RESUMEN

INTRODUCTION: Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. MATERIALS AND METHODS: Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. RESULTS: Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. DISCUSSION: The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.

RESUMEN

Background: Patients with a large vessel occlusion require a transfer from a primary stroke centre to access thrombectomy, often over significant distances in regional areas. We sought to optimise stroke care access in the regional South Australian Tele-Strokeservice (SATS) to improve patient access to thrombectomy. Methods: We undertook a 24-month interventional historically controlled cohort study comparing acute stroke care metrics in the SATS. This consisted of a 12-month control period and a 12-month intervention monitoring period. The study intervention considered of an education package provided to the regional hospitals, a stroke neurologist roster to receive consultations and the intervention of a centralised tele-stroke system to provide treatment advice and organise patient transfers where needed. The SATS services 61 rural hospitals in South Australia, and Alice Springs in the Northern Territory. Suspected acute stroke patients presenting to the participating regional hospitals in SATS network where a telehealth consultation took place. Results: Over the study period, there were 919 patient referrals, with 449 consultations in the pre-intervention phase and 470 in the post-intervention phase. Demographic features in both epochs were similar. The post-intervention phase was associated with shorter door-to-scan time (35 min, IQR: 18,70; vs. 49 min, IQR:25,102, p < 0.0001), faster door-to-thrombolysis time (58 min, IQR: 39,91, vs.83 min, IQR: 55,100, p = 0.0324) and a higher portion of patients treated with thrombectomy (54, 11.5% vs. 26, 5.8%, p = 0.002). Conclusion: An optimised implementation of a streamlined telehealth platform with ongoing education and feedback to referring sites was associated with improved stroke workflow metrics and higher thrombectomy rates.

RESUMEN

INTRODUCTION/BACKGROUND: Early identification of suspected stroke patients who might be eligible for a reperfusion strategy is a daily challenge in the management of patient referrals. The aim of this study was to evaluate the performance of a remote medical assessment in identifying patients eligible for endovascular therapy (EVT) while not eligible for intravenous thrombolysis (IVT), compared with a decision based on bedside clinico-radiological data. METHODS: Patients admitted to the emergency department for acute neurological symptoms lasting for less than 24h were prospectively included. Assessment of the clinical severity and medical history was performed simultaneously by two vascular neurologists (VNs), one remotely using a mobile telemedicine solution (NOMADEEC), the other at the bedside. RACE score was calculated from the NIHSS score. At the end of the evaluation, both VNs quoted their treatment convictions (IVT/EVT). Final therapeutic decision following brain and vascular imaging was recorded and compared to remote and bedside predictions. The performances of three different conditions were evaluated: complete medical evaluation (NIHSS+medical history), NIHSS score alone, and RACE score alone. Remote and bedside performances were also compared. Diagnostic accuracy parameters (sensitivity, specificity, positive and negative predictive values) of each condition were estimated, along with their two-sided 95% binomial confidence intervals. RESULTS: Out of 215 enrolled patients, 186 had a complete evaluation, 91 (54.3%) were diagnosed with an ischemic stroke or transient ischemic attack and 46 (24.7%) had an intracranial occlusion. Considering the three conditions evaluated remotely, RACE score-based decision provided the best sensitivity 54.6% [95% CI 23.4; 83.2]/specificity 80.6% [73.9; 86.2] combination. However, the complete medical evaluation had the best specificity (88.6% [82.9; 92.9] compared to RACE scores alone (P=0.038). Remote and bedside performances did not differ (κ=0.68 [0.59; 0.77]). DISCUSSION/CONCLUSION: This real-life study performed in the setting of emergency demonstrates that remote medical evaluations including recording of extensive medical information and NIHSS examination to address patient's eligibility to revascularization treatment is swiftly feasible and is as effective as bedside prediction to EVT and/or IVT. Remote standardized medical evaluation might improve the decision of patients' primary orientation and avoid overcrowding of comprehensive stroke centres.

RESUMEN

A group-based online psycho-education program for adults with attention deficit hyperactivity disorder (ADHD) and their families has been set up by a multi-professional psychiatric team. Feedback from users has mainly shown benefits in terms of improving self-esteem, destigmatization and accessibility to care. This suggests a real interest in developing this care offer in the pathway of ADHD adults.

Asunto(s)

RESUMEN

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE: The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS: The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS: A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION: In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS: With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.

