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      Using mHealth to Increase the Reach of Local Guidance to Health Professionals as Part of an Institutional Response Plan to the COVID-19 Outbreak: Usage Analysis Study

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          Abstract

          Background

          The ongoing coronavirus disease (COVID-19) pandemic forced health jurisdictions worldwide to significantly restructure and reorganize their medical activities. In response to the rapidly evolving body of evidence, a solid communication strategy is needed to increase the reach of and adherence to locally drafted and validated guidance to aide medical staff with COVID-19–related clinical decisions.

          Objective

          We present a usage analysis of a dedicated mobile health (mHealth) platform as part of an institutional knowledge dissemination strategy of COVID-19–related guidance to all health care workers (HCWs) in a large academic hospital.

          Methods

          A multidisciplinary team of experts drafted local guidance related to COVID-19. In total, 60 documents and 17 external links were made available through the platform. Documents were disseminated using a recently deployed mHealth platform for HCWs. Targeted dissemination of COVID-19–related content began on March 22, 2020. Using a third-party statistics tool, data concerning user activity and content use was anonymously collected. A quantitative analysis of user activity was performed over a 4-month period, separated into 3 periods: 2 months before (Period A), 2 weeks after (Period B), and 6 weeks following (Period C) targeted dissemination. Regional epidemiological data (daily new COVID-19 cases and total COVID-19–related hospitalizations) was extracted from an official registry.

          Results

          During the study period, the platform was downloaded by 1233 new users. Consequently, the total number of users increased from 1766 users before Period A to a total of 2999 users at the end of Period C. We observed 27,046 document views, of which 12,728 (47.1%) were COVID-19–related. The highest increase in activity occurred in Period B, rapidly following targeted dissemination, with 7740 COVID-19–related content views, representing 71.2% of total content views within the abovementioned period and 550 daily views of COVID-19–related documents. Total documents consulted per day increased from 117 (IQR 74-160) to 657 (IQR 481-1051), P<.001. This increase in activity followed the epidemiological curbing of newly diagnosed COVID-19 cases, which peaked during Period B. Total active devices doubled from 684 to 1400, daily user activity increased fourfold, and the number of active devices rose from 53 (IQR 40-70) to 210 (IQR 167-297), P<.001. In addition, the number of sessions per day rose from 166 (IQR 110-246) to 704 (IQR 517-1028), P<.001. A persistent but reduced increase in total documents consulted per day (172 [IQR 131-251] versus 117 [IQR 74-160], P<.001) and active devices (71 [IQR 64-89] versus 53 [IQR 40-70]) was observed in Period C compared to Period A, while only 29.8% of the content accessed was COVID-19–related. After targeted dissemination, an immediate increase in activity was observed after push notifications were sent to users.

          Conclusions

          The use of an mHealth solution to disseminate time-sensitive medical knowledge seemed to be an effective solution to increase the reach of validated content to a targeted audience.

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          Most cited references 13

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          The 2019 Novel Coronavirus Outbreak - A Global Threat.

          The 2019 Novel Corona virus infection (COVID 19) is an ongoing public health emergency of international significance. There are significant knowledge gaps in the epidemiology, transmission dynamics, investigation tools and management. In this article, we review the available evidence about this disease. Every decade has witnessed the evolution of a new coronavirus epidemic since the last three decades. The varying transmission patterns, namely, nosocomial transmission and spread through mildly symptomatic cases is an area of concern. There is a spectrum of clinical features from mild to severe life threatening disease with major complications like severe pneumonia, ARDS, acute cardiac injury and septic shock. Presence of bilateral ground glass opacity and consolidation on imaging in appropriate clinical background should raise a suspicion about COVID 19. Poor prognostic factors include Multilobular infiltration on chest imaging, Lymphopenia, Bacterial co-infection, Smoking history, Chronic medical conditions like Hypertension and age >60 years (MuLBSTA score). Diagnosis is confirmed with PCR based testing of appropriate respiratory samples. Management is primarily supportive, with newer antivirals (lopinavir ritonavir and Remdesivir) under investigation. Role of steroids is still inconclusive. Standard infection control and prevention techniques should be followed. Vigilant screening of suspected cases and their contacts is important. Isolation of symptomatic cases and home quarantine of asymptomatic contacts is recommended. To conclude, controlling this highly transmissible disease requires international co-ordination.
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            Medical student involvement in the COVID-19 response

