Identifying gaps and redesigning asthma care pathway in Primary Care with multidisciplinary teams

1. Introduction: Asthma causes significant morbidity and mortality worldwide. COVID-19 scenario has revealed lacks in the current model of asthma management in Primary Care (PC). 2. Aims and objectives: The aim was to build a reference framework and address patients' needs to help asthma management improvement in a COVID-19 scenario. 3. Method(s): A scientific committee from the Spanish Respiratory Group in PC (GRAP) defined an evidence-based gold standard model for asthma care pathway including: suspected asthma, confirmed asthma, asthma follow-up, asthma exacerbations and special situations in asthma. Multidisciplinary teams (family doctors, PC nurses, practice clerks, and community pharmacists) were recruited from 17 PC settings in 7 Spanish regions to characterise their local asthma care pathway and to identify room for improvement in different areas according to previously defined gold-standards. A national online Digital Innovation Laboratory was held with representatives of the local teams to prioritise areas of improvement in terms of clinical impact and to co-design action plans. 4. Result(s): 43 to-be-improved areas in asthma care pathways were identified, classified into different categories. Continuing care, collaborative work between Primary and Secondary care, availability of qualified healthcare staff, data recording and management, digital transformation and patient empowerment were some of the areas to prioritize. 5. Conclusion(s): Multidisciplinary pre-structured team work with Digital Innovation Laboratory support could help to redesign the asthma patient's pathway and to improve the effective asthma management in a COVID-19 scenario.

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).

Effectiveness of digital care platform CMyLife for patients with chronic myeloid leukemia: results of a patient-preference trial.

BACKGROUND: Two most important factors determining treatment success in chronic myeloid leukemia (CML) are adequate medication compliance and molecular monitoring albeit still being suboptimal. The CMyLife platform is an eHealth innovation, co-created with and for CML patients, aiming to improve their care, leading to an increased quality of life and the opportunity of hospital-free care. OBJECTIVE: To explore the effectiveness of CMyLife in terms of information provision, patient empowerment, medication compliance, molecular monitoring, and quality of life. METHODS: Effectiveness of CMyLife was explored using a patient-preference trial. Upon completion of the baseline questionnaire, participants actively used (intervention group) or did not actively use (questionnaire group) the CMyLife platform for at least 6 months, after which they completed the post-intervention questionnaire. Scores between the intervention group and the questionnaire group were compared with regard to the within-subject change between baseline and post-measurement using Generalized Estimating Equation models. RESULTS: At baseline, 33 patients were enrolled in the questionnaire group and 75 in the intervention group. Online health information knowledge improved significantly when actively using CMyLife and patients felt more empowered. No significant improvements were found regarding medication compliance and molecular monitoring, which were already outstanding. Self-reported effectiveness showed that patients experienced that using CMyLife improved their medication compliance and helped them to oversee their molecular monitoring. Patients using CMyLife reported more symptoms but were better able to manage these. CONCLUSIONS: Since hospital-free care has shown to be feasible in time of the COVID-19 pandemic, eHealth-based innovations such as CMyLife could be a solution to maintain the quality of care and make current oncological health care services more sustainable. TRIAL REGISTRATION: ClinicalTrials.gov NCT04595955 , 22/10/2020.

Early nutritional screening, appropriate first line advice and prescribed oral nutrition support across organisational boundaries. New oral nutrition support pathway striving for seamless delivery of care from Hospital into Community Care

