Browsing by Subject "Telemedicine"

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  • Stassen, Willem; Wallis, Lee; Castren, Maaret; Vincent-Lambert, Craig; Kurland, Lisa (2019)
    The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and rando-misation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency
  • Lehtovirta, Mikko (2018)
  • Sandborg, Johanna; Söderström, Emmie; Henriksson, Pontus; Bendtsen, Marcus; Henström, Maria; Leppänen, Marja H.; Maddison, Ralph; Migueles, Jairo H.; Blomberg, Marie; Löf, Marie (2021)
    Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (-1.33 kg; 95% CI -2.92 to 0.26; P=.10) and completers-only analyses (-1.67 kg; 95% CI -3.26 to -0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity.
  • Valja, Auri; Tenhunen, Henni; Harno, Hanna; Mäkitie, Laura; Tanila, Tuomo; Lillrank, Paul (IOS PRESS, 2019)
    Studies in Health Technology and Informatics
    A digital service pathway for managing chronic headache has been designed in tertiary care in Finland. The digital tool facilitates self-management by providing exercises, information and messaging opportunities for patients. However, the largest potential benefits are in primary and occupational care. Thus, the purpose of this study was to explore the needs and requirements of primary and occupational care actors for better understanding of the context in the transfer of the service. The study was performed as a single embedded case study. The qualitative data was collected through semi-structured interviews with 16 informants from different organizations and analyzed with Gioia-methodology. This study gathers important empirical knowledge about the meaning of context and transferring digital health interventions from one context to another from clinician and management perspective. Nine key contextual differences were identified and six main expectations emerged.
  • Karisalmi, Nina; Kaipio, Johanna; Lahdenne, Pekka (2017)
    Healthcare providers are increasingly paying attention to their customer’s experiences - meaning experiences of patients. This article reports a study which is part of a larger Lapsus research project. The aim of the project is to explore the perceptions and the experiences of child patients and their families about their visits to the hospital, about the given treatment and care, and about their everyday life with the illness. This article reports issues which children using special healthcare services consider as important and valuable in their experiences as patients. Basing on these issues the paper describes how digital services in the future can be incorporated in the patient paths of the children to enhance their patient experience. The study data was gathered from 10–16-year old chronically ill children with video diaries. All together 14 children participated in the study. The results show which issues are working fine and which still need improvements in the treatment of the children, as well as future wishes the children have regarding their care. These observations can be categorized into three themes: physical aspects, communication with the child and the family as well as ease and rationality of the care. Other things the children found valuable were practical and cosy spaces, individual and warm communication with professionals, continuity of care, and ease of visits and care. With these findings in mind, the improvement activities should focus on physical alterations, points of interaction in various phases of patient paths and digital services. In the future digital services may become a pivotal way to support better patient experience of children and their families.
  • Stenberg, Jan-Henry; Blanco Sequeiros, Sanna; Holi, Matti; Kampman, Olli; Kieseppä, Tuula; Korkeila, Jyrki; Mäki, Pirjo; Wahlbeck, Kristian; Joffe, Grigori; Häll, Pasi; Joutsenniemi, Kaisla (2016)
    Psykologisia etähoitoja voidaan antaa reaaliaikaisesti tai toisaalta ajasta riippumatta. Erilaisia etähoitoja on moniin eri häiriöihin ja monet niistä ovat tutkitusti tehokkaita. Hoitojen lisäksi on toimivia mielenterveyden edistämisen, kriisiauttamisen ja itsemurhien ehkäisyn menetelmiä. Tekniikan ja tiedonlouhinnan kehitys tuo yhä merkittävämpiä apuvälineitä mielenterveyden häiriöiden hoitoon.
  • Bergroth, Robin; Matikainen, Mika; Rannikko, Antti (2021)
    The prevalence of prostate cancer (PCa) is increasing. As the prognosis of PCa continues to improve, the increasing follow-up requirements after radical prosta-tectomy or radiotherapy puts significant pressure on health care systems. Follow-up is typically conducted by treating urologists, specialized nurses, or general practitioners. Despite the increase in patient numbers, resources are not likely to increase in proportion. Furthermore, the ongoing COVID-19 pandemic has led to a paradigm shift in our thinking towards telehealth solutions, primarily to avoid or limit physical contact and to spare resources. Here we report our novel telehealth solution for PCa follow-up, called Mobile PSA. Currently, more than 4500 PCa patients have been using Mobile PSA follow-up in our center. Mobile PSA can increase follow-up accuracy, as all biochemical relapses will be detected in a timely manner, can significantly reduce delays in reporting prostate-specific antigen results to patients, and can significantly reduce costs. Patient summary: We assessed a new telehealth information system for prostate cancer follow-up that does not use an app. More than 4500 prostate cancer patients in our center have used this system, called Mobile PSA, for follow-up. The system significantly reduces delays in reporting prostate-specific antigen (PSA) test results to patients, increases the accuracy of detecting recurrence of elevated PSA, and reduces costs. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creati-vecommons.org/licenses/by-nc-nd/4.0/).
  • Liu, Ville; Sellgren, Lasse; Koskela, Tuomas; Kaila, Minna (Helsingin yliopisto, 2021)
    Background Municipalities are reforming their health and social care services and creating online services to support patient self-treatment and self-care (The Omaolo-project). These include 15 symptom checkers which provide triage. As a result of the completed individual symptom assessment, the patient receives an assessment of the need for treatment of the corresponding symptom, instructions for a treatment site and, if necessary, self-care instructions. This study examines the usability of symptom checkers from the perspective of the patient and the study assistant. Methodology This is a mixed methods study that used data collected in the Omaolo project’s validation of symptom checkers study. Data were collected from 18 primary health care emergency centers throughout Finland. The user answered the questions posed by the symptom checker, after which a nurse familiar with triage assessed the need for treatment of the symptom of the user. The study assistant monitored the completion of the study user's symptom checker. The findings of 350 patient users, nurses, and study assistants were analyzed based on separate completed research forms. Thematic analysis was used to create research themes from the recorded observations of the individuals followed by the preparation of a thematic summary. Results The usability of symptom checkers was mainly assessed as good. However, there were challenges in usability. Relevant concepts (codes) describing the challenges were formed from the free text observations of the research forms. 59 codes were classified under two main themes; user-related challenges and issues related to the symptom checkers. The user-related challenges were divided into a) difficulties in understanding the symptom checkers and their questions, b) poor competence to use online tools, and c) ability to assess one’s health. The issues related to the symptom checkers were divided into a) a need to clarify the terms and questions used in the symptom checker, and b) a need to improve the visual layout and provide better instructions for the user. Conclusions Symptom checkers are acceptable, easy to use, and understandable to most patients. The study identified themes that may impair the availability of symptom checkers. Improving the availability of symptom checkers is likely to improve the process of triage as well as its success. In addition, usability issues can impair a patient's willingness to use symptom checkers.
  • Liu, Ville D.; Sellgren, Lasse; Kaila, Minna; Koskela, Tuomas (2021)
  • Lindsberg, Perttu J.; Toivonen, Lauri; Diener, Hans-Christoph (2014)