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Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory. A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied. Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).

ABSTRACT Objective: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. Method: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. Results: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. Conclusion: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv. RESUMO Objetivo: avaliar o efeito do monitoramento remoto de enfermagem na melhora das medidas antropométricas de mulheres com excesso de peso. Método: ensaio clínico controlado, randomizado, realizado em ambulatório de referência em obesidade. Constituíram o baseline 101 mulheres, alocadas aleatoriamente em dois grupos, 51 no grupo de intervenção (GI) e 50 no grupo controle (GC). O GI recebeu o monitoramento remoto por telefone e acompanhamento convencional e o GC acompanhamento convencional. A avaliação das mulheres ocorreu no baseline e após três meses de intervenção. Para avaliar as diferenças das medidas antropométricas intragrupos, utilizou-se o teste t pareado e, intergrupos, a análise de covariância, adotando-se significância estatística de 5%. Completaram o estudo 81 mulheres. Resultados: na comparação intergrupos após a intervenção, verificou-se redução de 1,66 kg na média do peso (p = 0,017) e redução de 0,66 kg/m2 na média do IMC (p = 0,015) para o grupo intervenção. Houve redução de 2,5 cm na CC no grupo intervenção com diferença estatística boderline (p=0,055). Conclusão: o efeito do monitoramento remoto foi benéfico na redução das medidas antropométricas. RBR-3hzdgv. RESUMEN Objetivo: evaluar el efecto del monitoreo remoto de enfermería en la mejora de las medidas antropométricas de mujeres con sobrepeso. Método: ensayo clínico controlado, aleatorio, realizado en ambulatorio de referencia en obesidad. Constituyeron el baseline 110 mujeres, colocadas aleatoriamente en dos grupos, 51 en el grupo de intervención (GI) y 50 en el grupo control (GC). El GI recibió el monitoreo remoto por teléfono y el seguimiento convencional y el GC tuvo seguimiento convencional. La evaluación de las mujeres ocurrió en el baseline y después de tres meses de intervención. Para evaluar las diferencias de las medidas antropométricas intragrupos se utilizó el test t pareado y, intergrupos, el análisis de covariancia, adoptando significancia estadística del 5%. Completaron el estudio 81 mujeres. Resultados: en la comparación intergrupos después de la intervención se verificó reducción de 1,66 Kg en la media del peso (p=0,017) y reducción de 0,66 Kg m2 en la media del IMC (p=0,015) para el grupo intervención. Hubo reducción de 2,5 cm en la CC en el grupo intervención con diferencia estadística boderline (p=0,055). Conclusión: el efecto del monitoreo remoto fue benéfico en la reducción de las medidas antropométricas. RBR-3hzdgv.

ABSTRACT Objectives: to map available evidence on telenursing use in the postoperative period and its impact on patient outcomes. Methods: a scoping review, conducted according to the JBI model and the PRISMA-ScR checklist. The search was carried out in the CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus and Cochrane Library databases. Results: twelve studies were included, published between 2011 and 2023, 66.6% of which were in developed countries. Of the positive outcomes, we highlight improved levels of disability, autonomy and quality of life, lower rates of post-operative complications, pain and reduced costs. Telephone monitoring was the most widely used modality, but there were few studies in the pediatric context and in Brazil. Conclusions: of the studies, 11 (91.6%) identified at least one positive outcome in telenursing use and none showed negative aspects in the postoperative period. The role of nurses in digital health needs further study. RESUMEN Objetivos: mapear la evidencia disponible sobre el uso de la teleasistencia en el periodo postoperatorio y su impacto en los resultados de los pacientes. Métodos: revisión de alcance, realizada según el modelo del JBI y la lista de verificación PRISMA-ScR. La búsqueda se realizó en las bases de datos CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus y Cochrane Library. Resultados: se incluyeron 12 estudios, publicados entre 2011 y 2023, de los cuales el 66,6% se realizaron en países desarrollados. Los resultados positivos incluyen mejora de los niveles de discapacidad, autonomía y calidad de vida, menores tasas de complicaciones postoperatorias, dolor y reducción de costes. La monitorización telefónica fue la modalidad más utilizada, pero hubo pocos estudios en el contexto pediátrico y en Brasil. Conclusiones: de los estudios, 11 (91,6%) identificaron al menos un resultado positivo en el uso de la teleenfermería y ninguno mostró aspectos negativos en el postoperatorio. El papel de las enfermeras en la salud digital requiere más estudios. RESUMO Objetivos: mapear as evidências disponíveis sobre a utilização da telenfermagem no pós-operatório e seu impacto nos desfechos de pacientes. Métodos: revisão de escopo, conduzida de acordo com o modelo JBI e o checklist PRISMA-ScR. A busca foi realizada nas bases de dados CINAHL, Embase, LILACS, PubMed, Web of Science, SciELO, Scopus e Cochrane Library. Resultados: foram incluídos 12 estudos, publicados no período de 2011 a 2023, dos quais 66,6% foram em países desenvolvidos. Dos desfechos positivos, destacam-se melhora nos níveis de incapacidade, autonomia e qualidade de vida, menor taxa de complicações pós-operatórias, dor e redução de custos. O monitoramento por telefone foi a modalidade mais utilizada com escassez de produções no contexto pediátrico e no Brasil. Conclusões: dos estudos, 11 (91,6%) identificaram pelo menos um desfecho positivo no uso da telenfermagem e nenhum apresentou aspectos negativos no pós-operatório. A atuação do enfermeiro na saúde digital necessita de novos estudos.

