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INTRODUCTION: Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation. METHODS: A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley. RESULTS: A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support. CONCLUSIONS: Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.

RESUMEN

Resumen: La ecocardiografía es una herramienta que desde hace años se ha introducido en las unidades de reanimación. La ausencia de una formación reglada, la larga curva de aprendizaje y el hecho de que la mayoría de protocolos orientados al estudio de la inestabilidad hemodinámica se basan en un concepto estructural, complican su aplicación rutinaria en un contexto tan complejo. Este artículo pretende dar una visión funcional de la ecocardiografía de manera que, integrándola junto con la clínica y otros sistemas de monitorización, se convierta en una herramienta de monitorización hemodinámica a pie de cama. Mediante el uso de un número limitado de planos explicaremos la valoración de diversas herramientas que nos permiten estimar las variables determinantes de la perfusión (precarga estática y dinámica, función biventricular), que a su vez integradas mediante un mapa mental nos asistirán en la toma de decisiones clínicas.

Abstract: Echocardiography has gained wide acceptance between intensive care physicians during the last fifteen years. The lack of accredited formation, long learning curve and structural orientation of the limited algorithms to study hemodynamic instability hampers its daily use in the intensive care unit. This article aims to explain a functional approach to echocardiography in which it serves as a hemodynamic monitoring tool, useful at the bed site in conjunction with clinical assessment and other monitoring devices. Through a limited number of planes and measurements we will explain how to asses perfusion determinants (static and dynamic preload, biventricular function) and integrate them with a mind map to help everyday decision making in the complex environment of the critical care unit.

Resumo: O ecocardiograma é uma ferramenta que foi introduzida há anos nas unidades de terapia intensiva. A ausência de treinamento formal, a curva de aprendizagem prolongada e o fato de que a maioria dos protocolos orientados ao estudo da instabilidade hemodinâmica são baseados em um conceito estrutural complicam sua aplicação de rotina em um contexto tão complexo. Este artigo tem como objetivo dar uma visão funcional da ecocardiografia de modo que, integrando-a com a clínica e outros sistemas de monitoramento, transforme-se em uma ferramenta de monitoramento hemodinâmico na cabeceira do paciente. Usando um número limitado de imagens e medições explicaremos a valorização de várias ferramentas que nos permitem estimar as variáveis determinantes de perfusão (pré-carga estática e dinâmica, função biventricular), que por sua vez integrados por um mapa mental nos ajudará a tomar decisões clínicas.