Factors Engaging Users of Diabetes Social Media Channels on Facebook, Twitter, and Instagram: Observational Study.

BACKGROUND: Diabetes patient associations and diabetes-specific patient groups around the world are present on social media. Although active participation and engagement in these diabetes social media groups has been mostly linked to positive effects, very little is known about the content that is shared on these channels or the post features that engage their users the most. OBJECTIVE: The objective of this study was to analyze (1) the content and features of posts shared over a 3-year period on 3 diabetes social media channels (Facebook, Twitter, and Instagram) of a diabetes association, and (2) users' engagement with these posts (likes, comments, and shares). METHODS: All social media posts published from the Norwegian Diabetes Association between January 1, 2017, and December 31, 2019, were extracted. Two independent reviewers classified the posts into 7 categories based on their content. The interrater reliability was calculated using Cohen kappa. Regression analyses were carried out to analyze the effects of content topic, social media channel, and post features on users' engagement (likes, comments, and shares). RESULTS: A total of 1449 messages were posted. Posts of interviews and personal stories received 111% more likes, 106% more comments, and 112% more shares than miscellaneous posts (all P<.001). Messages posted about awareness days and other celebrations were 41% more likely to receive likes than miscellaneous posts (P<.001). Conversely, posts on research and innovation received 31% less likes (P<.001), 35% less comments (P=.02), and 25% less shares (P=.03) than miscellaneous posts. Health education posts received 38% less comments (P=.003) but were shared 39% more than miscellaneous posts (P=.007). With regard to social media channel, Facebook and Instagram posts were both 35 times more likely than Twitter posts to receive likes, and 60 times and almost 10 times more likely to receive comments, respectively (P<.001). Compared to text-only posts, those with videos had 3 times greater chance of receiving likes, almost 4 times greater chance of receiving comments, and 2.5 times greater chance of being shared (all P<.001). Including both videos and emoji in posts increased the chances of receiving likes by almost 7 times (P<.001). Adding an emoji to posts increased their chances of receiving likes and being shared by 71% and 144%, respectively (P<.001). CONCLUSIONS: Diabetes social media users seem to be least engaged in posts with content topics that a priori could be linked to greater empowerment: research and innovation on diabetes, and health education. Diabetes social media groups, public health authorities, and other stakeholders interested in sharing research and innovation content and promoting health education on social media should consider including videos and emoji in their posts, and publish on popular and visual-based social media channels, such as Facebook and Instagram, to increase user engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12913-018-3178-7.

Panel: Big Data & Social Media for Empowering Patients with Diabetes.

Millions of people living with diabetes are using mobile phones, Internet and social media to socialize with other patients, share experience or search information relevant for their self-management. This phenomena is leading towards a new paradigm of hyper-connected diabetes digital self-management. This is also leading towards an explosion on data, a large amount of data is collected on populations around the world. This panel will address the opportunities this data presents, discuss the latest research that uses it, and the limitations and other concerns.

Assessing the impact of telestration on surgical telementoring: A randomized controlled trial.

INTRODUCTION: Using graphical annotations in surgical telementoring promises vast improvements in both clinical and educational outcomes. However, these assumptions do not consider the potential patient safety risks resulting from this feature. Major differences in regulations regarding the implementation of telestration encourage an assessment of the utility of this feature on the outcomes of telementoring sessions. METHODS: Eight students participated in a randomized controlled trial, comparing verbal with annotation-supplemented telementoring via video conferencing. A remote mentor guided the participants through four localization exercises, identifying the features in a still laparoscopic surgery scene using a laparoscopic simulator. Clinical and educational outcomes were assessed; the time consumption and quality of mentoring were determined. RESULTS: The study revealed no significant difference in localizing the intervention between the studied methods, while educational outcomes favoured verbal mentoring. Telestration-supplemented guidance was considerably faster and resulted in fewer miscommunications between the mentor and mentee. DISCUSSION: The initial hypothesis of the major clinical and education benefits of telestration in telementoring was not supported. A potential 33% decrease in the duration of the mentored episodes is expected due to the ability to annotate live video content. However, the impact of time saving on the outcome of the procedure remains unclear. Regardless of the quantitative measures, most of the participants and the mentor agreed that graphical annotations provide advantages over verbal guidance.

