Background: Telemedicine holds a potential to strengthen self-management support outside health care settings in the everyday management of type 1 diabetes (T1D). However, existing effectiveness reviews are older or include a relatively narrow focus on specific definitions of telemedicine or included databases. Objective: To conduct a systematic review of the effectiveness of telemedicine solutions versus any comparator on diabetes-related outcomes among people with T1D. Methods: Studies including adults (≥18 years) with T1D published before October 14, 2020, were eligible. Primary outcome was glycated hemoglobin (HbA1c, %). The Cochrane Library, PubMed, EMBASE, and CINAHL were searched. Meta-analysis based on the mean difference in HbA1c% was used to pool effects. The Cochrane tool was applied to assess risk-of-bias, and the certainty of evidence was graded using the GRADE approach. Results: A total of 22 studies were included (with 1615 participants). Treatment effect for HbA1c% favored telemedicine (mean difference of −0.26% [95% confidence interval:−0.37% to −0.15%]) with moderate effect certainty. Heterogeneity was moderate ( I² = 33.30%). Although not significant, secondary outcomes were all in favor of telemedicine except number of severe hypoglycemic events and diabetes knowledge, but the certainty of the evidence for those outcomes was all low or very low. Discussion: Reducing average HbA1c% levels are important to combat the risk of diabetic complications and premature death. However, the evidence mostly consist of small studies with a relative short duration and the estimated pooled effect is smaller than could be expected from quality improvement strategies in general for diabetes management. PROSPERO number: CRD42020123565.

Background: Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. Methods: PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI −47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate ( I² = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds −1.34 [95% CI: −2.61; −0.08]) that favored telemedicine (GRADE, low). Conclusions: No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.

Young carers often face a great amount of emotional burden and have high practical and social responsibilities. The role of being a young carer is associated with behavioural, developmental, physical and psychosocial problems that may not only affect the individual in childhood but also in adulthood. The aim of this study was to investigate the effect of a Danish respite volunteer programme called The Buddies for Children and Youngsters Programme on young carers' (n = 49; aged 6–16) social–emotional functioning. A pre–post‐design was applied, and data were collected through the parent version of the strengths and difficulties questionnaire (SDQ), here with an impact supplement at baseline and at the end of the programme (after 4 months). The programme showed a positive impact on emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, prosocial aspects and impact aspects, with mean differences values of −2.50 (p = .000), −0.62 (p = .271), −1.18 (p = .000), −0.74 (p = .008), 0.62 (p = .004) and −0.88 (p = .007), respectively. Furthermore, a large effect was found for the total difficulties score: −5.03 (p = .000). In conclusion, the programme seems promising considering its effect on young carers' social–emotional functioning. However, future research should include comparative studies with a longer duration.

This qualitative study sheds light on how some young carers aged between 6- and 16-years experienced participation in a volunteer respite programme named Buddies for Children and Youngsters (BCY). The programme was held in Northern Denmark and was based on the knowledge that young carers need a space for respite and support through conversation. The young carers were healthy children who had experienced serious, chronic somatic or mental illness and/or death in their immediate family. Over a minimum 4-month period, students (“buddies”) from University College of Northern Denmark offered respite to young carers in the form of their preferred social or other activities. From February to August 2020, 12 semi-structured individual interviews were conducted with young carers who had participated in the programme for at least 4 months. A thematic analysis generated four main themes: (1) A “buddy” is someone special, (2) feeling happier and less lonely, (3) Experiencing a social and personal influence, and (4) Experiencing influence on family life. Most of the young carers experienced a special relationship with their “buddy” – a relationship unlike but with some similarities to their relationships with peer friends and family, and one which gave them the opportunity for conversations about difficult topics. The time spent with the “buddy” was generally experienced as a respite space, leading to feelings of being happier and less lonely. Furthermore, for some of the young carers, the relationship influenced them socially and personally and caused their parents to pay more attention to them. The findings may increase awareness of young carers' experiences of support which can benefit future initiatives provided to this group.

Hyperphosphatemia is known as one of the more challenging conditions in end-stage renal disease patients. This study set out to present and evaluate a healthcare-oriented decision support tool in the management of hyperphosphatemia within hemodialysis therapy. A prototype module was designed to fit into the interface of a modern dialysis machine (Fresenius 5008). The prototype included three main functions: 1) immediate bedside blood sample access, 2) a model based prognosis tool with estimates of P-phosphate and 3) an overview of the user's phosphate related activities during dialysis treatments. The prototype was evaluated by a) heuristic evaluation with five human computer interaction experts and b) user testing with think-aloud by three users as (clinical) domain experts. The two evaluation procedures identified a total of 103 usability problems and led to some specific amendments to improve its practical potential. The overall results will guide further development of the decision support tool to ensure that the functions will support the user's needs. In conclusion, the prototype was evaluated to be relevant and potentially beneficial in the management of hyperphosphatemia in hemodialysis patients. Furthermore, it was found that some of the functions could be used for educational purposes or as decision support for some patient groups, e.g. for patient doing home-dialysis.