In the UK, approximately 3 million people are malnourished or at risk of malnutrition. Malnutrition is a major public health issue with costs the NHS over £19 billion per year in England alone. We know 93% of malnutrition happens in peoples own homes, 5% in care homes and 2% in hospital. It is also understood that 30% of inpatients are at higher risk of becoming malnourished in hospital. 1 As many departments, demand for dietetic services has outweighed capacity, in part due to improved rates of nutritional risk screening across the organisation. The Trust uses an internal validated nutritional screening tool but community partners largely use MUST (Malnutrition Universal Screening Tool). Within our Dietetic team, we identified a number of treatment strategies needed to ensure timely care, patient empowerment and patient safety with a focus on improved nutrition to help recovery across organisational boundaries from the acute admission and into primary care. Patients who are identified as malnourished or at very high risk of malnutrition, have specialist requirements should have immediate referral to a dietitian. Oral nutritional supplements are now prescribed appropriately whilst in hospital and post discharge in line with national and local guidelines. 4 Communication between different healthcare professionals and settings is essential for the seamless delivery of care2 and hospital teams discharging patients with an identified risk of malnutrition should communicate this in writing to primary care teams3. As a team, we decided to encompass nutrition and dysphagia scores as an inpatient on discharge letters. This was be achieved by working closely with the pharmacy, Speech and Language, catering, nursing and medical teams to develop and implement a clear process for all adult inpatients to improve ward based nutritional care and appropriate prescribing, based on their individual risk of malnutrition. We have developed and implemented a discharge process that provides patients with a nutrition pack (malnutrition pathway leaflets, cover letter +/- Care Homes information) +/- nutritional supplements on discharge. The process was developed with local CCGs, GPs, PCN Pharmacists and community dietetic services. Outcomes measured include;appropriate prescribing, access to snacks and supplements, clinical outcomes including length of stay (LOS), readmission rates and timely access to first line advice. Baseline audit information revealed only 8% of inpatients received the a first line nutrition leaflet, this has increased to 13% just 6 weeks post implementation, patient first line snacks has increased to 5 different categories as choice available has increased. Oral nutritional support (ONS) is now solely prescribed using the agreed ONS pathway. Early indications suggest a direct improvement in patient care and choice. References 1. Brothern A, Simmonds N, Stroud M.2010. Malnutrition Matters: Meeting Quality Standards in Nutritional Care. A report on behalf BAPEN Quality Group 2. ‘A Guide to Managing Adult Malnutrition in the Community’ Last accessed from: on 02.07.2021 3. ‘Pathway for using ONS in the Management of Malnutrition’ Last accessed from:https://www.malnutritionpathway.co.uk/library/ons_pathway.pdf on 29.06.2021 4. ‘Nutritional considerations for primary care teams managing patients with or recovering from COVID-19’ BDA and optimising nutritional prescribing last accessed :. 02.07.21

Use of Patients Know Best as a tool to improve patient engagement and deliver a digital dietetics service to kidney patients

Patient initiated follow up is being supported by NHS England and NHS Improvement1 to offer flexibility with follow up care and promote self-management and enable shared decision making. As a means of undertaking this, citizen held health records via web passed portals have become a new feature within clinical services, especially during the Covid-19 pandemic. It has been discussed elsewhere2 what benefits may be gained from using digital web based portals to improve patient engagement and self-management by patients with kidney disease. As a team of kidney dietitians, the citizen health held record known as Patients Know Best (PKB) was adopted as the portal of choice for use with patients as a means of patient initiated follow up and service improvement. A six month pilot phase was undertaken between September 2020 - March 2021 in which willing and interested patients had the opportunity to register on to the Kidney Dietitians’ PKB page. Upon registering the patients were able to use a two way message function which means direct access to their kidney dietitian, a full library of information ranging from YouTube tutorials, departmental information leaflets, links to charity websites, free cook books available on the internet and links to other platforms such as Humber Health Apps and Patient View. Dietitians had the ability to electronically undertake nutritional screening, bowel assessment questionnaires using PKB and could also send 24hr food recalls and 5 day food diaries (known as consultations) for completion ahead of booked appointments via telephone or video. PKB is also being used as a teaching aide during face to face and remote consultations to promote patient empowerment and self-care3. Data from the pilot phase showed that 49 patients had registered with the platform. In terms of instant messaging, 43% of messages had been instigated by the patient. Approximately 90% of messages received by the dietitians were read and responded to with 24 hours. Data also revealed that 100% of consultations initiated by the dietitian had also been completed within 24 hours enabling timely intervention. Due to the success of the pilot phase, a mail shot has now been sent to all dialysis patients (circa 400) offering them the opportunity to register with the Kidney Dietitians PKB site and a further consultation has been designed and added to PKB for audit data collection purposes. References 1. ‘Patient initiated follow up: Giving patients greater control over their hospital follow up care’ Last accessed fromhttps://www.england.nhs.uk/outpatient-transformation-programme/patient-initiated-follow-up-giving-patients-greater-control-over-their-hospital-follow-up-care/ 02.07.2021 2. The role of patient portals in enhancing self-care in patients with renal conditions (2020) Hazara, A. M., Durrans, K., Bhandari, S. Clinical Kidney Journal;Vol 13;1-7. 3. ‘The ‘future is bright’ for patients of the kidney dietetics service’ Patients Know Best last accessed from on 02.07.2021

