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This survey study investigates surgical patients’ use and perception of digital health technologies in Germany in the pre–COVID-19 era. The objective of this study was to relate surgical patients’ characteristics to the use and perception of several digital health technologies. In this single-center, cross-sectional survey study in the outpatient department of a university hospital in Germany, 406 patients completed a questionnaire with the following three domains: general information and use of the internet, smartphones, and general digital health aspects. Analyses were stratified by age group and highest education level achieved. We found significant age-based differences in most of the evaluated aspects. Younger patients were more open to using new technologies in private and medical settings but had more security concerns. Although searching for information on illnesses on the web was common, the overall acceptance of and trust in web-based consultations were rather low, with <50% of patients in each age group reporting acceptance and trust. More people with academic qualifications than without academic qualifications searched for information on the web before visiting physicians (73/121, 60.3% and 100/240, 41.7%, respectively). Patients with academic degrees were also more engaged in health-related information and communication technology use. These results support the need for eHealth literacy, health literacy, and available digital devices and internet access to support the active, meaningful use of information and communication technologies in health care. Uncertainties and a lack of knowledge exist, especially regarding telemedicine and the use of medical and health apps. This is especially pronounced among older patients and patients with a low education status.
Learning digital competencies can be successful if the information is also tried out immediately using interactive elements. However, interactive teaching poses a particular challenge, especially in large group formats. Various strategies are used to promote interaction, but there is little known about the results. This article shows different strategies and evaluates their influence on the interaction rate in a large group course over two terms that teaches digital medicine. Log files and participation in surveys as well as participation in chat were quantitatively evaluated. In addition, the chat messages themselves were evaluated qualitatively. For the evaluation, relation to the total number of participants was particularly relevant in order to be able to determine an interaction rate in the individual course sessions. A maximum average interaction rate of 90.97% could be determined over the entire term while the participants wrote an average of 3.96 comments during a session in the chat. In summary, this research could show that interactive elements should be well planned and used at regular intervals in order to reap the benefits.
Abstract The methodological challenges of evaluating digital interventions (DI) for health services research are omnipresent. The Digital Health Working Group of the German Network for Health Services Research (DNVF) presented and discussed these challenges in a two-part discussion paper. The first part addressed challenges in definition, development and evaluation of DI. In this paper, which represents the second part, the definition of outcomes, reporting of results, synthesis of evidence, and implementation are addressed as methodological challenges of DI. Potential solutions are presented and the need to address these challenges in future research are discussed.
Abstract The development and application of digital interventions in health-related topics are gaining momentum in health service research. Digital interventions are often complex and need to be evaluated and implemented in complex settings. Due to their characteristics, this poses methodological challenges for health services research that have to be identified and addressed. Hence, the Working Group on Digital Health of the German Network for Health Services Research (DNVF) has prepared a discussion paper. This paper discusses methodological, practical and theoretical challenges associated with the development and evaluation of digital interventions from the perspective of health services research. Possible solutions are suggested and future research needs to address these methodological challenges are identified.
Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care
(2022)
The skills, knowledge and resources to search for, find, understand, evaluate and apply health information is defined as health literacy (HL). If individuals want to use health information from the Internet, they need Digital Health Literacy (eHL), which in addition to HL also includes, for example, media literacy. If information cannot be found or understood by patients due to low (e)HL, patients will not have the opportunity to make informed decisions. In addition, many health apps for self-management or prevention also require (e)HL. Thus, it follows that active participation in healthcare, in terms of Person-Centered Care (PCC) is only possible through (e)HL. Currently, there is a great need to strengthen these competencies in society to achieve increased empowerment of patients and their health. However, at the same time, there is a need to train and improve competencies in the field of healthcare professionals so that they can counsel and guide patients. This article provides an overview with a focus on HL and eHL in healthcare, shows the opportunities to adapt services and describes the possible handling of patients with low (e)HL. In addition, the opportunities for patients and healthcare professionals to improve (e)HL are highlighted.
Background: Paediatric palliative care (PPC) is a noncurative approach to the care of children and adolescents with life-limiting and life-threatening illnesses. Electronic medical records (EMRs) play an important role in documenting such complex processes. Despite their benefits, they can introduce unintended consequences if future users are not involved in their development. Aim: The aim of this study was to evaluate the acceptance of a novel module for nursing documentation by nurses working in the context of PPC. Methods: An observational study employing concurrent think-aloud and semi-structured qualitative interviews were conducted with 11 nurses working in PPC. Based on the main determinants of the unified theory of acceptance and use of technology (UTAUT), data were analysed using qualitative content analysis. Results: The main determinants of UTAUT were found to potentially influence acceptance of the novel module. Participants perceived the module to be self-explanatory and intuitive. Some adaptations, such as the reduction of fragmentation in the display, the optimization of confusing mouseover fields, and the use of familiar nursing terminology, are reasonable ways of increasing software adoption. Conclusions: After adaptation of the modules based on the results, further evaluation with the participation of future users is required.