Asunto(s)

RESUMEN

PURPOSE: To meet the need for access to eye care in an area with a lack of physicians, a telemedicine workstation in ophthalmology was created. The main objective was to measure the improved access to eye care via telemedicine consultation. METHODS: No criteria of age, sex or geographical location were defined. Depending on the cause for the consultation and the results of the examinations conducted by an ophthalmic technician physically present in the center, the patient might be given a telemedicine consultation with an ophthalmologist. Eleven indicators were defined to achieve the study objectives. Data were compared with a reference eye care center. RESULTS: The quality, safety of care, and medical benefits of telemedicine consultation were not inferior to those of the reference center. The consultations screened 25 cases of age-related macular degeneration, 240 glaucoma, 229 cataracts and 27 diabetic retinopathy. 88.5% of patients were included in a cooperative ophthalmologist/technician protocol, compared with 27.3% in the reference center (P<0.0001). DISCUSSION: The telemedicine workstation must be linked to a main center located at most a one-hour drive away. The equipment must be adapted to the use of telemedicine and to allow the technician to perform the necessary assessments and examinations. The number of emergency department visits after telemedicine consultation at the telemedicine workstation was higher than the reference center, which may lead to a subsequent study. CONCLUSION: Telemedicine consultation improves access to eye care in a medically under-served area.

Asunto(s)

RESUMEN

OBJECTIVE: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. METHODS: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. RESULTS: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. CONCLUSIONS: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care.

Asunto(s)

RESUMEN

INTRODUCTION: Physical examination appears to be a limiting factor of teleconsultation (TC). We evaluated the feasibility of self-percussion of the lumbar fossae (sPLF) and TC for simple renal colic (SRC) in comparison with a face-to-face consultation (FC). MATERIAL AND METHODS: We performed a comparative prospective study in two steps. First: evaluation of the quality of an sPLF on a standardized patient in TC, without and with tutorial. Secondarily: evaluation of a TC and a FC for a SRC with a standardized patient in real conditions. Evaluation using objective clinical scores and qualitative scales by an observer, the standardized patient and the practitioner himself. RESULTS: Forty-two practitioners were included in the study. In the absence of a tutorial, the sPLF was most often "poorly done". The tutorial led to a significant improvement in the quality of sPLF. There was no difference in diagnostic and therapeutic performance among senior physicians between TC and FC. The therapeutic performances of the interns were significantly lower in TC without his being aware of it. The qualitative scores were significantly lower in TC vs FC according to the practitioners, the standardized patient and the observer. CONCLUSION: An sPLF is feasible but its practice should be taught. Unlike interns, senior physicians were able to perform a TC comparable to FC for the management of SRC. TC and telesemiology therefore require dedicated training and an experienced practitioner.

Asunto(s)

RESUMEN

Remote professional practices or telehealth have been adopted by most healthcare professions around the world. Telehealth is now part of the means available to health professionals to strengthen the quality of pathways. Telehealth is not a substitute for face-to-face exercise but complements it. The relevance of a use of telehealth is the responsibility of the health professional. In this article, we specify the place of telehealth in the professional practice of an advanced practice nurse, whether in private practice or salaried by a care institution.

Asunto(s)

RESUMEN

Introduction: The use of telemedicine in critical care is emerging, however, there is a paucity of information surrounding the costs relative to health gains in the pediatric population. This study aimed to estimate the cost-effectiveness of a pediatric tele-resuscitation (Peds-TECH) intervention compared to the usual care in five community hospital emergency departments (EDs). Using a decision tree analysis approach with secondary retrospective data from a 3-year time period, this cost-effectiveness analysis was completed. Methods: A mixed methods quasi-experimental design was embedded in the economic evaluation of Peds-TECH intervention. Patients aged <18 years triaged as Canadian Triage and Acuity Scale 1 or 2 at EDs were eligible to receive the intervention. Qualitative interviews were conducted with parents/caregivers to explore the out-of-pocket (OOP) expenses. Patient-level health resource utilization was extracted from Niagara Health databases. The Peds-TECH budget calculated one-time technology and operational costs per patient. Base-case analyses determined the incremental cost per year of life lost (YLL) averted, and additional sensitivity analysis confirmed the robustness of the results. Results: Odds ratio for mortality among cases was 0.498 (95% CI: 0.173, 1.43). The average cost of a patient receiving the Peds-TECH intervention was $2,032.73 compared to $317.45 in usual care. In total, 54 patients received the Peds-TECH intervention. Fewer children died in the intervention group resulting in 4.71 YLL. The probabilistic analysis revealed an incremental cost-effectiveness ratio of $64.61 per YLL averted. Conclusion: Peds-TECH appears to be a cost-effective intervention for resuscitating infants/children in hospital emergency departments.