The role of specialist physiotherapy in a pain management clinic - traditional and novel approaches

There is no doubt that coronavirus disease (COVID-19) has had a drastically negative impact on the NHS, as well as many other public services, individuals and families. The role of physiotherapy in managing chronic pain is challenging;even more so with the added burden of COVID-19. As COVID-19 cases increased many non-urgent outpatient services were suspended: This district general hospital continued to offer some appointments, albeit limited, but were they beneficial? This article not only considers the multidisciplinary approach to manage chronic pain;focusing on the bio-psycho-social model, which incorporates a variety of specialities within a pain clinic but also the impact of COVID-19. It considers both the clinicians' and patients' experiences respectively of offering, and receiving, key physiotherapy treatments such as patient education, patient empowerment, exercise and function;how these were modified, sometimes with digital support. It gives some insight into the differing patient responses and attitudes such as patients who fear exercise;those who expected physiotherapy to be a 'hands-on treatment' and the challenges of 'remote' patient supervision. Alternatives to educational groups are described and the patients' responses to them. Other treatments such as phased activities, goal setting, cognitive functional therapy, desensitization, mirror therapy, virtual reality, yoga, tai chi, and acceptance and commitment therapy are briefly outlined.

Ayurveda Practice during COVID-19 -Lessons from a Cross Sectional Survey

Methods: A cross-sectional study was conducted by sending a survey developed using SurveyMonkey. Local IRB approved the study. Responding to the survey was implied as providing consent. The survey was sent to all ayurveda professionals practicing in the United States. The list of professionals were obtained from the National Ayurveda Medical Association and through personal contacts of the principal investigator. The survey was open for 45 days and reminders were sent twice to the potential participants. Results: Eighty eight ayurvedic professionals completed the survey. Majority were females from California and belonged to Ayurveda Practitioner category and practiced mostly parttime. Ayurveda counselors and Ayurveda doctors (India based education) were the other categories of professionals, who also responded to the survey. The respondents reported that they adopted telehealth to continue their practice during the closures, but still majority reported that there was an economic impact of COVID-19 on their practices. Health promotion was the predominant type of service provided by these professionals. The methods included diet and lifestyle advices that incorporated dosha based diet and yoga and meditation practices. Additionally, they also provided some classical ayurveda formulas and simple herbal teas such as coriander tea and hot water to prevent easy susceptibility to viral infections. An important advice included a specific dosha based individual daily routine to improve general and mental health. Background: To understand the ayurveda practice patterns in the United States during COVID-19 Conclusion: Ayurveda, the oldest Indian System of Medicine may be a useful natural health care systemthat can be used for health promotion during a pandemic. The self-care practices do provide patient empowerment.

