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BackgroundGiven the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. ObjectiveThis study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. MethodsSearches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. ResultsA total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. ConclusionsMost studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps.

BackgroundThe COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. ObjectiveThe purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. MethodsA rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. ResultsOf 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19–specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality “best practice” guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). ConclusionsResults of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing “best practice” guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).

BackgroundeHealth is the use of information and communication technologies to enable and improve health and health care services. It is crucial that medical students receive adequate training in eHealth as they will work in clinical environments that are increasingly being enabled by technology. This trend is especially accelerated by the COVID-19 pandemic as it complicates traditional face-to-face medical consultations and highlights the need for innovative approaches in health care. ObjectiveThis review aims to evaluate the extent and nature of the existing literature on medical student training in eHealth. In detail, it aims to examine what this education consists of, the barriers, enhancing factors, and propositions for improving the medical curriculum. This review focuses primarily on some key technologies such as mobile health (mHealth), the internet of things (IoT), telehealth, and artificial intelligence (AI). MethodsSearches were performed on 4 databases, and articles were selected based on the eligibility criteria. Studies had to be related to the training of medical students in eHealth. The eligibility criteria were studies published since 2014, from a peer-reviewed journal, and written in either English or French. A grid was used to extract and chart data. ResultsThe search resulted in 25 articles. The most studied aspect was mHealth. eHealth as a broad concept, the IoT, AI, and programming were least covered. A total of 52% (13/25) of all studies contained an intervention, mostly regarding mHealth, electronic health records, web-based medical resources, and programming. The findings included various barriers, enhancing factors, and propositions for improving the medical curriculum. ConclusionsTrends have emerged regarding the suboptimal present state of eHealth training and barriers, enhancing factors, and propositions for optimal training. We recommend that additional studies be conducted on the following themes: barriers, enhancing factors, propositions for optimal training, competencies that medical students should acquire, learning outcomes from eHealth training, and patient care outcomes from this training. Additional studies should be conducted on eHealth and each of its aspects, especially on the IoT, AI, programming, and eHealth as a broad concept. Training in eHealth is critical to medical practice in clinical environments that are increasingly being enabled by technology. The need for innovative approaches in health care during the COVID-19 pandemic further highlights the relevance of this training.

Background: Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. Methods: A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l’Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7  days. The main outcome will be the difference in this score at 4  weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Discussion: Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. [ABSTRACT FROM AUTHOR]

Introduction: Patient education is recommended to improve the transition from paediatric to adult care for young people with chronic conditions. But a consensus has not been reached regarding a particular model. This study aimed to understand how to prepare for the implementation of a Developmentally Appropriate Patient Education during Transition (DAPET), which would revolve around the young person's psychosocial development. Method: Three focus groups were organised with healthcare providers and two focus groups took place with the parents of young people with chronic conditions. We used activity theory to explore practices and to identify obstacles to the implementation of DAPET, as well as to recognise which resources might be available to implement DAPET. Results: Healthcare providers agreed on the need to engage in an educational approach centred on the psychosocial development of young people during transition. However, study findings highlight the following obstacles to doing so: a lack of competencies in adolescent and young adult medicine and a lack of available resources to meet these goals. Furthermore, parents wanted to redefine their role in the transition process and to allow their children to develop self-management skills. Conclusion: Healthcare providers and parents considered the implementation of DAPET to be acceptable and even advisable. However, the programme's feasibility was questioned due to perceived shortfalls in the hospital system as it currently stands and the ways in which an educational approach would be applied. An environment that facilitates healthcare providers' educational initiatives and encourages the participation of parents is required.

Background: Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. Methods: We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-Mantel-Haenszel [chi square] tests and the Breslow-Day test. Results: We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality (p = 0.09): at the academic site, patients who used the decision aid were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict (p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites (p = 0.65). Conclusion: The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable. Contexte : Les aides à la décision guident les patients dans leurs choix quant à l'arthroplastie par prothèse totale, mais l'évaluation préopératoire pourrait modifier leur influence. Nous avons comparé cette influence chez les patients qui envisagent une arthroplastie totale du genou dans 2 cliniques de dépistage chirurgical ayant des processus d'évaluation différents. Méthodes : Nous avons effectué une analyse par sous-groupes d'un essai clinique randomisé. Les patients ont été recrutés dans 2 cliniques de dépistage chirurgical : une clinique universitaire offrant des consultations de 20 minutes avec un médecin et une clinique communautaire offrant des consultations de 45 minutes avec un physiothérapeute ou une infirmière et de l'enseignement. Nous avons comparé l'influence sur la qualité des décisions, les conflits décisionnels et le taux d'intervention chirurgicale à l'aide des tests de Cochran-Mantel-Haenszel ([chi square]) et du test de Breslow-Day. Résultats : Nous avons évalué 242 patients : 123 de la clinique universitaire (61 qui ont utilisé l'outil et 62 témoins) et 119 de la clinique communautaire (59 qui ont utilisé l'outil et 60 témoins). Les résultats semblaient indiquer une différence entre les sites quant à l'influence de l'aide sur la qualité des décisions des patients (p = 0,09) : au site universitaire, les patients qui l'ont utilisée étaient plus susceptibles de prendre des décisions de qualité que les témoins (54 % c. 35 %, p = 0,044), mais ce n'était pas le cas au site communautaire (47 % c. 51 %, p = 0,71). Moins de patients qui ont utilisé les aides à la décision au site universitaire qu'au site communautaire avaient vécu un conflit décisionnel (p = 0,007) (33 % c. 52 %, p = 0,05 au site universitaire; 40 % c. 24 %, p = 0,08 au site communautaire). L'influence de l'outil sur les taux d'intervention chirurgicale était la même aux 2 sites (p = 0,65). Conclusion : L'aide à la décision a eu un plus grand effet au site universitaire qu'au site communautaire, qui offrait de plus longues consultations et plus d'enseignement verbal. Ce type d'outil aurait donc plus de valeur dans les cas où il est difficile ou impossible d'offrir une évaluation préopératoire détaillée et des conseils approfondis pour l'arthroplastie totale du genou., In Canada, patients considering total knee arthroplasty (TKA) have traditionally been referred from primary care directly to an orthopedic surgeon, causing unequal referral distribution and variation in wait times among [...]