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The COVID-19 pandemic has affected the care of patients with other diseases. Difficulty in access to healthcare during these months has been especially relevant for persons with HIV infection (PWH). This study therefore sought to ascertain the clinical outcomes and effectiveness of the measures implemented among PWH in a region with one of the highest incidence rates in Europe.Retrospective, observational, pre-post intervention study to compare the outcomes of PWH attended at a high-complexity healthcare hospital from March to October 2020 and during the same months across the period 2016-2019. The intervention consisted of home drug deliveries and preferential use of non face-to-face consultations. The effectiveness of the measures implemented was determined by reference to the number of emergency visits, hospitalisations, mortality rate, and percentage of PWH with viral load50 copies, before and after the two pandemic waves.A total of 2,760 PWH were attended from January 2016 to October 2020. During the pandemic, there was a monthly mean of 106.87 telephone consultations and 2,075 home deliveries of medical drugs dispensed to ambulatory patients. No statistically significant differences were found between the rate of admission of patients with COVID-HIV co-infection and that of the remaining patients (1,172.76 admissions/100,000 population vs. 1,424.29,Our results show that the strategies implemented during the first 8 months of the pandemic prevented any deterioration in the control and follow-up parameters routinely used on PWH. Furthermore, they contribute to the debate about how telemedicine and telepharmacy can fit into future healthcare models.Introducción: La pandemia causada por el SARS-CoV-2 ha afectado a la atención de pacientes con otras enfermedades. La dificultad en el acceso a la asistencia sanitaria durante estos meses es especialmente relevante en las personas con infección por VIH (PWH). El objetivo del estudio fue conocer los resultados clínicos y la efectividad de las medidas implementadas en PWH en una de las regiones con mayor incidencia de Europa.Métodos: Estudio observacional retrospectivo, pre-post intervención, comparando los resultados de PWH atendidos en un hospital de alta complejidad entre marzo-octubre de 2020 y el mismo periodo de 2016 a 2019. La intervención consistió en el envío a domicilio de medicamentos y la realización preferente de consultas no presenciales. La efectividad de las medidas implementadas se determinó por el número de visitas a Urgencias, hospitalizaciones, mortalidad y porcentaje de PWH con carga viral50 copias antes y después de dos olas pandémicas.Resultados: Se atendieron 2.760 PWH entre enero de 2016 y octubre de 2020. Durante la pandemia se realizaron una media mensual de 106,87 consultas telefónicas y 2.075 envíos a domicilio de medicamentos de dispensación ambulatoria. No se encontraron diferencias estadísticamente significativas en la frecuentación de pacientes con co-infección COVID-VIH respecto al resto (1.172,76 ingresos/100.000 habitantes vs. 1.424,29, p = 0,401), ni en su mortalidad (11,54% vs. 12,96%, p = 0,939). El porcentaje de PWH con carga viral50 copias fue similar antes y después de la pandemia (1,20% pre-pandemia vs. 0,51% en 2020, p = 0,078).Conclusión: Nuestros resultados revelan que las estrategias implementadas durante los 8 primeros meses de pandemia han evitado el deterioro en parámetros de control y seguimiento empleados habitualmente en PWH. Además, contribuyen a la reflexión sobre el encaje de la telemedicina y telefarmacia en modelos asistenciales futuros.

In the recent years the utilization of cloud to store and process the big data is increased rapidly. Security is the major concern faced by the big data in cloud environment. This paper proposed the authentication scheme for preserving the security and privacy of the big data in cloud environment. This paper considered the medical big data processing from the telemedicine system as the big data. The medical big data consists of huge volumes of medical records which are stores in the cloud. In the proposed mechanism follows mutual authentication and performs encryption operation between user and cloud environment. The proposed authentication mechanism has less computational load compared to the existing algorithms.

During the first COVID-19 lockdown, from March 12 to May 15, 2020, private dental practices in France and in many other countries remained closed. Dental emergencies were therefore partly redirected to hospital dental departments. The aim of this article is to describe the modalities of remote management of emergencies during this period, by the pediatric dentistry department of Nancy University Hospital (France), via an oral telemedicine protocol.All parents of children in difficulty were invited to contact the department by phone. Initial triage was managed by externs, interns, or dental practitioners following a management protocol specifically adapted to pediatric dentistry for this context. Depending on the situation (type of complaint, geographical location of the patients, possibility of travel, availability of digital equipment, etc.), an oral telemedicine solution was proposed using the Covotem® software (Maincare Society, Canejan, France) via the Pulsy platform (public interest grouping validated by the Grand Est Regional Agency for Health) and possibly using an intraoral photographic protocol suggested by the team.During this period, 176 patients used the pediatric dental department, 40 of whom were managed via oral telemedicine. Of these children, 57% (23/40) required an appointment in the department during the lockdown, 30% (12/40) did not require follow-up, and 13% (5/40) required a post-lockdown appointment. This teledentistry protocol resulted in a diagnosis in most cases (93%).Patient management through oral telemedicine appears to be an effective tool for planning and organizing oral healthcare. It should be more widely considered in dentistry in the current context of pressure in medical emergencies, significant medical needs, and medical desertification.

The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists. info:eu-repo/semantics/publishedVersion

Background Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care. Objective To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC). Methods Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05). Results During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001). Study limitations The TD service is available only for the public health network and analysis for a limited period (five years). Conclusions Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level.