ASSESSING THE EFFECTIVENESS OF READY STEADY GO-PEEER PROJECT YOUTH WORK IN MEETING THE PSYCHOSOCIAL NEEDS OF CHILDREN AND YOUNG PEOPLE

BACKGROUND: Studies show that young people (YP) with chronic kidney disease do less well than their well peers in terms of mental health and employability. In the UK 30% of YP on renal replacement therapy have mental health issues compared to 15% of the general population and more are unemployed compared with their well peers. Many of the issues start in childhood as studies show that children with chronic kidney disease have significant psychosocial issues including: • Depression • Anxiety • Educational difficulties • Relationship issues • Lowself-esteem • Social isolation, family dependency • Professional restriction To address these issues, we developed the PEEER project to help improve Patient Empowerment, self-Esteem, Employability and Resilience. • PEEER brings YP together to participate in fun activities to help build selfesteem, develop an 'I can do' attitude, build a peer support group and reduce the sense of isolation patients feel. • PEEER offers a formal peer support mentorship and peer ambassador programme for those who wish to participate. Helping others will help the mentors and their peers by improving the self-esteem and psyche of both parties. PEEER offers the Duke Of Edinburgh Award and ASDAN to provide a range of nationally approved qualifications based around the development of individual and social skills leading to improved chances of employment. • Volunteering is an integral part of PEEER that helps to strengthen and improve self-esteem. • PEEER directly supports YP learn digital skills so they can develop appropriate information resources to help other young people, families and healthcare professionals. Pre-coronavirus disease (COVID-19) PEEER youth worker support was delivered face-to-face (F2F) in a 1:1 setting or group sessions in the hospital, youth spaces, or educational settings. With the onset of lockdown due to the COVID-19 pandemic from 23 March 2020 PEEER youth worker support was adapted to be delivered virtually on the ZOOM platform to meet the needs of CYP. AIMS: To assess the effectiveness of PEEER youth work project in meeting the psychosocial needs of children and young people with kidney disease when delivered virtually compared with F2F. METHOD: Group 1: Pre-COVID-19 lockdown: 1 January 2020-23 March 2020 CYP and their families received youth worker support F2F. Group 2: During COVID-19 lockdown: 23 March 2020-31 December 2020 youth work was delivered virtually. CYP in Groups 1 and 2 received 1:1 sessions, fun group activities and workshops. Feedback was collected on the effectiveness of these sessions. RESULTS: CYP: Group 1 n = 105. Group 2 n = 639. In Group 2 there was a 102% increase/month in CYP accessing PEEER events. In both Groups, 100% said they enjoyed the sessions, would like to attend future sessions. CYP in both Groups felt part of a friendship group, said the sessions allowed them to socialize with their peers. CYP in both Groups felt more confident, more independent and good about themselves. (See Table 2.) CONCLUSION: PEEER youth worker support is effective and can meet the psychosocial needs of CYP when delivered virtually and F2F. More work is needed on a hybrid approach of F2F and virtual delivery. (Figure Presented).

Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study.

BACKGROUND: Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions. OBJECTIVE: This study aimed to identify and model the key factors leading to health consumers' engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT. METHODS: This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis. RESULTS: Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant). CONCLUSIONS: The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process.

A Yoga Exercise App Designed for Patients With Axial Spondylarthritis: Development and User Experience Study.

BACKGROUND: Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with axial spondyloarthritis (AS). Digital health apps (DHAs) such as the yoga app YogiTherapy could remotely empower patients to autonomously and correctly perform exercises. OBJECTIVE: This study aimed to design and develop a smartphone-based app, YogiTherapy, for patients with AS. To gain additional insights into the usability of the graphical user interface (GUI) for further development of the app, this study focused exclusively on evaluating users' interaction with the GUI. METHODS: The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by engineering students, rheumatologists, and patients with AS. After the initial development process, a pilot version of the app was evaluated by 5 patients and 5 rheumatologists. The participants had to interact with the app's GUI and complete 5 navigation tasks within the app. Subsequently, the completion rate and experience questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) were completed by the patients. RESULTS: The results of the posttest questionnaires showed that most patients were already familiar with digital apps (4/5, 80%). The task completion rates of the usability test were 100% (5/5) for the tasks T1 and T2, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists indicated that they were even more experienced with digital devices (2/5, 40% experts; 3/5, 60% intermediates). In this case, they scored task completion rates of 100% (5/5) for all 5 usability tasks T1 to T5. The mean results from the User Experience Questionnaire range from -3 (most negative) to +3 (most positive). According to rheumatologists' evaluations, attractiveness (mean 2.267, SD 0.401) and stimulation (mean 2.250, SD 0.354) achieved the best mean results compared with dependability (mean 2.000, SD 0.395). Patients rated attractiveness at a mean of 2.167 (SD 0.565) and stimulation at a mean of 1.950 (SD 0.873). The lowest mean score was reported for perspicuity (mean 1.250, SD 1.425). CONCLUSIONS: The newly developed and tested DHA YogiTherapy demonstrated moderate usability among rheumatologists and patients with rheumatic diseases. The app can be used by patients with AS as a complementary treatment. The initial evaluation of the GUI identified significant usability problems that need to be addressed before the start of a clinical evaluation. Prospective trials are also needed in the second step to prove the clinical benefits of the app.

