Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care.

Background: COVID-19 increased the demand for Remote Patient Monitoring (RPM) services as a rapid solution for safe patient follow-up in a lockdown context. Time and resource constraints resulted in unplanned scaled-up RPM pilot initiatives posing risks to the access and quality of care. Scalability and rapid implementation of RPM services require social change and active collaboration between stakeholders. Therefore, a participatory action research (PAR) approach is needed to support the collaborative development of the technological component while simultaneously implementing and evaluating the RPM service through critical action-reflection cycles. Objective: This study aims to demonstrate how PAR can be used to guide the scalability design of RPM pilot initiatives and the implementation of RPM-based follow-up services. Methods: Using a case study strategy, we described the PAR team's (nurses, physicians, developers, and researchers) activities within and across the four phases of the research process (problem definition, planning, action, and reflection). Team meetings were analyzed through content analysis and descriptive statistics. The PAR team selected ex-ante pilot initiatives to reflect upon features feedback and participatory level assessment. Pilot initiatives were investigated using semi-structured interviews transcribed and coded into themes following the principles of grounded theory and pilot meetings minutes and reports through content analysis. The PAR team used the MoSCoW prioritization method to define the set of features and descriptive statistics to reflect on the performance of the PAR approach. Results: The approach involved two action-reflection cycles. From the 15 features identified, the team classified 11 as must-haves in the scaled-up version. The participation was similar among researchers (52.9%), developers (47.5%), and physicians (46.7%), who focused on suggesting and planning actions. Nurses with the lowest participation (5.8%) focused on knowledge sharing and generation. The top three meeting outcomes were: improved research and development system (35.0%), socio-technical-economic constraints characterization (25.2%), and understanding of end-user technology utilization (22.0%). Conclusion: The scalability and implementation of RPM services must consider contextual factors, such as individuals' and organizations' interests and needs. The PAR approach supports simultaneously designing, developing, testing, and evaluating the RPM technological features, in a real-world context, with the participation of healthcare professionals, developers, and researchers.

Rethinking the Campus Experience in a Post-COVID World: A Multi-Stakeholder Design Thinking Experiment

In a post-COVID world, rethinking the campus experience is critical for defining new pedagogical strategies. As higher education moves toward more student-centred action learning models, university leaders should engage in democratic design methods that empower students and professors. Design thinking (DT) is a user-centred design approach that can aid in the creation of future learning environments. While DT has been used in innovative space design, we know little about how students, professors, and other community members can act as codesign partners. To understand their role in codesign and how their experiences are incorporated into new building design decisions, we need a conceptual model. To develop this model, we examined a case study of the evolutionary co-design process of a new building for a leading information management school in Europe. Using the concept of three phases of design thinking defined by Brown (2009): Inspire, Ideate, and Implement, we collaborated with a group of 50 design thinking students and more than 500 members of the community representing different stakeholders, to create new spaces and rethink the learning experience. Our discussion will centre on the creation of a participatory design thinking model that positions students as design partners alongside university decision makers. The findings conclude that, by applying design thinking methods, it was possible to unveil new dimensions of the success of future campuses that go beyond the building design. Creating meaningful learning spaces that inspire creativity and critical thinking requires an alignment between human centred design, organizational change management and new pedagogical strategies.

Addressing hospitalisations with non-error-free data by generalised SEIR modelling of COVID-19 pandemic.

Successive generalisations of the basic SEIR model have been proposed to accommodate the different needs of the organisations handling the SARS-CoV-2 epidemic. These generalisations have not been able until today to represent the potential of the epidemic to overwhelm hospital capacity until today. This work builds on previous generalisations, including a new compartment for hospital occupancy that allows accounting for the infected patients that need specialised medical attention. Consequently, a deeper understanding of the hospitalisations rate and probability as well as of the recovery rates for hospitalised and non-hospitalised individuals is achieved, offering new information and predictions of crucial importance for the planning of the health systems and global epidemic response. Additionally, a new methodology to calibrate epidemic flows between compartments is proposed. We conclude that the two-step calibration procedure is able to recalibrate non-error-free data and showed crucial to reconstruct the series in a specific situation characterised by significant errors over the official recovery cases. The performed modelling also allowed us to understand how effective the several interventions (lockdown or other mobility restriction measures) were, offering insight for helping public authorities to set the timing and intensity of the measures in order to avoid the implosion of the health systems.

IL-10 and IL-12 (P70) Levels Predict the Risk of Covid-19 Progression in Hypertensive Patients: Insights From the BRACE-CORONA Trial.

Background: Cardiovascular comorbidities such as hypertension and inflammatory response dysregulation are associated with worse COVID-19 prognoses. Different cytokines have been proposed to play vital pathophysiological roles in COVID-19 progression, but appropriate prognostic biomarkers remain lacking. We hypothesized that the combination of immunological and clinical variables at admission could predict the clinical progression of COVID-19 in hypertensive patients. Methods: The levels of biomarkers, including C-reactive protein, lymphocytes, monocytes, and a panel of 29 cytokines, were measured in blood samples from 167 hypertensive patients included in the BRACE-CORONA trial. The primary outcome was the highest score during hospitalization on the modified WHO Ordinal Scale for Clinical Improvement. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and biomarkers associated significantly with the primary outcome. Results: During hospitalization, 13 (7.8%) patients showed progression to more severe forms of COVID-19, including three deaths. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography examination, the C-reactive protein level, levels of 15 cytokines, and lymphopenia on admission were associated with progression to severe COVID-19. Elevated levels of interleukin-10 and interleukin-12 (p70) combined with two or three of the abovementioned clinical comorbidities were associated strongly with progression to severe COVID-19. The risk of progression to severe disease reached 97.5% in the presence of the five variables included in our model. Conclusions: This study demonstrated that interleukin-10 and interleukin-12 (p70) levels, in combination with clinical variables, at hospital admission are key biomarkers associated with an increased risk of disease progression in hypertensive patients with COVID-19.