Video Conferencing Services in Healthcare: One Communication Platform to Support All.

We present a novel approach to the design of video conferencing (VC) systems, taking advantage of recent technological achievements in web-based implementation. Delivering VC functionality as a service over the Internet opens new grounds for easier integration, support, and application in many scenarios, since hardware-agnostic ad-hoc VC connections are a feature of the proposed architecture. Validity is demonstrated through latency measures in surgical telementoring service and comparing them to reported thresholds.

Video calls from lay bystanders to dispatch centers - risk assessment of information security.

BACKGROUND: Video calls from mobile phones can improve communication during medical emergencies. Lay bystanders can be instructed and supervised by health professionals at Emergency Medical Communication Centers. Before implementation of video mobile calls in emergencies, issues of information security should be addressed. METHODS: Information security was assessed for risk, based on the information security standard ISO/IEC 27005:2008. A multi-professional team used structured brainstorming to find threats to the information security aspects confidentiality, quality, integrity, and availability. RESULTS: Twenty security threats of different risk levels were identified and analyzed. Solutions were proposed to reduce the risk level. CONCLUSIONS: Given proper implementation, we found no risks to information security that would advocate against the use of video calls between lay bystanders and Emergency Medical Communication Centers. The identified threats should be used as input to formal requirements when planning and implementing video calls from mobile phones for these call centers.

Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review.

Patients failing to attend hospital appointments contribute to inefficient use of resources. We conducted a systematic review of studies providing a reminder to patients by phone, short message service (SMS) or automated phone calls. A PubMed search was conducted to identify articles published after 1999, describing studies of non-attendance at hospital appointments. In addition, we searched the references in the included papers. In total, 29 studies were included in the review. Four had two intervention arms which were treated as independent studies, giving a total of 33 estimates. The papers were analysed by two observers independently. A study quality score was developed and used to weight the data. Weighted means of the absolute and the relative changes in non-attendance were calculated. All studies except one reported a benefit from sending reminders to patients prior to their appointment. The synthesis suggests that the weighted mean relative change in non-attendance was 34% of the baseline non-attendance rate. Automated reminders were less effective than manual phone calls (29% vs 39% of baseline value). There appeared to be no difference in non-attendance rate, whether the reminder was sent the day before the appointment or the week before. Cost and savings were not measured formally in any of the papers, but almost half of them included cost estimates. The average cost of using either SMS, automated phone calls or phone calls was €0.41 per reminder. Although formal evidence of cost-effectiveness is lacking, the implication of the review is that all hospitals should consider using automated reminders to reduce non-attendance at appointments.

Flexibility in interaction: sociotechnical design of an operating room scheduler.