Scoping health literacy in Latin America.

Studies evaluating the influence of health literacy on patient behavior and outcomes suggest a positive relationship between health literacy and health knowledge, health behaviors, and health status. In Latin American countries, studies assessing health literacy are few, regional, and demonstrate considerable variation, with reported rates of adequate health literacy ranging from 5.0% to 73.3%. In this paper, we examine and explore the state of health literacy and efforts to promote it in Latin America. Key challenges to those efforts include socioeconomic inequality, social/geographic isolation, and cultural-, language-, and policy-related barriers, many of which disproportionately affect indigenous populations and others living in rural areas. Greater use of infographics, videos, and mobile apps may enhance health literacy and patient empowerment, especially when language barriers exist. This paper provides strategies and tools for tailored programming, examples of successful health literacy interventions, and policy recommendations to improve health literacy in Latin America, intending to spur additional discussion and action. Centrally organized collaboration across multiple sectors of society, with community involvement, will enhance health literacy and improve health and well-being across Latin America.

DEMPOWER STUDY: EVALUATION OF THE EFFECT OF A PATIENT EMPOWERMENT AND COMMUNICATION DIGITAL TOOL ON METABOLIC CONTROL IN T2DM PATIENTS

Background and Aims: There is still a high number of inadequately controlled T2DM patients. Therefore, it is essential to develop innovative solutions to improve patient's empowerment by increasing patient-physician communication and their selfmanagement. The aim of this study was to analyze the effect of a home digital patient empowerment tool (Figure 1), on metabolic control in T2DM patients. Methods: Multicentric, randomized prospective clinical trial including adult T2DM patients without adequate glycemic control treated according to usual clinical practice across Spain. Figure 2 summarizes the study design and study population. The primary endpoint was the comparison of the proportion of patients who did not achieve the study glycemic target (defined as HbA1c levels ≤7.5% with a reduction in HbA1c ≥0.5 from baseline) at week 24 between groups 1 and 2. It was also performed a comparison of mean HbA1c changes from baseline to week 24 between groups 1 and 2. Results: The COVID-19 pandemic led to a premature study closure since patient's enrollment and follow-up were active during the 2020 lockdown. In total, 50 patients completed week 24 visit. Figure 3 shows the main study results. 46% patients from group 1 achieved study glycemic target vs 18% in group 2 (p = 0.067), whereas the difference in the HbA1c reduction between group 1 and 2 was -0.66% (p < 0.05). Conclusions: Our results suggest the patient empowerment through a home digital tool might allow an improvement in metabolic control and consequently a more effective management of T2DM.

Towards a Didactic Concept for Heterogeneous Target Groups in Digital Learning Environments-First Course Implementation.