ABSTRACT Objective: to identify telenursing contributions in Primary Health Care during the COVID-19 pandemic. Methods: an integrative literature review, conducted between January and August 2022 in the PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE and SciELO databases. A total of 493 studies was found, 62 were read in full, and of these, 16 were selected. For analysis, a dynamic reading of the studies and synthesis of the main results were carried out. Results: the main results highlighted telenursing practice as a challenge for professionals and the population. Among the contributions and positive points and aspects that require improvement, practice showed promise when considered in a post-pandemic scenario. Final considerations: through telenursing, the population’s access to Primary Health Care was guaranteed in the face of the COVID-19 pandemic. However, a critical look at current technological advances in healthcare is necessary. RESUMEN Objetivo: identificar los aportes de la teleenfermería en la Atención Primaria de Salud en el contexto de la pandemia COVID-19. Métodos: revisión integrativa de la literatura, realizada entre enero y agosto de 2022 en las bases de datos PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE y SciELO. Se encontraron un total de 493 estudios, 62 fueron leídos en su totalidad y de estos, 16 fueron seleccionados. Para el análisis se realizó una lectura dinámica de los estudios y síntesis de los principales resultados. Resultados: los principales resultados destacaron la práctica de la teleenfermería como un desafío para los profesionales y la población. Entre los aportes y puntos positivos y aspectos que requieren mejora, la práctica se mostró prometedora cuando se la considera en un escenario pospandemia. Consideraciones finales: a través de la teleenfermería se garantizó el acceso de la población a la Atención Primaria de Salud ante la pandemia de COVID-19. Sin embargo, es necesaria una mirada crítica a los avances tecnológicos actuales en la atención sanitaria. RESUMO Objetivo: identificar as contribuições da telenfermagem na Atenção Primária à Saúde no contexto pandêmico da COVID-19. Métodos: revisão integrativa da literatura, conduzida entre janeiro e agosto de 2022 nas bases de dados PubMed, CINAHL, LILACS, BDENF, Scopus, WoS, EMBASE e SciELO. Foram encontrados 493 estudos no total, 62 lidos na íntegra, e, desses, 16 foram selecionados. Para análise, realizou-se uma leitura dinâmica dos estudos e síntese dos principais resultados. Resultados: os principais resultados evidenciaram a prática da telenfermagem como um desafio para os profissionais e para a população. Entre as contribuições e os pontos positivos e aspectos que necessitam de aprimoramento, a prática mostrou-se promissora ao ser pressuposta em um cenário pós-pandêmico. Considerações finais: por meio da telenfermagem, foi garantido o acesso da população à Atenção Primária à Saúde diante da pandemia de COVID-19. No entanto, faz-se necessário um olhar crítico para os atuais avanços tecnológicos na área da saúde.

Background Children suffering from rheumatic disease are faced with multidimensional challenges that affect their quality of life and family dynamics. Symptom management and monitoring of the course of the disease over time are important to minimize disability and pain. Poor disease control and anticipation of the need for treatment changes may be prompted by specialist medical follow-up and regular nurse-led consultations with the patient and families, in which information and support is provided. The purpose of this study was to evaluate the impact of a nurse-led telephone intervention or Telenursing (TN) compared to standard care (SC) on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their parents. Methods A multicentered, randomized, longitudinal, crossover trial was conducted with pediatrics outpatients newly diagnosed with inflammatory rheumatic diseases. Participants were randomly assigned to two groups TN and SC for 12 months and crossed-over for the following 12 months. TN consisted of providing individualized affective support, health information and aid to decision making. Satisfaction (primary outcome) and health outcomes were assessed with the Client Satisfaction Questionnaire-8 and the Juvenile Arthritis Multidimensional Assessment Report, respectively. A mixed effect model, including a group x time interaction, was performed for each outcome. Results Satisfaction was significantly higher when receiving TN (OR = 7.7, 95% CI: 1.8–33.6). Morning stiffness (OR = 3.2, 95% CI: 0.97–7.15) and pain (OR = 2.64, 95% CI: 0.97–7.15) were lower in the TN group. For both outcomes a carry-over effect was observed with a higher impact of TN during the 12 first months of the study. The other outcomes did not show any significant improvements between groups. Conclusion TN had a positive impact on satisfaction and on morning stiffness and pain of children with inflammatory rheumatic diseases and their families. This highlights the importance of support by specialist nurses in improving satisfaction and symptom management for children with inflammatory rheumatisms and their families. Trial registration ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