In this review, we discuss the evidence regarding the course and management of COVID-19 in patients with pulmonary arterial hypertension (PAH), the challenges in PAH management during the pandemic and, lastly, the long-term complications of COVID-19 in relation to pulmonary vascular disease. The inherent PAH disease characteristics, as well as age, comorbidities, and the patient's functional status act synergistically to define the prognosis of COVID-19 in patients with PAH. Management of COVID-19 should follow the general guidelines, while PAH-targeted therapies should be continued. The pandemic has caused a shift toward telemedicine in the chronic care of patients with PAH. Whether COVID-19 could predispose to the development of chronic pulmonary hypertension is a subject of future investigation.

Objective: To assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases. Methods: A cross-sectional study was carried out to analyze otoscopies in patients seen at a general otorhinolaryngology (ORL) outpatient clinic, from June to December 2019. Eighty-three images of patients obtained from otoscopies performed through a smartphone device and a rigid endoscope were included, recorded, and stored for further analysis. The images were first analyzed by an experienced otologist, who assigned his diagnostic impression (defined as the gold standard) on each of the images. After this analysis, the images were displayed to a group of secondary raters (an experienced otorhinolaryngologist, a second-year resident in ORL, and a general practitioner). A questionnaire was applied related to each image. Results: There was high agreement between the smartphone device and the otoendoscopy images for all professionals, with a Kappa coefficient of 0.97 (p < 0.001). The smartphone device showed a diagnostic sensitivity of 81.1% and a specificity of 71.1%. As for the otoendoscopy, it showed a sensitivity of 84.7% and a specificity of 72.4%. The image classification as “2 = Good” was the most frequent one, with 34.9% for otoendoscopy and 31.6% for the smartphone device. Conclusion: There was a high diagnostic agreement between smartphone device-guided otoscopy and the rigid otoendoscopy, demonstrating the feasibility of using this device in clinical practice. Level of Evidence: 3

To explore the perspectives of lactation support providers delivering breastfeeding education via in-person and telehealth consultations and assess the impact of COVID-19 on the provision of breastfeeding education.Qualitative descriptive study using purposive sampling.Massachusetts-based lactation support providers who provided in-person and/or telehealth consultations in various practice settings (e.g., inpatient; outpatient; private practice; and the Special Supplemental Nutrition Program for Women, Infants, and Children).Fourteen Massachusetts-based lactation support providers, ages 36 to 68 years.Participants completed an online demographic and employment characteristics survey and virtual key informant interviews, from which six main themes were defined.The six main themes included Common Questions Asked by Clients, Prenatal and Postpartum Consultation Topics, Facilitators for Telehealth Versus In-Person Consultations, Barriers for Telehealth Versus In-Person Consultations, Best Practices, and COVID-19 Adaptations. From participant interviews, common subthemes emerged. The primary adaptation due to COVID-19 was shifting to telehealth. Content in lactation consultations was similar via in-person and telehealth sessions. Typical content areas included breast pumping and mother's milk supply. A notable difference was the lack of physical examinations for women and newborns in telehealth sessions. Scheduling flexibility was a key facilitator of telehealth consultations, whereas the inability to provide hands-on assistance and chaotic home environments were common barriers. In-person facilitators included weighing newborns to assess feeding success and insurance billing coverage, whereas unsupportive family members were noted as a barrier. Diversity, equity, and inclusion-related barriers (e.g., language barriers, lack of reflective diversity, lack of stable Internet access) were observed in both settings. Best practices for in-person and telehealth consultations included meeting mothers where they are and focusing on mothers' goals.Practice adaptations adopted during the pandemic and best practice recommendations may be useful for lactation support providers and other health care professionals caring for breastfeeding dyads.

Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape.This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (RC) checklists, as well as to describe student perceptions of the pedagogy.Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but RC scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth.Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

The Coronavirus pandemic outbreak in 2019 and the saturation of healthcare system led to an increased use of digital tools for surveillance. In this study we described our experience using telemedicine to follow-up on patients with intraductal papillary mucinous neoplasms during the COVID-19 era and analyze those factors associated to patients' satisfaction.This 1-year retrospective observational study enrolled patients with intraductal papillary mucinous neoplasms followed-up by telemedicine during COVID-19 outbreak. Patients with high-risk features needing on-site physical examination or declining remote follow-up were excluded. A 13-question survey was conducted; demographic, geographic, and employment information was collected. Univariate and multivariate analyses were performed to evaluate those factors associated to patients' satisfaction.Out of 287, a total of 177 patients with intraductal papillary mucinous neoplasms were included: the mean age was 69 (44-87) years and the male/female ratio was 0.78. A total of 80 (45.2%) patients had previously experienced abdominal pain. Most patients (85.3%) were satisfied with telemedicine: at univariate analysis, age ≥70 years (P = .007), retirement (P = .001), and absence of previous abdominal pain (P = .05) were significantly associated with patient satisfaction. At multivariate analysis, the absence of previous abdominal pain was the only factor independently associated with patient satisfaction (odds ratio 5.964, 95% confidence interval 2.21-16.11, P.001).Telemedicine allows a new follow-up strategy that can be used in selected patients with intraductal papillary mucinous neoplasms. The absence of previous abdominal pain is associated with patient satisfaction during follow-up. Further studies are needed to evaluate safety of remote follow-up in patients with intraductal papillary mucinous neoplasms.