In the context of the ongoing digitization of interdisciplinary subjects, the need for digital literacy is increasing in all areas of everyday life. Furthermore, communication between science and society is facing new challenges, not least since the COVID-19 pandemic. In order to deal with these challenges and to provide target-oriented online teaching, new educational concepts for the transfer of knowledge to society are necessary. In the transfer project "Zukunftslabor Gesundheit" (ZLG), a didactic concept for the creation of E-Learning classes was developed. A key factor for the didactic concept is addressing heterogeneous target groups to reach the broadest possible spectrum of participants. The concept has already been used for the creation of the first ZLG E-Learning courses. This article outlines the central elements of the developed didactic concept and addresses the creation of the ZLG courses. The courses created so far appeal to different target groups and convey diverse types of knowledge at different levels of difficulty.

Patient-Generated Health Photos and Videos Across Health and Well-being Contexts: Scoping Review.

BACKGROUND: Patient-generated health data are increasingly used to record health and well-being concerns and engage patients in clinical care. Patient-generated photographs and videos are accessible and meaningful to patients, making them especially relevant during the current COVID-19 pandemic. However, a systematic review of photos and videos used by patients across different areas of health and well-being is lacking. OBJECTIVE: This review aims to synthesize the existing literature on the health and well-being contexts in which patient-generated photos and videos are used, the value gained by patients and health professionals, and the challenges experienced. METHODS: Guided by a framework for scoping reviews, we searched eight health databases (CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, MEDLINE, Scopus, and Web of Science) and one computing database (ACM), returning a total of 28,567 studies. After removing duplicates and screening based on the predefined inclusion criteria, we identified 110 relevant articles. Data were charted and articles were analyzed following an iterative thematic approach with the assistance of NVivo software (version 12; QSR International). RESULTS: Patient-generated photos and videos are used across a wide range of health care services (39/110, 35.5% articles), for example, to diagnose skin lesions, assess dietary intake, and reflect on personal experiences during therapy. In addition, patients use them to self-manage health and well-being concerns (33/110, 30%) and to share personal health experiences via social media (36/110, 32.7%). Photos and videos create significant value for health care (59/110, 53.6%), where images support diagnosis, explanation, and treatment (functional value). They also provide value directly to patients through enhanced self-determination (39/110, 35.4%), social (33/110, 30%), and emotional support (21/110, 19.1%). However, several challenges emerge when patients create, share, and examine photos and videos, such as limited accessibility (16/110, 14.5%), incomplete image sets (23/110, 20.9%), and misinformation through photos and videos shared on social media (17/110, 15.5%). CONCLUSIONS: This review shows that photos and videos engage patients in meaningful ways across different health care activities (eg, diagnosis, treatment, and self-care) for various health conditions. Although photos and videos require effort to capture and involve challenges when patients want to use them in health care, they also engage and empower patients, generating unique value. This review highlights areas for future research and strategies for addressing these challenges.

Darwinian Dentistry? Social Media, Smartphones and Selfie Sticks.

The COVID-19 pandemic produced numerous challenges for clinical dentistry which necessitated adaptation and innovation. This article will illustrate the use of selfie stick devices and ring lights for dental care practitioners to create customised 'selfie' videos of them using very effective cleaning devices on the patient's own smartphone. Because these short, engaging videos are now readily available to the patient at their home it reminds them which brushes to use, where and how. Patients are empowered by these videos which put them at the centre, reinforcing the key preventive message that they can improve and maintain their oral health by introducing effective oral hygiene behaviours. The many advantages, both for patients and for their practice teams, will be discussed in detail.

Telehealth e-mentoring in postgraduate musculoskeletal physiotherapy education: A mixed methods case study to inform implementation for advanced clinical practice