An innovative simulation was used to teach pre-licensure USA nursing students about telenursing for screening, assessment, and patient education during a home visit. The students used telepresence technology to deliver nursing care to a homebound geriatric patient. After the simulation, students (N = 73) felt increased confidence with the skills needed to deliver telenursing care and in using telepresence technology. Students reported that they modified and improved their communication in order to adapt to perceived barriers posed by the new technology. As telenursing becomes more prevalent for managing patient care at a distance, nursing programs will need to incorporate educational strategies to reflect this change. Telepresence integration in educational simulation improved students':•Confidence in assessment, performance of wound care, and the use of a depression-screening tool.•Confidence in their own ability to communicate via telepresence video technology.•Opinion of telepresence technology's value in delivery of healthcare.

Doc number: 24 Abstract Background: Despite the efforts of the healthcare community to improve the quality of diabetes care, about 50% of people with type 2 diabetes do not reach their treatment targets, increasing the risk of future micro-and macro-vascular complications. Diabetes self-management education has been shown to contribute to better disease control. However, it is not known which strategies involving educational programs are cost-effective. Telehealth applications might support chronic disease management. Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high methodological quality. \"The COACH Program\" was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions. It proved to be effective in patients with coronary heart disease after hospitalization. Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes in Belgium needs to be assessed. Methods/Design: Randomized controlled trial in patients with type 2 diabetes. Patients were selected based on their medication consumption data and were recruited by their sickness fund. They were randomized to receive either usual care plus \"The COACH Program\" or usual care alone. The study will assess the difference in outcomes between groups. The primary outcome measure is the level of HbA1c. The secondary outcomes are: Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol, Triglycerides, Blood Pressure, body mass index, smoking status; proportion of people at target for HbA1c, LDL-Cholesterol and Blood Pressure; self-perceived health status, diabetes-specific emotional distress and satisfaction with diabetes care. The follow-up period is 18 months. Within-trial and modeled cost-utility analyses, to project effects over life-time horizon beyond the trial duration, will be undertaken from the perspective of the health care system if the intervention is effective. Discussion: The study will enhance our understanding of the potential of telehealth in diabetes management in Belgium. Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions. Trial registration: Belgian number: B322201213625. ClinicalTrials.gov Identifier: NCT01612520

Telenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given. The aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177. A qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study. The CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency. Telenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers' different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.

The objective of the current pilot study was to determine whether nurse-led telephone counseling improves health behavior, self-care, and physiological indices for low-income older adults using a telemonitoring system. The control group ( n = 15) was provided with weekly health education only, and the intervention group ( n = 20) was given additional telephone support by nurses. At baseline and 8 weeks, data on health and self-care behaviors were collected using a self-reported questionnaire, and blood pressure and fasting blood glucose levels were assessed. Nurse-led telephone support had a medium effect on improving health behavior (Cohen's d = 0.58, 95% confidence interval [CI] [−0.10, 1.27]), reducing systolic blood pressure (Cohen's d = −0.61, 95% CI [−1.29, 0.08]), and improving self-care behavior for hypertension (Cohen's d = 1.16, 95% CI [0.05, 2.27]). Findings support that nurse-led telephone support may be effective for improvements in health behavior, systolic blood pressure, and hypertension self-care in disadvantaged older adults under remote monitoring. Further studies are needed to obtain a powered sample size and investigate the long-term effects of personalized elements surrounding telehealth in community-based settings. [Res Gerontol Nurs. 2018; 11(4):198–206.]

ObjectiveTo establish the effect of tele-nursing in the improving of the ultrasound findings in patients with non-alcoholic fatty liver disease. MethodsIn this clinical trial, 60 patients with non-alcoholic fatty liver referring to specialized gastroenterology clinics affiliated to Shiraz University of Medical Sciences (Iran) were selected were randomly assigned to control or intervention group. All patients received necessary trainings on diet and physical activity. The subjects in the intervention group were followed up via phone by nurses for 12 weeks (twice a week during the first month and once a week during the following two months). The control group participants did not receive any interventions and were only followed up as usual by a specialist. Before and after the intervention, the liver size and histological status of their liver were examined using ultrasound in all the participants. ResultsAfter 12 weeks of start of the study, the mean of liver size decreased in the group followed up via phone by a nurse (13.15±1.22 cm to 12.90±1.16 cm, p=0.013), but this did not change significantly in the control group (12.55±1.56 cm to 12.56±1.57 cm, p=0.326). The greater difference in the mean liver size between the evaluations was in the intervention group with 0.26±0.53 cm versus -0.003±0.018 cm in the control group (p=0.012). Additionally, the fatty infiltration status of the liver tissue improves in the 66.6% of the intervention group versus 6.6% in the control group (p<0.001). Conclusion The results of this study showed that tele-nursing led to improvement in liver size and liver histology in patients with Non-alcoholic fatty liver. Descriptors: telenursing; non-alcoholic fatty liver; control groups; ultrasonography; randomized controlled trial.