Remote, or tele-, consultations became a necessary form of mental healthcare provision during the COVID-19 pandemic. As the prevalence of mental health problems rises, they may have a role in future mental health services. We aimed to review the literature on patient and provider perspectives on factors influencing the implementation of remote consultations for community-dwelling people with mental health conditions. We searched five electronic databases (PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO) for empirical research up to July 13th, 2022. Only studies of synchronous, interactive remote consultations conducted via video, phone, or live-messaging between patients and providers were included. Two reviewers independently assessed the quality of included studies using the Mixed Methods Appraisal Tool. We integrated qualitative and quantitative data from 39 studies into a single mixed-methods synthesis. We mapped reported factors to the domains of the Consolidated Framework for Implementation Research (CFIR). Acceptability was generally high among participants, despite concerns about the quality of care and the perceived impeded therapeutic relationship. A prominent facilitator was the increased accessibility and convenience of remote consultations, while lack of appropriate infrastructure and low patient comfort and competence were among the most prevalent barriers. This review highlights the importance of patient preferences and provider buy-in to the future of remote consultations.

PURPOSE: To assess changes in retinopathy of prematurity (ROP) diagnosis in single and serial retinal images. DESIGN: Cohort study. PARTICIPANTS: Cases of ROP recruited from the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) consortium evaluated by 7 graders. METHODS: Seven ophthalmologists reviewed both single and 3 consecutive serial retinal images from 15 cases with ROP, and severity was assigned as plus, preplus, or none. Imaging data were acquired during routine ROP screening from 2011 to 2015, and a reference standard diagnosis was established for each image. A secondary analysis was performed using the i-ROP deep learning system to assign a vascular severity score (VSS) to each image, ranging from 1 to 9, with 9 being the most severe disease. This score has been previously demonstrated to correlate with the International Classification of ROP. Mean plus disease severity was calculated by averaging 14 labels per image in serial and single images to decrease noise. MAIN OUTCOME MEASURES: Grading severity of ROP as defined by plus, preplus, or no ROP. RESULTS: Assessment of serial retinal images changed the grading severity for > 50% of the graders, although there was wide variability. Cohen’s kappa ranged from 0.29 to 1.0, which showed a wide range of agreement from slight to perfect by each grader. Changes in the grading of serial retinal images were noted more commonly in cases of preplus disease. The mean severity in cases with a diagnosis of plus disease and no disease did not change between single and serial images. The ROP VSS demonstrated good correlation with the range of expert classifications of plus disease and overall agreement with the mode class (P = 0.001). The VSS correlated with mean plus disease severity by expert diagnosis (correlation coefficient, 0.89). The more aggressive graders tended to be influenced by serial images to increase the severity of their grading. The VSS also demonstrated agreement with disease progression across serial images, which progressed to preplus and plus disease. CONCLUSIONS: Clinicians demonstrated variability in ROP diagnosis when presented with both single and serial images. The use of deep learning as a quantitative assessment of plus disease has the potential to standardize ROP diagnosis and treatment.

This article discusses the use of telehealth in the role of pediatric health care. Management of common pediatric complaints and concerns are discussed in the context of a virtual setting. Benefits, as well as limitations and challenges, and the future of telehealth within the care of pediatric patient are reviewed.

Remote patient monitoring programs collect and analyze a variety of health-related data to detect clinical deterioration with the goal of early intervention. There are many program designs with various deployed devices, monitoring schemes, and escalation protocols. Although several factors are considered, the disease state plays a foundational role when designing a specific program. Remote patient monitoring is used both in chronic disease states and patients with acute self-limited conditions. These programs use health-related data to identify early deterioration and then successfully intervene to improve clinical outcomes and decrease costs of care.

Telehealth programs existed in many subspecialities before the COVID-19 pandemic, and the public health event motivated many subspecialties to reflect on how current technologies could be leveraged to benefit patient outcomes and increase health-care access. This article reviews the history and current state of telehealth access in many areas of subspecialty care. Primary care physicians (PCPs) may be unaware of the telehealth services and options local subspecialists offer. To best serve patients, PCPs could partner with subspecialists to develop processes to link patients to the right subspecialist at the right time and in the right visit type.

Physical assessment courses for nurses typically include a didactic education component and a physical skills laboratory for hands-on practice. Skills instruction focuses on a head-to-toe assessment of body systems, including inspection, palpation, percussion, and auscultation. Comparable learning outcomes can be achieved in both online and traditional classrooms. Telehealth education needs to be included in physical assessment instruction as telehealth services expand to provide greater access to health care. This article provides strategies for incorporating education into online physical assessment courses for nurses and suggests online resources for effective telehealth integration into clinical practice.

Telemedicine has played an increasingly important role in surgical care during the coronavirus disease 2019 (COVID-19) pandemic, yet little is known about its usage and correlation to cost both within and across surgical specialties during the pandemic.We collected data on telehealth encounters from April 2020 to June 2021 for all surgical specialties at a pediatric academic institution. The percent of total encounters that were telemedicine vs. in-person were analyzed over time. Data on charge and reimbursement were averaged for each encounter type, and the percent difference in average charge and reimbursement was calculated and compared between surgical specialties.Of the 147,007 surgical clinical visits identified, 6,566 encounters (4.5%) were telemedicine. Usage peaked in April and plateaued in June of 2020. The specialties with the highest total percentages of telemedicine visits were neurosurgery (23.2%) and cardiovascular-thoracic (11.9%). Orthopedics reported the lowest usage at 2%. Charges for in-person encounters were higher for nearly all specialties while reimbursements remained equal.Our institutional trends reveal that conversion to telemedicine varied across surgical specialty during the COVID-19 pandemic. Charges for in-person encounters were higher than telehealth ones for nearly all specialties, but the reimbursements were fairly the same. Understanding trends in telemedicine volume instigated by and following the pandemic may better prepare pediatric institutions to navigate the accelerated adoption and influence policy changes. This is particularly relevant given the fluctuating impact of the pandemic on healthcare institutions as new strains of COVID-19 emerge.Level V.