            Coronavirus disease 2019 (COVID-19) has been formally declared a pandemic by WHO, 1 reflecting an inability to contain its spread internationally. The associated harm of the COVID-19 pandemic to populations and health systems cannot be understated. In this unprecedented situation, perhaps one of the more under-recognised and enduring repercussions will be on medical student training worldwide. The paradoxical dual role of medical students is that, as the future health-care workforce, we potentially form part of a health-care system's response to public health emergencies but, conversely, are considered non-essential in clinical delivery and might be restricted from clinical learning. Medical schools have had various responses to date.2, 3 Some medical schools have cancelled teaching 3 and medical electives entirely, whereas others continue to encourage clinical placements. Although these measures felt appropriate to protect both patients and the health-care workforce, they nevertheless represent the loss of essential learning opportunities. A clear and unified response at national levels is needed to ensure that all students receive timely and consistent advice and that the impact on their future practice is minimised. Several governments have alluded that medical students could be used in health systems affected by COVID-19.2, 4 Although there is no question about their willingness, given no recent precedent, the lack of guidance for any students drafted is concerning. In particular, we find an absence of official and unambiguous statements on indemnity, governing body regulation, contractual agreements, expected roles and responsibilities, and the clinical supervision expected. Several health-care systems, such as in Italy and Iran, are in crisis, 5 and others expect substantial challenges in the coming weeks and months. In this context, students could be placed in challenging and compromising situations if asked to support health-care staff in providing care. The case of the British trainee paediatrician, Bawa-Garba, 6 who was convicted of manslaughter and temporarily lost her medical licence despite recognition of systemic failings and extreme pressure that she was under, has eroded trust from health-care professionals that they will be adequately supported in the event of potential mistakes under mitigating factors. These points must be explicitly addressed and conveyed on national levels before any student is used within clinical practice. Governments, regulatory bodies, and medical schools have a responsibility to both current and future patients to ensure that our future doctors are sufficiently trained and supported to deliver essential patient care, even in crises. Medical students, alongside all health-care staff, are prepared to contribute to patient care in the COVID-19 pandemic, yet in these uncertain times, forethought and transparency are essential.
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              Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review

              Background Health care providers (HCPs) play an important role in public health emergency preparedness and response (PHEPR) so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications. Methods A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1) What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2) Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3) What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs? Results We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems. Conclusions We found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available are rarely evaluated in any systematic fashion. To meet present-day and future information needs for emergency preparedness, more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                August 2020
                19 August 2020
                19 August 2020
                : 8
                : 8
                Affiliations
                [1 ] Division of Urology Department of Surgery University Hospitals of Geneva Geneva Switzerland
                [2 ] Division of General Internal Medicine Department of Medicine University Hospitals of Geneva Geneva Switzerland
                [3 ] Faculty of Medicine University of Geneva Geneva Switzerland
                [4 ] School of Education Johns Hopkins University Baltimore, MD United States
                [5 ] Division of Infectious Diseases Department of Medicine University Hospitals of Geneva Geneva Switzerland
                [6 ] Division of Clinical Epidemiology Department of Community Health and Medicine University Hospitals of Geneva Geneva Switzerland
                [7 ] Medical Directorate University Hospitals of Geneva Geneva Switzerland
                [8 ] Division of Anesthesiology Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine University Hospitals of Geneva Geneva Switzerland
                [9 ] Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton, ON Canada
                Author notes
                Corresponding Author: Olivier Windisch olivier.windisch@ 123456hcuge.ch
                Article
                v8i8e20025
                10.2196/20025
                7439805
                32749996
                ©Olivier Windisch, Ido Zamberg, Marie-Céline Zanella, Angèle Gayet-Ageron, Katherine Blondon, Eduardo Schiffer, Thomas Agoritsas. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 19.08.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

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