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
Background: Electronic medical records (EMRs) play a key role in improving documentation and quality of care in paediatric palliative care (PPC). Inadequate EMR design can cause incorrect prescription and administration of medications. Due to the fact of complex diseases and the resulting high level of medical complexity, patients in PPC are vulnerable to medication errors. Consequently, involving users in the development process is important. Therefore, the aim of this study was to evaluate the acceptance of a medication module from the perspective of potential users in PPC and to involve them in the development process. Methods: A qualitative observational study was conducted with 10 nurses and four physicians using a concurrent think-aloud protocol and semi-structured qualitative interviews. A qualitative content analysis was applied based on a unified theory of acceptance and use of technology. Results: Requirements from the user’s perspective could be identified as possible influences on acceptance and actual use. Requirements were grouped into the categories “performance expectancies” and “effort expectancies”. Conclusions: The results serve as a basis for further development. Attention should be given to the reduction of display fragmentation, as it decreases cognitive load. Further approaches to evaluation should be taken.
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
Editorial
(2021)
KI in der Pflege
(2021)
Body shaming (BS) is a popular term for a type of negative social interaction, which frequently occurs in social media. However, there is a lack of a clear scientific definition of BS and data on its relation to other concepts in social aggression research. The present study therefore aimed at providing a definition and classification of BS. In an exploratory online-study, 25 participants (60%) provided personal definitions of BS and rated the fit of a suggested definition. In addition, they reported similarities with and differences to related concepts (appearance teasing, cyberbullying, trolling). We conducted qualitative analyses of the verbal definitions guided by the Grounded Theory approach and quantified the fit to existing concepts in the field of social aggression. The results show that BS is perceived as an unrepeated act in which a person expresses unsolicited, mostly negative opinions/comments about a target’s body, without necessarily intending to harm him/her. Still, the target perceives the comments as negative. BS can range from well-meant advice to malevolent insults and it can occur online and offline. Participants saw similarities between BS and appearance teasing. BS can be a tool for trolling and can evolve to cyberbullying with repetition over time. Altogether, BS is a form of social aggression that has a negative impact on individuals. The definition and classification help to investigate BS and its effects on body image and mental health in future research.
Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.
Background
During shortages of filtering face pieces (FFP) in a pandemic, it is necessary to implement a method for safe reuse or extended use. Our aim was to develop a simple, inexpensive and ecological method for decontamination of disposable FFPs that preserves filtration efficiency and material integrity.
Steigerung der Versorgungsqualität in der Palliativversorgung durch elektronische Gesundheitsakten
(2021)
BACKGROUND Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. OBJECTIVE In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. METHODS In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. RESULTS The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. CONCLUSIONS The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.
Adhärenz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen
(2021)
AbstractMany digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as “the degree to which the user followed the program as it was designed,” which can also be paraphrased as “intended use” or “use as it is designed.” However, both the theoretical–conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.
Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects
(2021)
Background: Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary: The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message: EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.
Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.
Einfach.Klar.Verständlich.
(2020)
„Leichte Sprache“ in der Ambulanten Pflege Menschen mit kognitiver Einschränkung oder schlechten Deutschkenntnissen haben häufig Schwierigkeiten, Texte zu lesen und zu verstehen. Aber auch sie brauchen Informationen. Bei der Betreuung dementiell erkrankter Pflegebedürftiger oder auch von Migranten muss die Sprache deshalb deren Fähigkeiten angepasst werden.
Implementation and Analysis of Two Knowledge Base Approaches for the Treatment of Chronic Wounds
(2020)
In der Corona-Krise 2020 waren und sind die Gesundheitssysteme und damit einhergehend die Pflegeberufe sehr gefordert – auch in psychiatrischen Handlungsfeldern. Die Deutsche Fachgesellschaft Psychiatrische Pflege e. V. (DFPP) hat in einer Stellungnahme Forderungen beschrieben, um eine gute psychiatrisch-pflegerische Versorgung in Zeiten einer Pandemie zu gewährleisten. Dieser Artikel ist eine verkürzte und leicht geänderte Version der Stellungnahme. Er beschreibt, welche Auswirkungen die Corona-Krise auf die psychiatrische Pflegepraxis hat und begründet damit die Forderungen der DFPP. Die ausführliche Stellungnahme findet sich auf der Homepage (www.dfpp.de).
Der Beitrag diskutiert anhand des Forschungsprojektes Game Based Learning in Nursing – Spielerisch Lernen in authentischen, digitalen Pflegesimulationen (GaBaLEARN)
die Einbindung von Learning Analytics in digitale Fallsimulationen eines Serious Games. Es werden pflege- und mediendidaktische Impulse zur Entwicklung und Integration von Learning Analytics für die Darstellung von situativen, komplexen Kompetenzen im Bereich personenbezogener Dienstleistungsberufe, wie der Pflege, dargestellt.