The COVID-19 pandemic has highlighted the urgent need for behavioral health care services. A substantial portion of mental health care transitioned to virtual care during the COVID-19 pandemic, remains virtual today, and will continue that way in the future. Mental health needs continue to grow, and there has been growing evidence showing the efficacy of virtual health for behavioral health conditions at the system, provider, and patient level. There is also a growing understanding of the barriers and challenges to virtual behavioral health care.

Telehealth was rapidly adopted during the COVID-19 pandemic. A survey was distributed to neurosurgeons in the United States (U.S.) to understand its use within neurosurgery, what barriers exist, unique issues related to neurosurgery, and opportunities for improvement.A survey was distributed via email and used the SurveyMonkey platform. The survey was sent to 3828 practicing neurosurgeons within the U.S., 404 responses were collected between October 30, 2021 and December 4, 2021.During the pandemic, telehealth was used multiple times per week by 60.65% and used daily by an additional 12.78% of respondents. A supermajority (89.84%) of respondents felt that evaluating patients across state lines with telemedicine is beneficial. Most respondents (95.81%) believed that telehealth improves patient access to care. The major criticism of telehealth was the inability to perform a neurological exam.Telehealth has been widely implemented within the field of neurosurgery during the COVID-19 pandemic and has increased access to care. It has allowed patients to be evaluated remotely, including across state lines. While certain aspects of the neurological exam are suited for video evaluation, sensation and reflexes cannot be adequately assessed. Neurosurgeons believe that telehealth adds value to their ability to deliver care.

Urgent care as a distinct clinical care entity began in the 1970s to treat low-acuity conditions. Virtual urgent care (VUC) can be provided by the primary care physician (PCP) or home health system of the patient, and many commercial direct-to-consumer (DTC) companies have emerged to provide this service. Quality of care continues to be evaluated, but some studies suggest that DTC providers prescribe antibiotics at a higher rate than PCPs. VUC has been proposed to improve equity and access to care, but early evidence is mixed. New utilization owing to convenience may lead to overall higher health care costs.

Centre-based cardiac rehabilitation (CR) programs were disrupted and urged to adopt telehealth modes of delivery during the COVID-19 public health emergency. Previously established telehealth services may have faced increased demand. This study aimed to investigate a) the impact of the COVID-19 pandemic on CR attendance/completion, b) clinical outcomes of patients with cardiovascular (CV) diseases referred to CR and, c) how regional and rural centre-based services converted to a telehealth delivery during this time.A cohort of patients living in regional and rural Australia, referred to an established telehealth-based or centre-based CR services during COVID-19 first wave, were prospectively followed-up, for ≥90 days (February to June 2020). Cardiac rehabilitation attendance/completion and a composite of CV re-admissions and deaths were compared to a historical control group referred in the same period in 2019. The impact of mode of delivery (established telehealth service versus centre-based CR) was analysed through a competitive risk model. The adaption of centre-based CR services to telehealth was assessed via a cross-sectional survey.1,954 patients (1,032 referred during COVID-19 and 922 pre-COVID-19) were followed-up for 161 (interquartile range 123-202) days. Mean age was 68 (standard deviation 13) years and 68% were male. Referrals to the established telehealth program did not differ during (24%) and pre-COVID-19 (23%). Although all 10 centre-based services surveyed adopted telehealth, attendance (46.6% vs 59.9%; p0.001) and completion (42.4% vs 75.4%; p0.001) was significantly lower during COVID-19. Referral during vs pre-COVID-19 (sub hazard ratio [SHR] 0.77; 95% CI 0.68-0.87), and to a centre-based program compared to the established telehealth service (SHR 0.66; 95% CI 0.58-0.76) decreased the likelihood of CR uptake.An established telehealth service and rapid adoption of telehealth by centre-based programs enabled access to CR in regional and rural Australia during COVID-19. However, further development of the newly implemented telehealth models is needed to promote CR attendance and completion.

BackgroundThe COVID-19 pandemic yielded rapid telehealth deployment to improve healthcare access, including for surgical patients.MethodsWe conducted a secret shopper study to assess telehealth availability for new patient and follow-up colorectal cancer care visits in a random national sample of Commission on Cancer accredited hospitals and investigated predictive facility-level factors.ResultsOf 397 hospitals, 302 (76%) offered telehealth for colorectal cancer patients (75% for follow-up, 42% for new patients). For new patients, NCI-designated Cancer Programs offered telehealth more frequently than Integrated Network (OR: 0.20, p=0.01), Academic Comprehensive (OR: 0.18, p=0.001), Comprehensive Community (OR: 0.10, p&nbsp

COVID-19 has resulted in reliance on telecommunication technologies for the provision of supportive cancer care. However, research on the use of these resources among older adults, who are the majority of cancer survivors, is limited. The objective of this study was to gather information on older cancer survivors' perspectives and use of telehealth their cancer survivorship care in the United States.Potential participants were recruited through ResearchMatch® from December 2020-January 2021. Online semi-structured interviews were conducted. Descriptive statistics were used to analyze the participants' demographic and health characteristics. Content analysis were conducted by two independent coders for identification of common themes. Coding agreement was reached through consensus, and count comparisons of participant responses were made.The majority of respondents (n = 21; mean age = 73.5 ± 4.9) were female (57%), White (90%), and had a variety of cancer diagnoses. Participants reported using a variety of technology devices and telehealth products. Older cancer survivors (n = 10) endorsed telehealth video use for physical health concerns and basic check-ups, but some (n = 4) preferred in-person visits for major concerns and sensitive issues (e.g., mental health). Half of participants reported mobile health app use; however, ten participants did not use these apps as they felt the technology was not useful. Barriers to health technology use included missing face-to-face connections with providers, lack of familiarity with the technology, and perceived lack of utility and personalized telehealth platforms. Lastly, video-based conferencing and social media site use among seventeen participants was reported for social interaction during the COVID-19 pandemic.These findings suggest that older cancer survivors utilize online platforms for their general health; however, they prefer in-person visits for serious issues and value personalization with telehealth. Despite from a highly educated sample of ResearchMatch® participants, these results can be used to inform clinicians and researchers about the appropriateness and provision of telehealth-based supportive care among older cancer survivors.