RESUMEN

OBJECTIVES: There was rapid uptake of pediatric diabetes telehealth at the onset of the COVID-19 pandemic and initial studies demonstrated good usability and satisfaction. As exposure to telehealth continued to increase during the pandemic, we aimed to determine changes in telehealth usability and changes in future preferences for telehealth care. METHODS: A telehealth questionnaire was administered early in the pandemic and again more than 1 year later. Survey data were linked with a clinical data registry. A multivariable proportional odds logistic mixed-effects model was used to assess the association between exposure to telehealth and outcome of future preference for telehealth. Multivariable linear mixed-effects models were used to examine associations between exposure to early and later pandemic periods and the outcome of usability scores. RESULTS: Survey response rate was 40%, with 87 early and 168 later period participants. Virtual visits increased from 46% to 92% of all telehealth visits. Virtual visits improved in "ease of use" (p=0.0013) and "satisfaction" (p=0.045); there were no improvements in telephone visits. The odds of indicating higher preference for more future telehealth visits was 5.1-fold higher in the later pandemic group (p=0.0298). Eighty percent of participants would like their future care to include telehealth visits. CONCLUSIONS: At our tertiary diabetes centre, families' desire for future telehealth care has increased during this 1-year period of additional telehealth exposure, and virtual care has now become the preferred option. This study provides important family perspectives that can help guide development of future diabetes clinical care.

Asunto(s)

RESUMEN

INTRODUCTION: The use of telehealth, such as remote patient monitoring (RPM), for chronic heart failure (CHF) impacts patient pathways. Patient-centricity in chronic disease management is valuable. Even though RPM is recommended in practice, the evaluation of patient satisfaction has been limited to date. The objective of this study was to assess the perceptions and satisfaction of patients with CHF when using RPM. METHODS: A voluntary declarative survey was conducted with users of Satelia® Cardio, an RPM web application which was included in an experimental model program in France funded by the ETAPES program initiative sponsored by the French Ministry of Health. Monitoring was based on patient-reported outcomes (seven questions on symptoms, one question on weight) which were answered online (digitally literate patients) or by phone with a nurse (patients with poor digital literacy). The survey included questions on perceived usefulness, ease of use and impact on quality of life (QoL). RESULTS: Overall, 87% of the 825 patients were satisfied with having their CHF digitally monitored. Patients found that the application was easy to use (94%), problem free (95%), provided well-timed notifications (98%), easily accessible (96.5%), understandable (89%), and did not require an unreasonable amount of time to answer questions (99%). Most patients felt that RPM helped physicians provide better care during their follow-ups (70%, mean score: 7.98/10) and 45% of the digitally literate patients indicated an improved QoL. CONCLUSION: Poor digitally literate patients may need human-based or assisted RPM. Patients monitored daily for CHF through RPM expressed strong satisfaction and acceptance.

Asunto(s)

RESUMEN

La télémédecine existe depuis les années 1980 et met en relation um patient à distance avec un médecin ou un professionnel de la santé qui échange des données numériques grâce à des outils informatiques. L'Ordre des médecins considère que les nouvelles technologies facilitent l'accès aux soins et à l'expertise, même si cela va à l'encontre des principes éthiques fondamentaux. Elle se substitue à l'acte médical traditionnel, et il est nécessaire de s’interroger sur sa pertinence et sur l’intérêt de ses conditions d’application pour le patient. Pendant l'épidémie de COVID-19, les conditions de la télémédecine ont été assouplies et le système d'assurance maladie a facilité son remboursement de manière dérogatoire. Les professionnels de la santé, les établissements de soins et les patients ont pu apprécier les nouvelles possibilités offertes par la télémédecine et en reconnaître les limites. Cependant, la sécurité n'est pas la principale préoccupation des patients, qui utilisent largement les outils informatiques pour surfer sur Internet et considèrent la médecine à distance comme un exercice facilement accessible sans en connaître les limites. Ils ne font pas de distinction entre la télémédecine clinique sous contrôle médical et les services de santé en ligne proposés sur Internet, qui sont des offres commerciales de bien-être. Dans cette présentation, nous décrirons d'abord l'évolution de la télémédecine, mise en œuvre depuis longtemps en France sous diverses formes, puis le développement spectaculaire des téléconsultations lors de l’épidémie COVID-19, dont les conséquences bénéfiques permettent une meilleure accessibilité et un meilleur remboursement par la sécurité sociale.(AU)

