners who are implementing TBH in practice. This competency framework can also be used to integrate clinical social work professional development, research, and training. Additionally, considerations for other behavioral health professions regarding licensure, certification, and policy may apply to clinical social work. Future research is needed on implementation and evaluation of the competencies.

Background and Aims: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. Materials and Methods: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: –£118.72 (–£150.16 to –£54.16) over ten years. Increasing MDMW costs (10%): –£50.49 (–£82.24-£14.14). Decreasing MDMW costs (10%): –£186.95 (–£218.53 to –£122.51). Conclusions: MDMW is “dominant” over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.

Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain., Graphical Abstract

Introduction/Aim: Data about electronic health (eHealth) literacy and potential differences in eHealth literacy between university students are lacking. The aim of this study was to evaluate eHealth literacy in students of sports and medicine and to assess the factors associated with better eHealth literacy. Material and Methods: This cross-sectional study was carried out from April to October 2017 among final year students of the Faculty of Sports and Physical Education and the Faculty of Medicine, University of Belgrade, Serbia. A total of 89 sports students and 301 medical students were included. The eHealth Literacy Scale (eHEALS) was used to evaluate eHealth literacy. Results: Compared with sports students, medical students had higher median eHEALS score (27 vs. 30, respectively, p=0.008). Medical students were twice as confident as sports students in their efforts to locate helpful online health resources and use online health information. A significant hierarchical linear regression model was not obtained in the sample of sports students regarding predictors of better eHealth literacy. In the sample of medical students, the following was associated with better self-perceived eHealth literacy: being female, residing outside of the capital before becoming a student, younger age at the time of the first Internet use, the use of health-related websites and smartphone apps as well as lower influence of online health-related information on decision making regarding health. Conclusion: Medical students were more confident in perceiving their eHealth literacy skills compared to sports students. The factors associated with better eHealth literacy may depend on the fields of study.

eHealth is widely recognized as the application of information and communication technologies (ICT) in health. However, eHealth initiatives are still incipient in Latin America and the Caribbean, and, in many cases, restrictions in terms of access have been reported, also the necessary infrastructure, interoperability and scalability of these. This work proposes a set of critical success factors (CSFs) for the implementation of eHealth, which allow the identification of gaps, and the proposal of alternatives for the optimization of eHealth. It starts with the establishment of an eHealth domain, its scope and contributions, prior to the identification of key topics, and the establishment of every CSF, with support in guiding questions and metrics. The CSFs can facilitate the planning of projects or activities in eHealth, promoting strengths, either in ICT, management, or another of the involved topics. The CSFs must be employed with a criterion of flexibility and adequacy regarding the case in which they are applied. Finally, opportunities to evaluate and apply the CSFs in a specific context are set out.

Purpose of review To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders. Recent findings Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Summary Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high.

Nowadays, the Internet of Things (IoT) has an astonishingly societal impact in which healthcare services stand out. Amplified by the COVID-19 pandemic scenario, challenges include the development of authenticatable smart IoT devices with the ability to simultaneously track people and sense in realtime human body temperature aiming to infer a health condition in a contactless and remote way through user-friendly equipment such as a smartphone. Univocal smart labels based on quick response (QR) codes were designed and printed on medical substrates (protective masks and adhesive) using flexible organicinorganic luminescent inks. Luminescence thermometry and physical unclonable functions (PUFs) are simultaneously combined allowing non-contact temperature detection, identification, and connection with the IoT environment through a smartphone. This is an intriguing example where luminescent inks based on organic-inorganic hybrids modified by lanthanide ions are used to fabricate a smart label that can sense temperature with remarkable figures of merit, including maximum thermal sensitivity of Sr = 1.46 %K−1 and temperature uncertainty of δT = 0.2 K, and an authentication methodology accuracy, precision, and recall of 96.2%, 98.9%, and 85.7%, respectively. The methodology proposed is feasibly applied for the univocal identification and mobile optical temperature monitoring of individuals, allowing the control of the access to restricted areas and the information transfer to medical entities for post medical evaluation towards a new generation of mobile-assisted eHealth (mHealth). published

Aims: To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; ‘third-wave’ psychotherapies vs. other types). Background: Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access. Design: A systematic review of quantitative studies. Methods: A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools. Results: The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents (‘third-wave’ psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 ‘third wave’ psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found. Conclusion: The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and ‘third-wave’ psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions. Protocol registration: PROSPERO CRD42022310199. No Patient or Public Contribution.