ObjectiveThe utilization of video telemedicine has dramatically increased due to the COVID-19 pandemic. However, significant social and technological barriers have led to disparities in access. We aimed to identify factors associated with patient inability to successfully initiate a video visit across a high-volume urologic practice.Materials and methodsVideo visit completion rates and patient characteristics were extracted from the electronic medical record and linked with census-level socioeconomic data. Associations between video visit failure were identified using multivariate regression modeling and random forest ensemble classification modeling.ResultsSix thousand eighty six patients and their first video visits were analyzed. On multivariate logistic regression analysis, Hispanic or Latino patients (OR 0.52, 95%CI 0.31-0.89), patients insured by Medicare (OR 0.46, 95%CI 0.26-0.79) or Medicaid (OR 0.50, 95%CI 0.29-0.87), patients of low socioeconomic status (OR 0.98, 95%CI 0.98-0.99), patients with an un-activated MyChart patient portal (OR 0.43, 95%CI 0.29-0.62), and patients unconfirmed at appointment reminder (OR 0.68, 95%CI 0.48-0.96) were significantly associated with video visit failure. Patients with primary diagnosis category of men's health (OR 47.96, 95%CI 10.24-856.35), and lower urinary tract syndromes (OR 2.69, 95%CI 1.66-4.51) were significantly associated with video visit success. Random forest analyses identified insurance status and socioeconomic status as the top predictors of video visit failure.ConclusionAn analysis of a urology video telemedicine cohort reveals clinical and demographic disparities in video visit completion and priorities for future interventions to ensure equity of access. Our study further suggests that specific urologic indications may play a role in success or failure of video visits.

The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination.Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests.Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing.These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits.

Consumer technology in the form of personal computers, mobile devices, and wearable technology, despite current underutilization, has the potential to greatly enhance the practice of urologic oncology and the surgical care of bladder cancer patients, particularly through the dissemination of educational videos, telemedicine, and the use of wearable technology for patient monitoring. A comprehensive healthcare application can unite all of these features, providing curated educational videos at different timepoints in surgical care, facilitating communication between the patient and the care team, and interfacing with wearable technology and other peripherals to allow for nonintrusive patient monitoring to help facilitate early identification of complications and to follow post-operative patient progress. Here we seek to review the available literature on this topic, discuss our institutional experience, and provide future perspectives in the perioperative management of bladder cancer patients.

Drug repurposing is a major field of value-added medicine. It involves investigating and evaluating existing drugs for new therapeutic purposes that address unmet healthcare needs. Several unmet needs in allergic rhinitis could be improved by drug repurposing. This could be game-changing for disease management. Current medications for allergic rhinitis are centered on continuous long-term treatment, and medication registration is based on randomized controlled trials carried out for a minimum of 14 days with adherence of 70% or greater. A new way of treating allergic rhinitis is to propose as-needed treatment depending on symptoms, rather than classical continuous treatment. This rostrum will discuss existing clinical trials on as-needed treatment for allergic rhinitis and real-world data obtained by the mobile health app MASK-air, which focuses on digitally-enabled, patient-centered care pathways.

This study aimed to evaluate the feasibility and acceptability of a nurse-led eHealth transition care program for adolescents with spina bifida.This study used a single-arm, pretest-posttest intervention study. Adolescents with spina bifida, aged 12-15 years, and their parents participated in the program. A 6-week program was delivered through an online platform in real-time by nurses. We evaluated feasibility and acceptability using criteria such as the completion rate, program satisfaction, changes in transition readiness, social support, career preparation behavior, sexual knowledge, and sexual worries at three time points from July to September 2021.Thirteen adolescents completed all sessions and surveys (13/14, 92.9%). All adolescents expressed high satisfaction with both the content and delivery methods of the program. Significant benefits in transition readiness, career preparation behavior, and sexual knowledge were identified over the study period. However, the evaluation of social support and sexual worries did not demonstrate any significant improvements. Additionally, through family counseling, adolescents benefited from experiences such as reflecting on their current transition readiness, setting and achieving individualized goals and plans using a self-checklist with their parents and nursing professionals.This nurse-led eHealth intervention was feasible and acceptable for adolescents with spina bifida. Furthermore, our results highlight the practicability and the potential for strategic dissemination of using this eHealth program in transitional care during the COVID-19 pandemic.The eHealth transition care program contributes to broadening existing nursing interventions not only in medical areas but also in daily life areas.

Telemedicine is a method of health care delivery well suited for epilepsy care, where there is an insufficient supply of trained specialists. The telemedicine "Hub and Spoke" approach allows patients to visit their local health clinic ('Spokes') to establish appropriate care and monitoring for their seizure disorder or epilepsy, and remotely connect with epileptologists or neurologists at centralized centers of expertise ('Hubs'). The COVID-19 pandemic resulted in an expansion of telemedicine capabilities and use, with favorable patient and provider experience and outcomes, allowing for its wide scale adoption beyond COVID-19.

