Evaluating a Smart Healthcare System Design Through Participatory Approach.

Advances in computer communication technology have enabled the rapid growth of e-health services for delivering healthcare, such as facilitating online consent and data sharing between patients and health professionals. Developing a patient-centric healthcare system is challenging because by necessity, it should be secure, reliable, and resilient to cyber threats, whilst remaining user-friendly. Key to any development aiming for a refined proof-of-concept (PoC) system is the pursuit of comprehensive public system testing and evaluation. This paper focuses on the methodology and results obtained from the participatory approach adopted by the EU H2020 project Serums to evaluate and demonstrate the effectiveness of a smart healthcare system based on emergent technologies like blockchain, data lake, and multi-factor authentication. We discuss the challenges faced by remote PoC system evaluations with end-users as a consequence of the Covid-19 pandemic.

Studying trajectories of multimorbidity: a systematic scoping review of longitudinal approaches and evidence.

OBJECTIVES: Multimorbidity-the co-occurrence of at least two chronic diseases in an individual-is an important public health challenge in ageing societies. The vast majority of multimorbidity research takes a cross-sectional approach, but longitudinal approaches to understanding multimorbidity are an emerging research area, being encouraged by multiple funders. To support development in this research area, the aim of this study is to scope the methodological approaches and substantive findings of studies that have investigated longitudinal multimorbidity trajectories. DESIGN: We conducted a systematic search for relevant studies in four online databases (Medline, Scopus, Web of Science and Embase) in May 2020 using predefined search terms and inclusion and exclusion criteria. The search was complemented by searching reference lists of relevant papers. From the selected studies, we systematically extracted data on study methodology and findings and summarised them in a narrative synthesis. RESULTS: We identified 35 studies investigating multimorbidity longitudinally, all published in the last decade, and predominantly in high-income countries from the Global North. Longitudinal approaches employed included constructing change variables, multilevel regression analysis (eg, growth curve modelling), longitudinal group-based methodologies (eg, latent class modelling), analysing disease transitions and visualisation techniques. Commonly identified risk factors for multimorbidity onset and progression were older age, higher socioeconomic and area-level deprivation, overweight and poorer health behaviours. CONCLUSION: The nascent research area employs a diverse range of longitudinal approaches that characterise accumulation and disease combinations and to a lesser extent disease sequencing and progression. Gaps include understanding the long-term, life course determinants of different multimorbidity trajectories, and doing so across diverse populations, including those from low-income and middle-income countries. This can provide a detailed picture of morbidity development, with important implications from a clinical and intervention perspective.