PURPOSE: The purpose of this study was to learn about factors that influence the design and implementation of situated computing solutions that support hospital work. This includes social and technical aspects of the actual systems that will be implemented, as well as the appropriate design methodology for developing these systems. METHODS: Staff at a surgical department at a University hospital were engaged in a participatory design (PD) process to help solve a problem that was presented by the staff: scheduling of patients and surgery rooms, and creating awareness of the status of ongoing surgeries. The PD process was conceptually aided by a model that describes Medical Informatics Systems as comprising of three components, a service component, a technical component and a social component. The process included the use of ethnographic field work and iterative redesign of both technical and social components of the system after it had been implemented into day-to-day work practice. RESULTS: The PD process resulted in the creation of a system that was iteratively created over a period of about 2 years, and which then handed over to the IT department of the hospital and used by the surgical department for a period of about 1 additional year. The first version of the prototype that was implemented contained usability flaws that made the system difficult to use in time critical situations. As a result of observations and a redesign of the technical component and social component of the system a new version was possible to implement that managed to overcome this problem. A key feature of this second version of the system was that some responsibility for data entry validation was shifted from the technical component of the system to the social component of the system. This was done by allowing users to input poor data initially, while requiring them to fix this data later on. This solution breaks from "traditional" usability design but proved to be quite successful in this case. A challenge with the solution, however, was that the IT department could not understand the concept of systems being described as comprising of both social components and technical components, and thus they had difficulty in understanding the overall design of the system during the handover process. CONCLUSIONS: Situated computing can present a number of design challenges that may not be easy for designers and hospital workers to understand before a system has been implemented. Situated computing development may thus need to be aided by PD that includes both ethnographic observations and iterative redesign of the system after it has been implemented. Traditional data validation mechanisms may create poor system performance in cases where users are rushed to input data into the computer due to pressures created by other more critical work activities. In this case it may be better to rely on social mechanisms for correcting errors later on, rather than error catching mechanisms that reject incorrect data. It can be challenging, however, to maintain such systems over time, as IT-departments may lack skills and interest in social components.

Disrupted rhythms and mobile ICT in a surgical department.

PURPOSE: This study presents a study of mobile information and communication technology (ICT) for healthcare professionals in a surgical ward. The purpose of the study was to create a participatory design process to investigate factors that affect the acceptance of mobile ICT in a surgical ward. METHODS: Observations, interviews, a participatory design process, and pilot testing of a prototype of a co-constructed application were used. RESULTS: Informal rhythms existed at the department that facilitated that people met and interacted several times throughout the day. These gatherings allowed for opportunistic encounters that were extensively used for dialogue, problem solving, coordination, message and logistics handling. A prototype based on handheld mobile computers was introduced. The tool supported information seeking functionality that previously required local mobility. By making the nurses more freely mobile, the tool disrupted these informal rhythms. This created dissatisfaction with the system, and lead to discussion and introduction of other arenas to solve coordination and other problems. CONCLUSIONS: Mobile ICT tools may break down informal communication and coordination structures. This may reduce the efficiency of the new tools, or contribute to resistance towards such systems. In some situations however such "disrupted rhythms" may be overcome by including additional sociotechnical mechanisms in the overall design to counteract this negative side-effect.

A large, high resolution tiled display for medical use: experiences from prototyping of a radiology scenario.

The scope of the project was to assess the value of using high-resolution, very large displays in a hospital setting. We applied a scenario informed prototyping method and user-involvement in order to do this. Initial results suggest that the technology could prove very useful in clinical conferencing settings like the communicating process between the radiology department and the other hospital departments using their services. The possibility of bringing more visual information simultaneously to the audience is especially intriguing. However, issues such as floor control - who administers the (extra) information space and information-overload, are imminent in interface design and our prototype suggests that the clinicians do want functionality that stresses these issues.

The potential of digital monochrome images versus colour slides in telescreening for diabetic retinopathy.

We explored the potential of digital monochrome images as an alternative to colour slides in screening for diabetic retinopathy. Twenty-eight patients with diabetes were recruited for the study and 20 actually participated. Using a fundus camera (Nikon 505AF) one set of three digital images and one set of three colour slides were taken per eye. Two independent ophthalmologists graded the colour slides and the digital images for diabetic retinopathy. The ophthalmologists spent about two minutes grading each set of images, suggesting that specialists could potentially screen a large number of patients. The agreement between the two screening methods was 0.95 and 0.89, with respect to disease or no disease. The agreement (kappa) between the two ophthalmologists for grade of retinopathy was 0.47 when colour slides were employed and 0.61 when digital monochrome images were employed. The results indicate that digital red-free monochrome images represent a superior screening tool for diabetic retinopathy. Tele-screening may be beneficial when patients have to travel substantial distances to visit an ophthalmologist.

Challenges in telemedicine and eHealth: lessons learned from 20 years with telemedicine in Tromsø.