The use of telemedicine has increased in allergy/immunology, with rapid uptake of its use during the coronavirus disease 2019 pandemic. Existing data indicate an overall positive view of telemedicine by patients, particularly during the coronavirus disease 2019 pandemic. However, patients and clinicians prefer in-person visits for specific types of allergy/immunology encounters, such as those requiring a physical examination or diagnostic testing. The most data for telemedicine exist with asthma, and provide a model for treatment technique, therapeutic monitoring, and education in other allergic and immunologic conditions. Clinician satisfaction is also necessary for telemedicine to be an enduring option for patient/clinician interactions, and this is influenced by a multitude of factors, including technology quality, reimbursement, and maintenance of patient/clinician relationships. Areas of future research should include the need for more outcome data in additional disease states, which will likely help facilitate improved logistical policies around telemedicine that would facilitate its adoption.

The COVID-19 pandemic created an explosion in the use of telehealth. However, telehealth consists of much more than a video discussion between doctor and patient. Since the onset of the COVID-19 pandemic, allergists have demonstrated a high level of synchronous telemedicine adoption with existing patients but have not taken full advantage of other virtual care modalities that have the potential to facilitate the efficient delivery of allergy care to the broader population. This is partially due to a lack of awareness about the various remote care services and how to implement and bill for them appropriately. This rostrum describes the spectrum of telehealth services, reviews existing literature on the use of telehealth in allergy, and provides suggestions about how allergists and immunologists can optimize the use of telehealth to optimize patient access and outcomes as well as receive appropriate compensation for specialty clinical services provided by themselves and their staff.

Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.

The COVID-19 pandemic has created many barriers to providing health care, yet it also has created new opportunities. Although telemedicine was a nascent means of health care delivery before COVID-19, it now is one of the principal means for doing so today, and it is likely to remain so. Whether this will happen may depend in part on continued relaxation of regulations that hampered it before the pandemic. Whereas enforcement of compliance with Health Information Portability and Accountability Act will most likely resume, platform operators and providers have had an opportunity to prepare for this. State licensure requirements may also resume; however, the regulations were in the process of becoming more liberal before COVID-19 so that process might continue. There is no reason to anticipate that payment for telemedicine services including check-ins, remote physiologic and therapeutic monitoring, and relaxation of location and service requirements will end. For these reasons, telemedicine therefore is likely to continue as an important part of medical practice.

This multiauthored communication gives a state-of-the-art global perspective on the increasing adoption of tele-critical care. Exponentially increasing sophistication in the deployment of Computers, Information, and Communication Technology has ensured extending the reach of limited intensivists virtually and reaching the unreached. Natural disasters, COVID-19 pandemic, and wars have made tele-intensive care a reality. Concerns and regulatory issues are being sorted out, cross-border cost-effective tele-critical care is steadily increasing Components to set up a tele-intensive care unit, and overcoming barriers is discussed. Importance of developing best practice guidelines and retraining is emphasized.

One of the most compelling arguments for telemedicine is its potential to increase health care access by making care more affordable for patients and families, including those affected by asthma. This goal is critically important in the United States, where the high cost of asthma care is associated with nonadherence to preventive care regimens and suboptimal health outcomes. In this clinical commentary review, we draw from the literature and our own research to identify opportunities for and challenges to leveraging telemedicine to reduce the financial burden of asthma care. Our interviews with 42 families affected by asthma during the COVID-19 pandemic suggest that under favorable circumstances, telemedicine can meaningfully reduce costs, including those related to transportation and missed work, while offering high-quality care. However, families also identified ways in which telemedicine can increase costs. For example, some reported reduced access to support services and material resources such as medication samples, which they relied on to manage costs. In this way, our findings underscore the need for careful care coordination and communication in telemedicine. We conclude by discussing the 4Rs, a structured communication approach designed to support cost conversations, increase care coordination, and help families reduce asthma care cost burden.

As more complex surgery is performed in 1-day admissions there is a growing demand for appropriate postoperative follow-up. A digital patient portal (DPP) is a promising tool to support this and increase patients' quality of recovery. However, both patients and health care professionals have not fully embraced this eHealth technology. This study investigates the extent to which a patient portal is used in a tertiary ambulatory surgical care unit and assesses usability, applicability and user-friendliness both for the patient and health care worker.Mixed method research design combining qualitative and quantitative methods.Four hundred and fifteen patients undergoing knee arthroscopic surgery or endonasal sinus surgery were included. Quantitative log data from the patient platform, clinical outcome measures and a patient questionnaire were used. Additionally, qualitative data was collected through interviews (with patients, n = 13; involved caregivers and physicians, n = 7) and observations (first introduction to patient with platform and team meetings, n = 15).Forty percent of the included patients effectively used the patient platform (≥1 login). The patients mainly used the platform for gathering information; 62% of the active patients on the platform registered questionnaires initiated from the surgery center (eg, preoperative questionnaire) or diaries (e.g, daily follow-up using the Quality of Recovery Scale). Different barriers and facilitators toward DPP implementation were noted. Attention should be paid to the intrinsic and extrinsic motivation for using the portal and to the added value of the portal for the patient and health care professionals.Patients' perceptions of the DPP were positive and an increase in DPP use was observed during the study due to adjustments (eg, technical adjustments). However, a decline over time was noticed. The role of intrinsic and extrinsic motivation of all included parties needs to be further corroborated.