Keywords: Telehealth e-mentoring, Advanced musculoskeletal practice, Professional development Purpose: Mentored clinical practice is central to development of advanced clinical practice in musculoskeletal physiotherapy, and core within national and international educational standards. Whilst mentoring is traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative, affording a unique andragogy to facilitate mentee critical reflection, deep learning and enhanced knowledge translation – all developed to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to specialist mentors often limited by clinic space, geography and cost, the potential value of telehealth e-mentoring is considerable. The purpose of this study was to understand the experiences and outcomes of/for multiple stakeholders (patients, student-mentees and mentors) engaged in musculoskeletal physiotherapy telehealth e-mentoring. Methods: Using case study design, sequential mixed methods explored stakeholder experiences of a 20-week telehealth e-mentoring service in a UK University as part of an advanced practice Masters programme. Quantitatively, validated outcome measures, patient participant experiences for care and empathy, patient empowerment and change in musculoskeletal health were collected at baseline and discharge. Qualitatively, semi-structured interviews exploring experiences of telehealth e-mentoring, including influence on critical thinking, clinical reasoning, communication skills, confidence, motivation, career enhancement etc. with mentee participants, and a focus group with mentor participants (topic guide informed by earlier analysis) were audio recorded and transcribed verbatim. Quantitative data were analysed using descriptive statistics (median, IQR) and qualitative data were analysed following the Framework Method. Trustworthiness was assured through reflexivity and code/recode audits with experts. Results: Data from patients (n = 90), mentees (n = 10) and mentors (n = 6) contributed to the developed analytic framework. Patients were aged median 42 years (18-73 years) presenting with a range of musculoskeletal complaints;n = 52 receiving follow up appointments. Of those followed up, improvements > MCID were clear, with MSK-HQ increasing by 11 points (MCID 6), Patient Specific Functional Scores improving by 4 points (MCID 2.7), and high scores for the Consultation and Relational Empathy and Patient Enablement Instrument. Mentors and mentees provided rich descriptions of their experiences. Main themes (sub-themes) for mentee participants’ included a) social learning (group mentorship, feedback, individualisation), b) advanced professional practice (communication, clinical reasoning, reflective practice), c) learner experience (expectation/acceptance, enjoyment/motivation) and c) limitations of telehealth (hands-on skill development, caseloads, therapeutic relationship). Mentor participants included a) preparedness (telehealth skills, relationship building, managing perceptions/expectations), b) journey of development (formative feedback, peer discussions, mimicking behaviours) and c) challenges (non-verbal communication, home environment, exercise prescription/goal-setting). Conclusion(s): Telehealth e-mentoring is an appropriate alternative to face-to-face mentored clinical practice, with improved patient outcomes and developed advanced musculoskeletal physiotherapy skills, knowledge and attributes. Planning for telehealth e-mentoring requires multi-stakeholder preparation, including setting expectations, embracing creativity in practice, and acquisition of technical skills. Impact: Adoption of telehealth e-mentoring may enhance opportunities for practice-based professional development and provide needed additional capacity to support profession specific skill development and service capability, to meet planned growth in advanced musculoskeletal physiotherapists. This study provides evidence from patients, mentees and mentors to support e-mentorship within teleheal h clinical practice. Preparation, planning and articulation of clear expectations are important to optimise the experience. Funding acknowledgements: Elsevier Research Award, MACP 2020

Severe Asthma, Telemedicine, and Self-Administered Therapy: Listening First to the Patient.

Severe asthma patients are at an increased risk of major complications and they need to be monitored regularly. The COVID-19 pandemic has notably impacted on the health care resources. The telemedicine approach applied to the follow-up of asthmatic patients has been proven to be effective in monitoring their disease and their adherence to the therapy. The aim of our study was to investigate the satisfaction of severe asthma patients before the activation of a telemedicine management, as well as their current experience with self-administration of injection therapy. An ad hoc questionnaire was developed and sent by e-mail to 180 severe asthma patients. Most of subjects, 82%, were confident with the idea of doing self-measurements and self-managing their disease. Further, 77% of subjects favoured to carry out virtual visits and telemedicine. Regarding the home treatment, 93% of patients considered the self-injection therapy easy, 94% of subjects felt safe, and 93% were not worried while self-administering. Only mild adverse events were reported in 22% of patients after self-administration. Our results showed an agreement between what is considered necessary and practicable by healthcare personnel and what is perceived by the severe asthma patients in terms of treatment and monitoring of the disease with Telehealth. Biologics have a safety profile and can be easily self-administred at home.