La telemedicina existe desde los años 80 y pone en contacto a distancia a un paciente con un médico o profesional sanitario que intercambia datos digitales mediante herramientas informáticas. La Orden de Médicos considera que las nuevas tecnologías facilitan el acceso a los cuidados y a los conocimientos especializados, aunque vaya en contra de principios éticos fundamentales. Se trata de un sustituto del acto médico tradicional, y hay que cuestionarse su pertinencia y si las condiciones de aplicación aportan un beneficio al paciente. Durante la epidemia de COVID-19, las condiciones para la telemedicina se relajaron y el sistema de seguros sanitarios facilitó su reembolso de forma derogatoria. Los profesionales sanitarios, las instituciones sanitarias y los pacientes pudieron apreciar las nuevas posibilidades que ofrece la telemedicina y reconocer sus limitaciones. Sin embargo, la seguridad no es la principal preocupación de los pacientes, que hacen un amplio uso de las herramientas informáticas para navegar porInternet y consideran la medicina a distancia como un ejercicio de fácil acceso sin conocer sus límites. No distinguen entre telemedicina clínica bajo supervisión médica y servicios de salud electrónica ofrecidos por Internet, que son ofertas comerciales de bienestar. En esta presentación expondremos en primer lugar la evolución de la telemedicina, implantada desde hace tiempo en Francia bajo diversas formas, y a continuación el espectacular desarrollo de las teleconsultas durante la epidemia de COVID-19, cuyas beneficiosas consecuencias permiten una mejor accesibilidad y reembolso por parte de la seguridad social.(AU)

Telemedicine has existed sincethe 1980s and puts a patient in contact with a doctor or health professional at a distance who exchanges digital data using computer tools. The Ordre des Médecins considers that new technologies facilitate access to care and specialised expertise, even ifit goes against fundamental ethical principles. It is a substitute for the traditional medical act, and one must question its relevance and whether the conditions of implementation bring a benefit to the patient. During the COVID-19 epidemic, the conditions for telemedicine were relaxed and the health insurance system facilitated its reimbursement in a derogatory manner. Healthcare professionals, healthcare institutions and patients were able to appreciate the new possibilities offered by telemedicine and recognize its limitations. However, safety is not the main concern of patients, who make extensive use of IT tools to surf the Internet and consider remote medicine as an easily accessible exercise without knowing its limits. They do not distinguish between medically supervised clinical telemedicine and e-health services offered over the Internet, which are commercial wellness offerings. In this presentation, we will first describe the evolution of telemedicine, which has long been implemented in France in various forms, and then the spectacular development of teleconsultations during the COVID-19 epidemic, the beneficial consequences of which allow better accessibility and reimbursement by social security.(AU)

Asunto(s)

RESUMEN

La population française comprendra 23,4 % de personnes de plus de 65 ans en 2030. La plupart d’entre elles présentera des pathologies chroniques (cancers) nécessitant une prise en charge globale par les équipes de soins palliatifs. Toutefois le nombre restreint de lits d’hospitalisation et de médecins suggère que l’on aura rapidement besoin de developper la télémédecine pour le suivi des patients en soins palliatifs Nous avons proposé à 30 patients un suivi mensuel par téléconsultation après une première évaluation en Hospitalisation De Jour de soins palliatifs afin d’évaluer la faisabilité matérielle des consultations par télémédecine (patients altérés dans le cadre de leur parcours avancé dans la maladie cancéreuse, souvent âgés) et l’adhésion des patients dans cette pratique. Nous avons recueilli le vécu et ressenti des patients par rapport à ces téléconsultations 3 mois post inclusion. Nous avons montré la faisabilité de la téléconsultation pour les patients suivis en soins palliatifs. Les patients sontfavorables à ce type de suivi. Ils n’ont aucune difficulté à se connecter indépendamment de leur âge. Tous en tirent bénéfice. Une relation de confiance s’établit facilement avec leur médecin, malgré leur méconnaissance antérieure à la téléconsultation.(AU)

En 2030, el 23,4% de la població francesa tindrà més de 65 anys. La majoria d'ells tindran patologies cròniques (càncers) que requeriran una gestió integral per part dels equips de cures pal·liatives. No obstant això, el limitat nombre de llits hospitalaris i de metges suggereix que aviatserà necessari desenvolupar la telemedicina per al seguiment dels pacients en cures pal·liatives. Vam oferir a 30 pacients un seguiment mensual per teleconsulta després d'una avaluació inicial en un hospital de dia de cures pal·liatives amb la finalitat d'avaluar la viabilitat material de les consultes de telemedicina (pacients amb càncer avançat, sovint ancians) i l'acceptació d'aquesta pràctica per part dels pacients. Vam recollir l'experiència i els sentiments dels pacients respecte a aquestes teleconsultas 3 mesos després de la inclusió. Vam demostrar la viabilitat de la teleconsulta per a pacients seguits en cures pal·liatives. Els pacients estan a favor de este tipus de seguiment. No tenen cap dificultat per a connectar-se, independentment de la seva edat. Tots es beneficien d'això. S'estableix fàcilment una relació de confiança amb el seu metge, malgrat el seu desconeixement previ a la teleconsulta. (AU)