The COVID-19 pandemic has significantly impacted oncology. With pandemic restrictions limiting close contact between individuals, telehealth (the use of teleconferencing/videoconferencing to conduct real-time medical consultations) has been increasingly utilised. This qualitative study aimed to explore adult cancer patient, caregiver, and clinician (doctor, nurse, allied health) telehealth experiences during COVID-19 in urban and rural Australian settings and identify potential enablers and barriers to sustained telehealth implementation.English-speaking participants completed semi-structured interviews regarding their telehealth experiences since March 2020. Interviews ceased when data saturation occurred. Iterative thematic analysis was conducted using NVivo 12 Pro.Thirty-four interviews (clinician=14, patient=13, caregiver=7) were conducted from April to August 2021. Analysis generated seven themes relating to telehealth use: 1) Acceptability as a form of consultation, 2) Impacts on healthcare provision, 3) Communicationrelationships, 4) Efficient form of consultation, 5) Comfort of conducting telehealth in different environments, 6) Technological barriers and 7) Future preferences.The rapid uptake of telehealth during the pandemic has mostly been well-received, and telehealth can be appropriately used in oncology.Barriers including providing appropriate facilities, technology, and telehealth training; and selecting appropriate patients must be addressed to enable sustained telehealth use in future cancer care.

The first-line management of behavioral and psychological symptoms of dementia (BPSD) is based on nonpharmacologic interventions such as the provision of guidance and medical support to caregivers. However, accessibility to specialized care and medical resources is often scarce. The ongoing COVID-19 pandemic has compromised the delivery of outpatient care (notably in order to minimize the risk of disease transmission), thus making it essential to provide other means of accessing care for these patient populations. The use of telemedicine (TM) may be a means of increasing access to specialist care for patients with disabilities and poor access to health services, such as those with BPSD. The aim of this study is to provide a review of the literature on the use of TM for treatment and follow-up of patients with BPSD and their caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published between January 1st, 2000, and December 31st, 2020, on the applicability of TM support for people with BPSD and their caregivers. We included open-label studies, qualitative studies, and randomized controlled trials . We did not include studies on the use of TM during the COVID-19 pandemic. A total of 22 publications were included and reviewed. TM was found to 1) be acceptable and feasible for both patients and caregivers, 2) decrease the frequency and intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental health. Videoconferencing was effective for patient-centered interventions in nursing homes. Telephone-based interventions were more relevant when they were targeted at caregivers. The published studies are lacking in scope and high-quality studies are now needed to confirm these findings and assess TM's cost-effectiveness and ability to improve the management of patients with BPSD. In view of the ongoing COVID-19 pandemic, remote solutions for assessing and monitoring individuals with BPSD are urgently needed - particularly those living in rural areas and so-called "medical deserts."

This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article.PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores.The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms.To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.

We evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI.Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) was a three-arm trial. Patients were randomized to 1) post-MI education-only; 2) nurse-administered telephone program; or 3) web-based interactive tool. The study was conducted 2009-2013.Participants (n = 415) had a mean age of 61 years (standard deviation [SD], 11). Relative to the education-only group, the 12-month differential improvement in SBP was - 3.97 and - 3.27 mmHg for nurse-administered telephone and web-based groups, respectively. Neither were statistically significant. Post hoc exploratory subgroup analyses found participants who received a higher dose (12 encounters) in the nurse-administered telephone intervention (n = 60; 46%) had an 8.8 mmHg (95% CI, 0.69, 16.89; p = 0.03) differential SBP improvement versus low dose (11 encounters; n = 71; 54%). For the web-based intervention, those who had higher dose (n = 73; 53%;1 web encounter) experienced a 2.3 mmHg (95% CI, -10.74, 6.14; p = 0.59) differential SBP improvement versus low dose (n = 65; 47%).The main effects were not statistically significant.Completing the full dose of the intervention may be essential to experience the intervention effect.The unique identifier is NCT00901277 (http://www.gov/ct2/show/NCT00901277?term=NCT00901277rank=1).

Immediate public health interventions and solutions, including the virtual provision of patient care via telehealth, were exponentially employed in response to the coronavirus disease 2019 pandemic. As a result, the U.S. Department of Health and Human Services temporarily waived Medicare telehealth restrictions. Dramatic increases in the provision of care via telehealth were observed, beginning in March 2020. Yet, despite these changes, there was a deficit in relevant telehealth readiness assessment, resources, and training that incorporated critical elements brought forth by the pandemic. This article describes the need for and provides a telehealth readiness assessment tool as a digital health strategy for health professional students, clinicians, and organizations to be prepared for patient care engagement during and beyond the pandemic.

Teleradiology is well established in many small animal practices, whereas teleultrasound is slowly gaining prominence. The demand for teleultrasound services in the veterinary profession has increased substantially because access to ultrasound to general practitioners increases faster than the number of imaging specialists and Point of Care Ultrasound (POCUS) becomes part of the standard of care. Two main methods of teleultrasound currently exist: asynchronous (eg, "store-and-forward") and synchronous (eg, real-time) interpretations. Few standardized protocols for teleultrasound in small animals are available. Similarly, there are no standardized training programs for sonographic examination acquisition and interpretation outside of the traditional diagnostic imaging residency under the purview of the American College of Veterinary Radiology. The success of a telesonographic evaluation largely depends on the relationship between the veterinarian requesting remote assistance and the expert providing support.

Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM. Copyright © 2022 Elsevier Ltd. All rights reserved.

