Background Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect. Objective The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents. Methods An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out. Results The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results. Conclusions Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence.
Introducción: El presente proyecto pretende simplificar circuitos complejos que encarecen el coste del proceso asistencial debido a los numerosos trámites administrativos asociados, aplicando la metodología Lean y la reingeniería de proceso. Este estudio se enmarca en el área ambulatoria del Hospital Sant Joan de Déu de Martorell, Barcelona. Métodos: Estudio cuantitativo preexperimental analítico retrospectivo, basado en la conceptualización del modelo de proceso asistencial de estructura, proceso y resultado, propuesta por Avedis Donabedian, en el que se revisaron los principales circuitos de actividad asistencial y procedimientos administrativos que realizaba el usuario. Se establecieron líneas de acción, como la revisión de circuitos asistenciales, rediseño de circuitos aplicando la reducción de ciclos de tiempo y la optimización de recursos. Resultados: Los procesos que obtuvieron mayor beneficio tras esta revisión fueron: el ingreso hospitalario con una reducción del 53% en el tiempo total de realización, el acto único preoperatorio con un 75% de reducción en tiempos para la programación de las diferentes pruebas y desplazamientos del paciente, y la programación quirúrgica, del área ambulatoria y pruebas diagnósticas, con una reducción de un 100% del tiempo invertido por el paciente, ya que al salir de la consulta se marchaba a casa, sin tener que volver a pasar por el mostrador de programación. Conclusiones: Es posible aplicando la metodología Lean, simplificar los circuitos administrativos, la reducción de colas y tiempos de espera, así como implementar procesos de atención no presencial mejorando de forma significativa la atención al usuario.
IntroductionIn recent years, the GRADE system has been adopted internationally to make judgments about evidence and/or recommendations. Recently, the Spanish Network of HTA (RedETS) has promoted among its members the use of the GRADE system, especially the “Evidence to Decision” tool (EtD) where a multidisciplinary panel is involved. The objective is to describe the methodological approach with the first AQuAS experience using this methodology in HTA, focused on inclusion/exclusion of these technologies in the Spanish National Health Service (NHS) portfolio.MethodsThe standard EtD tool was used for clinical and financial decisions. Four multidisciplinary panels were constituted by relevant professionals in clinical practice and, where possible, patients. The four panels discussed on the following four interventions: in two cases, AQuAS prepared preliminary recommendations and participants provided feedback, while in the other two cases, experts received the evidence review and were asked to formulate recommendations. These recommendations were voted on and, in the case of disagreement, adapted and then voted on for a second time. Finally, any discrepancies were noted in the report. Evaluated interventions were: maxillofacial 3D-reconstruction, cataract surgery equipment, non-invasive surgery in obesity and pharmacological treatment in secondary fracture prevention.ResultsEspecially when more than one evaluative question was addressed in the HTA report the EtD and the consensus results required discussion. Consensus was fast but not immediate. Meeting length depended on the number of HTA questions and the amount of original disagreement in the recommendations. The nuances on how to write recommendations also affected the panel duration. All panels were successful in formulating the final recommendations.ConclusionsStandardizing methodologies increased the homogeneity across HTA reports. The GRADE system is a feasible and useful tool because it favors transparency and rigor in drawing up recommendations on the inclusion/exclusion of technologies in the NHS portfolio. The EtD framework complements GRADE tables, which display the relevant evidence in a way that can be used by multidisciplinary groups to reach a consensual recommendation.Although all participants received a short training video, more experience in the use of these methodologies might shorten the duration of the process and facilitate reaching consensus. Some considerations on how to overcome the difficulties and complexity of this methodological approach are discussed.
IntroductionThe Agency for Health Quality and Assessment of Catalonia (AQuAS) is developing an evaluation tool for mobile health (mHealth) solutions to be used by health technology assessment (HTA) agencies and evaluation experts. In order to have a practical and comprehensive tool taking into account the particularities and challenges of mobile interventions, we considered the views and opinions of key stakeholders. The objective was to present the final selection of general aspects (dimensions) to be assessed in the evaluation, as well as the specific items (criteria) to be included in each of these topics, as a result of different co-design approaches with health professionals, developers, hospital managers, HTA agencies and patients.MethodsA list of criteria used for health apps evaluation were drawn from a literature review. The initial list included eighty-nine criteria items grouped in nine domains. Those criteria and domains were discussed during four focus groups (FG). The importance of the criteria that were not considered as mandatory were later rated through a Delphi online sub-study, in a scale from one to six points, taking as consensus value when median value (median 6, Interquartile range, 0–1) was reached.ResultsFG reduced domains and criteria from nine to seven and from eighty-nine to thirty-three, respectively. Most mandatory criteria were related with security, user experience, and clinical effectiveness. Fifty-seven individuals (53.7% of 106 invited to participate) were registered in the online platform (50.1% women, 68.4% 35–64years old and 42.1% from HTA agencies). From fifty non-mandatory criteria under consensus, ten criteria reached consensus (most from solution's content and health problem covered domains) concluding with a 43/7 criteria/domain tool.ConclusionsInsights from main stakeholders on the content of the tool for mHealth assessment were considered through the FG and Delphi technique. The dimensions of security and privacy, clinical effectiveness, solutions’ content, technological aspects, users’ experience and costs were considered mandatory. The dimension related to the impact on the organization was appraised as a secondary domain for evaluation. A workshop with AQuAS research team and HTA external researchers will help to define: the assessment methods (type of instrument, dichotomous responses and/or Likert scales) for the evaluation and the format and dimension's weights of the final design of the tool.
Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011 in the specialties of teledermatology, teleulcers, teleeyelids and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits have been recorded. Objective: To analyse the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, within a three-month period. Results: Telemedicine saved € 780,397 over the period analysed. A differential cost favourable to telemedicine of about € 15/visit has been observed, the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Users’ saving of time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favourable for the healthcare system, enabling it to provide a more agile service, which also benefits the healthcare professionals.
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