En 2030, el 23,4% de la población francesa tendrá más de 65 años. La mayoría de ellos tendrán patologías crónicas (cánceres) que requerirán una gestión integral por parte de los equipos de cuidados paliativos. Sin embargo, el limitado número de camas hospitalarias y de médicos sugiere que pronto será necesario desarrollar la telemedicina para el seguimiento de los pacientes en cuidados paliativos. Ofrecimos a 30 pacientes un seguimiento mensual por teleconsulta tras una evaluación inicial en un hospital de día de cuidados paliativos con el fin de evaluar la viabilidad material de las consultas de telemedicina (pacientes con cáncer avanzado, a menudo ancianos) y la aceptación de esta práctica por parte de los pacientes. Recogimos la experiencia y los sentimientos de los pacientes con respecto a estas teleconsultas 3 meses después de la inclusión. Demostramos la viabilidad de la teleconsulta para pacientes seguidos en cuidados paliativos. Los pacientes están a favor deeste tipo de seguimiento. No tienen ninguna dificultad para conectarse, independientemente de su edad. Todos se benefician de ello. Se establece fácilmente una relación de confianza con su médico, a pesar de su desconocimiento previo a la teleconsulta.(AU)

In 2030, 23.4% of the French population will be over 65 years old. Most of them will have chronic pathologies (cancers) requiring comprehensive management by palliative care teams. However, the limited number of hospital beds and physicians suggests that there will be a rapid need to develop telemedicine for the follow-up of palliative care patients. We proposed to 30 patients a monthly follow-up by teleconsultation after an initial evaluation in a palliative care day hospital in order to evaluate the material feasibility of consultations by telemedicine (patients altered in the context of their advanced course of cancer, often elderly) and the adherence of the patients to this practice. We collected the patients' experience and feelings regarding these teleconsultations 3 months after inclusion. We have shown the feasibility of teleconsultation for patients followed in palliative care. Patients are in favour of this type of follow-up. They have no difficulty connecting regardless of their age. They all benefit from it. A relationship of trust is easily established with their doctor, despite their lack of knowledge prior to teleconsultation.(AU)

Asunto(s)

RESUMEN

BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

Asunto(s)

RESUMEN

The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.

Asunto(s)

RESUMEN

Maintaining the growth of rural areas and providing patients with the best possible support in the context of a coordinated healthcare pathway is a challenge that has been met thanks to teleconsultation. An experiment in Nouvelle-Aquitaine is benefiting patients at a hospital and residents of a home for the elderly, allowing them to be monitored by their primary care physician or a specialist from a distance. Nursing professionals are enriching their practice, integrating new information and communication technologies with all the guarantees in terms of security of practices.

Asunto(s)

RESUMEN

INTRODUCTION: Support care aims to improve the experience of patients. m-health is one of the tools recently developed to promote patient empowerment. The objective of this study was to evaluate the appreciation of an m-health application to enhance prostatectomy path for patients suffering from prostate cancer. METHOD: A prospective monocentric study was conducted in the urology department of the University Hospital of Rennes from February to April 2023. MyCHU application was optimized by integrating information sheets in the postoperative period after prostatectomy on sphincter rehabilitation exercises, erectile dysfunction and urinary incontinence. The questionnaire used to evaluate the usability of "MyCHU" application was the System Usability Scale (SUS). Semi-structured interviews explored the patients' feelings about the content of the information sheets and the impact on their empowerment regarding sexual disorders. RESULTS: Twelve patients participated in this study and 7 agreed to complete an interview The average SUS score was 75.58, which indicate an high usability. Patients appreciated the fact that the application structured their healthcare pathway by centralizing information. The information sheets were clear and accurate. The impact on their empowerment was positive, with a gain in their ability to take ownership of the therapies. CONCLUSION: The role of digital technology in health care has been growing in recent years. Our study has shown the interest that mobile application can bring to the patient who undergoes prostatectomy. It increases his empowerment and favor the dialogue with his surgeon.

RESUMEN

The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.

Asunto(s)