This study aimed to assess the cost-effectiveness of a remotely operated referral management system (RORMS) compared with a conventional referral management system (CRMS) in Brazil.This is a model-based cost-effectiveness analysis under the perspective of the Unified Healthcare System (Sistema Único de Saúde [SUS]) in Brazil. A Markov microsimulation model was developed to compare costs and referral outcomes of the RORMS and the CRMS. Model consisted of 4 states representative of sequential stepwise assessments of referral suitability, 3 states representative of referral outcomes, and 1 exit model state. Target population represented cases being referred from primary healthcare units to specialized care in SUS. Model inputs related to costs and effectiveness in the RORMS arm were obtained from the data set of a RORMS between July and December 2019. Model inputs for the CRMS model arm were obtained from administrative data sets of 2 Brazilian localities for the year 2019. Relative effect size of RORMS in comparison with CRMS in SUS was obtained from published studies. Effectiveness outcome was unnecessary referrals averted. The incremental cost-effectiveness ratio was calculated for the base case. Probabilistic sensitivity analysis was conducted.In the base-case analyses, RORMS dominated CRMS, with expected cost-savings from $50.42 to $80.62 per unnecessary referral averted. RORMS was the dominant strategy in 83.7% of 100 000 simulations in the probabilistic sensitivity analysis. In 16.2% of simulations, incremental cost-effectiveness ratio was between $0 and $222 per unnecessary referral averted.Model-based simulations indicate that the RORMS is likely to be cost saving in comparison with the CRMS.

Telemedicine use within pediatric surgery fields has been growing, but research on the utility of remote evaluation in the perioperative period remains scarce. The objective of this study was to examine the utility of perioperative telemedicine care for the pediatric patient by evaluating the outcomes following completion of an outpatient appointment with a surgical provider.We performed a retrospective chart review of all patients who completed a telemedicine appointment with a provider across nine pediatric surgery divisions, without a limitation based on patient-specific characteristics or telemedicine platform. We examined the result of the initial telemedicine appointment and the outcome of any surgical procedure that was performed as a result.A total of 803 patients were evaluated by telemedicine during the study period. Of the 164 encounters (20.2%) that were followed by a surgery, nearly 70% were performed using a video. There was no discordance in the preoperative and postoperative diagnoses for more than 98% of patients. Nearly 25% of operations were followed by at least a 1-night hospital stay and 6.7% of patients developed a postoperative complication.Telemedicine is a safe tool for evaluating pediatric patients in the preoperative and postoperative phases of care and offers potential value for families seeking an alternative to the traditional in-person appointment. Ongoing support will require permanent legislative changes aimed at ensuring comparable compensation and the development of strategies to adapt the outpatient healthcare model to better accommodate the evolving requirements of remotely evaluating and treating pediatric patients.

The concept of telecritical care has evolved over several decades. ICU Telemedicine providers using both the hub-and-spoke ICU telemedicine center and consultative service delivery models offered their services during the COVID-19 pandemic. Telemedicine center responses were more efficient, timely, and widely used than those of the consultative model. Bedside nurses, physicians, nurse practitioners, physician assistants, and respiratory therapists incorporated the use of ICU telemedicine tools into their practices and more frequently requested critical care specialist telemedicine support.

BackgroundTelehealth use rapidly increased during the COVID-19 pandemic, including for contraceptive care (e.g., counseling and method provision). This study explored providers' experiences with contraceptive care via telehealth.MethodsWe conducted a survey with open-ended responses among contraceptive providers across the United States. The study population included physicians, nurse practitioners, health educators, and other health professionals (n=546). Data were collected from April 10, 2020, to January 29, 2021. We conducted qualitative content analysis of the open-ended responses.ResultsProviders highlighted the benefits of telehealth, including continuing access to contraceptive services and accommodating patients who faced challenges attending in-person contraceptive visits. Providers at school-based health centers reported telehealth allowed them to reach young people while schools were closed. However, many providers noted a lack of patient awareness about the availability of telehealth services and disparities in access to technology. Providers felt there was less personal connection in virtual contraceptive counseling, noted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.ConclusionsThe pandemic significantly impacted contraceptive health care delivery. Telehealth has sustained access to contraception in important ways, but has been accompanied by various challenges, including technological access and confidentiality. As hybrid models of care evolve, it is important to assess how telehealth can play a role in providing contraceptive care while addressing its barriers.

Background: Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pan-demic, and whether country acute accent s income, geographical location, COVID-19-transmission pat-tern, and levels of specialization of the burn units affected reallocation of resources and access to burn care.Methods: The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, chi 2 or Fishers exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic.Results: The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedi-cated nursing staff was reduced (< 0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration be-tween burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors.Conclusions: During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.(c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The number of college students who need mental health treatment outpaces the resources available to counseling centers to provide these needed services, presenting a need for low-cost, scalable interventions for college populations. We conducted a pilot implementation-effectiveness trial of a scalable treatment package that consisted of a single (telehealth) workshop plus a companion app that provided ecological momentary intervention. Participants (n = 177) received a workshop provided by counseling center staff and trainees. We were interested in (1) engagement with the app, (2) acceptability of the treatment package, and (3) initial effectiveness of the treatment package. Regarding engagement with the app, we found that participants preferred two reminder prompts per day and identified two key breakpoints when engagement declined significantly: at day 15, when just over half of the sample practiced a skill on the app at least once during the day and at day 41, when just over one third of people practiced a skill on the app each day. Regarding acceptability of the treatment package, students generally reported positive attitudes about the single-session workshop and app, but also noted that the content and assessments in the app needed to be more dynamic to improve how engaging it is. Regarding effectiveness, we found that about 75% of the sample experienced a significant reduction in negative affect from pre- to post-ecological momentary intervention. Moreover, there were significant pre- to post-study decreases in experiential avoidance and symptoms of anxiety and depression and increases in self-efficacy for managing negative emotions. The results of this study are promising in terms of providing initial support for this novel treatment package and provide useful information for researchers planning to develop and test similar interventions.