Das Streben nach Gleichberechtigung und Chancengleichheit zeigt sich in unserer Gesellschaft besonders durch die kognitiv unterschiedliche Entwicklung der Menschen (Schönenberg, 2020). Diese Unterschiedlichkeit führt allerdings häufig zu einer Ausgrenzung und erschwert Betroffenen den Zugang zu Hilfsangeboten (Schönenberg, 2020). Aber menschliche Ausgrenzung erfolgt nicht nur ausschließlich aufgrund von körperlichen Einschränkungen, sondern auch durch sprachliche Probleme (Romanowski, 2015). Insbesondere sprachliche Barrieren gilt es in Deutschland, einem der best alphabetisierten Länder der Welt, zu durchbrechen (Buddeberg, Dutz, Grotlüschen, Heilmann und Stammer, 2019). Sowohl Leichte-, als auch Einfache Sprache kann hier helfen.
„Attention Bias“ für sozial-bedrohliche Reize bei körperbezogenen Sorgen – ein systematischer Review
(2020)
Contact-Tracing-Apps als unterstützende Maßnahme bei der Kontaktpersonennachverfolgung von COVID-19
(2020)
Die Kontaktpersonennachverfolgung ist derzeit eine der wirksamsten Maßnahmen zur Eindämmung der COVID-19 Pandemie. Digitales Contact Tracing mittels Smartphones scheint eine sinnvolle zusätzliche Maßnahme zur manuellen Kontaktpersonennachverfolgung zu sein, um Personen zu identifizieren, die nicht bekannt oder nicht erinnerlich sind und um den zeitlichen Verzug beim Melden eines Infektionsfalles und beim Benachrichtigen von Kontaktpersonen so gering wie möglich zu halten. Obwohl erste Modellierungsstudien eine positive Wirkung in Bezug auf eine zeitnahe Kontaktpersonennachverfolgung nahelegen, gibt es bislang keine empirisch belastbaren Daten, weder zum bevölkerungsweiten Nutzen noch zum potenziellen Schaden von Contact-Tracing-Apps. Die Beurteilung der Zweckerfüllung und eine wissenschaftliche interdisziplinäre Begleitforschung sowohl zur Wirksamkeit, Risiken und Nebenwirkungen als auch zu Implementierungsprozessen (z. B. Planung und Einbezug verschiedener Beteiligter) sind wesentliche Bestandteile einer Nutzen-Risiko Bewertung. Dieser Beitrag betrachtet daher den möglichen Public-Health-Nutzen sowie technische, soziale, rechtliche und ethische Aspekte einer Contact-Tracing-App zur Kontaktpersonennachverfolgung im Rahmen der COVID-19-Pandemie. Weiterhin werden Bedingungen für eine möglichst breite Nutzung der App aufgezeigt.
Sensor‐based assessment of challenging behaviors in dementia may be useful to support caregivers. Here, we investigated accelerometry as tool for identification and prediction of challenging behaviors. We set up a complex data recording study in two nursing homes with 17 persons in advanced stages of dementia. Study included four‐week observation of behaviors. In parallel, subjects wore sensors 24 h/7 d. Participants underwent neuropsychological assessment including MiniMental State Examination and Cohen‐Mansfield Agitation Inventory. We calculated the accelerometric motion score (AMS) from accelerometers. The AMS was associated with several types of agitated behaviors and could predict subject's Cohen‐Mansfield Agitation Inventory values. Beyond the mechanistic association between AMS and behavior on the group level, the AMS provided an added value for prediction of behaviors on an individual level. We confirm that accelerometry can provide relevant information about challenging behaviors. We extended previous studies by differentiating various types of agitated behaviors and applying long‐term measurements in a real‐world setting.
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasingly popular as digital interventions in a wide range of health-related applications in almost all sectors of healthcare. The surge in demand for digital medical solutions has been accelerated by the need for new diagnostic and therapeutic methods in the current coronavirus disease 2019 pandemic. This also applies to clinical practice in gastroenterology, which has, in many respects, undergone a recent digital transformation with numerous consequences that will impact patients and health care professionals in the near future. MHAs and MAs are considered to have great potential, especially for chronic diseases, as they can support the self-management of patients in many ways. Despite the great potential associated with the application of MHAs and MAs in gastroenterology and health care in general, there are numerous challenges to be met in the future, including both the ethical and legal aspects of applying this technology. The aim of this article is to provide an overview of the current status of MHA and MA use in the field of gastroenterology, describe the future perspectives in this field and point out some of the challenges that need to be addressed.
Vom Standard- zum IT-Bett
(2019)