In the current dissertation the effectiveness and cost-effectiveness of Featback, an internet-based self-help intervention for eating disorders, and online support by individuals with a lived experience of an eating disorder were investigated. The findings suggest that low-threshold internet-based interventions for eating disorders, such as Featback, can complement existing treatment options in three ways. First, they have been repeatedly found to be effective in reducing eating disorder symptomatology. Second, such interventions can reach individuals that are currently not reached by other forms of treatment and stimulate them to get professional help. Finally, internet-based interventions are likely to be cost-effective compared to care as usual. Concordantly, implementing highly scalable and easily accessible interventions like Featback likely helps to reduce both the individual and societal burden of eating disorders.

The Active4Life (A4L) project, consists of four work packages (WPs). In WP1, five large scale secondary datasets from randomized controlled trials (RCTs) on online interventions to stimulate physical activity (PA) were combined and analyzed using Bayesian Network analyses. This provided knowledge on important elements, processes and determinants of the interventions. A RCT during WP2, where three mobile elements were separately added to the computer-based PA interventions, showed that the addition of an activity tracker further improved the efficacy of the already existing Active Plus intervention. In WP3, the insights from WP1 and WP2 were combined which resulted in a reinforced Active Plus intervention including an activity tracker. In WP4, the reinforced intervention will be tested in practice by means of an implementation study. During the study, we will focus on two target populations: 1) adults aged 50 years and older without a (chronic) disease and 2) adults aged 50 years and older with a (chronic) disease. Particular attention will be paid to vulnerable populations among which groups with low socioeconomic status (LSES). The aim is to provide insight on use of the intervention, intervention drop-out, intervention related engagement, and effects on PA in a practical setting for the total sample and separated for the two target populations. Additionally, the three recruitment strategies (1. municipality, 2. NL Actief/gyms and 3. social media) will be compared on number of yielded participants, their sociodemographic characteristics, and differences in use, drop-out and PA.

Objective: Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reim-bursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations. Methods: This is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed. Results: Multiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme. Conclusion: Our interviews found barriers and facilitators concerning structural reimbursement of RPM in hos-pital settings in the Netherlands. Our results emphasize that the successful integration of structural reimburse-ment requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers. Public Interest Summary: The COVID-19 pandemic has demonstrated the strong potential of consultation and monitoring patients at a distance. Remote patient monitoring -the use of information technologies for moni-toring patients at a distance -is seen as a potential solution to urgent challenges in the healthcare system. Nevertheless, embedding remote patient monitoring innovations into routine healthcare is often challenging, partly due to difficulties in reimbursing these initiatives. Barriers to reimbursing remote patient monitoring included organizational factors, no uniform quality and outcome indicators, and difficulties using different payment models. Perceived facilitators included an increase in the total number of patients per project, better interdisciplinary cooperation and transparency, and help from the Dutch Healthcare Authority. Introducing these insights into healthcare policy dialogues could support reimbursement of remote patient monitoring and stim-ulate the collaboration of healthcare stakeholders responsible for implementing and scaling up remote patient monitoring projects.

We are conducting a scoping review to explore the use of Tele-Rehabilitation in Occupational Therapy during the COVID-19 pandemic. All practice settings, ages and health conditions will be considered to understand for which health conditions and clientele it has been used, its impacts, and facilitators and barriers to its implementation.

A scoping review on eHealth interventions for physical activity that are used by older adults

This review aims to map the telehealth care practices developed by nurses in primary health care services.

The primary aim of this systematic review is to evaluate the effect of online culinary nutrition programs on improving the cooking skills of the direct intervention participants. As a secondary aim, in the case of professionals participating in the intervention, to evaluate the effect of online culinary nutrition programs on improving the cooking skills of the patients.