The Norwegian Centre for Telemedicine (NST) has, over the past two decades, contributed to the development and implementation of telemedicine and ehealth services in Norway. From 2002, NST has been a WHO Collaboration Center for telemedicine. In August 1996, Norway became the first country to implement an official telemedicine fee schedule making telemedicine services reimbursable by the national health insurer. Telemedicine is widely used in Northern Norway. Since the late 1980's, the University Hospital of North-Norway has experience in the following areas: teleradiology, telepathology, teledermatology, teleotorhinolaryngology (remote endoscopy), remote gastroscopy, tele-echocardiography, remote transmission of ECGs, telepsychiatry, teleophthalmology, teledialysis, teleemergency medicine, teleoncology, telecare, telegeriatric, teledentistry, maritime telemedicine, referrals and discharge letters, electronic delivery of laboratory results and distant teaching for healthcare personnel and patients. Based on the result achieved, the health authority in North-Norway plans to implement several large-scale telemedicine services: Teleradiology (incl. solutions for neurosurgery, orthopedic, different kinds of surgery, nuclear medicine, acute traumatic and oncology), digital communication and integration of patient data, and distant education. In addition, the following services will also be considered for large-scale implementation: teledialysis, prehospital thrombolysis, telepsychiatry, teledermatology. Last in line for implementation are: pediatric, district medical center (DMS), teleophthalmology and ear-nose-throat (ENT).

Risk analysis of information security in a mobile instant messaging and presence system for healthcare.

INTRODUCTION: Instant messaging (IM) is suited for immediate communication because messages are delivered almost in real time. Results from studies of IM use in enterprise work settings make us believe that IM based services may prove useful also within the healthcare sector. However, today's public instant messaging services do not have the level of information security required for adoption of IM in healthcare. We proposed MedIMob, our own architecture for a secure enterprise IM service for use in healthcare. MedIMob supports IM clients on mobile devices in addition to desktop based clients. METHODS: Security threats were identified in a risk analysis of the MedIMob architecture. The risk analysis process consists of context identification, threat identification, analysis of consequences and likelihood, risk evaluation, and proposals for risk treatment. RESULTS: The risk analysis revealed a number of potential threats to the information security of a service like this. Many of the identified threats are general when dealing with mobile devices and sensitive data; others are threats which are more specific to our service and architecture. Individual threats identified in the risks analysis are discussed and possible counter measures presented. DISCUSSION: The risk analysis showed that most of the proposed risk treatment measures must be implemented to obtain an acceptable risk level; among others blocking much of the additional functionality of the smartphone. To conclude on the usefulness of this IM service, it will be evaluated in a trial study of the human-computer interaction. Further work also includes an improved design of the proposed MedIMob architecture.

[May heart murmurs be assessed by telemedicine?]. / Kan hjertebilyder evalueres med telemedisin?

BACKGROUND: Children often have heart murmurs; referral to a specialist is common. A service for remote auscultation of heart murmurs was established in which heart sounds and short texts were sent as attachment to e-mails. Our aim was to assess the quality of this method. MATERIAL AND METHODS: Heart sounds from 47 patients with no murmur (n = 7), innocent murmurs (n = 20), or with pathological murmurs (n = 20) were recorded using a sensor-based stethoscope and e-mailed to a computer. The sounds were repeated giving 100 cases, randomly distributed on a CD. Four specialists categorised the cases as having "no murmur", "innocent murmur", or "pathological murmur", recorded assessment time, degree of certainty, and need for referral. RESULTS: On average 2.1 minutes were spent on each case. Mean sensitivity and specificity were 90% and 98%, respectively. Inter- and intra-observer variability were low (kappa 0.81 and 0.87). 93% of cases with a pathological murmur and 13% with an innocent murmur were recommended for referral. INTERPRETATION: Telemedical referral of children with heart murmurs to a cardiologist is safe, reduces travelling, and saves time. Skilled auscultation is adequate to detect those with innocent murmurs.