Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery.

BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

Cosmetic prescription and photodocumentation: Virtual model of facial skin assessment and follow-up of continuous use of cosmetics

After the COVID-19 pandemic, new skin care habits were evidenced through self-care tips, often without professional monitoring. The aim of this work was to highlight the importance of cosmetic prescription and photocomposition, presenting a virtual model of systemic facial skin evaluation and monitoring of the continued use of cosmetics. The methodology adopted used Google Meet with recording as a virtual tool, following the steps: prior submission of the evaluation form with guidelines for attending the volunteer, instructions for capturing images and signing documents (Term of Responsibility, Term of Authorization for Use of Personal Image and Informed Consent Form);scheduling and virtual service;analysis of the results of the systemic evaluation and research of cosmetic products through the selection of components and technology;ending with the delivery of the cosmetic prescription and monitoring of cosmetic use. The proposed model of facial cosmetic prescription and photo documentation documented the need for a systemic anamnesis with information on self-assessment, habits, diet, health history, clinical laboratory and cosmetic evaluation (access, guidelines and use). The standardized photographic record was necessary as a complementary resource of information to effect a safe cosmetic prescription. The results showed that the cosmetic market makes products available according to the clinical need of the evaluated person's skin, but some of these people do not have access to the product due to transport logistics in cities far from large urban centers. Patients reported performing self-care and having the need for specialized professional pharmacist monitoring, as they use cosmetic products that are not compatible with the current state of the skin, with facial care most often associated with hygiene, epidermal pigment spots, periorbital hyperchromia, facial flaccidity, wrinkles, lipid imbalance, comedones and acne. The lack of guidance for a healthy life with balanced habits and diet, in addition to the incorrect use of cosmetics were the probable causes of the need for a careful and safe cosmetic prescription based also on the health history and laboratory tests that proved the skin imbalance. The analysis of photo-documentation was important to assess the extent of the need for care, which was often not revealed in systemic anamnesis. The main cosmetic forms prescribed were liquid soap, tonic, moisturizer, sunscreen, rejuvenating and anti-dark circles cosmetics. All products were selected according to the skin's needs, carefully analyzing the composition and technology of the pharmaceutical form. The follow-up of the assessed person was important in this prescription model, as adjustments to the prescribed cosmetics were necessary due to access, price or incompatibility with the skin. The virtual model of facial care directs the cosmetic prescription to the well-being of the evaluated person's skin according to the current state, suggesting the rational use and credibility of the prescribed cosmetic products. This activity model highlights the need for professional training in cosmetic prescription, the satisfaction of the evaluated and the recognition of the pharmaceutical professional. Care for others can be proposed in several ways: from a correct cosmetic prescription, for example, to multiprofessional partnerships that offer support for artificial intelligence.