COVID‐19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource‐limited settings is challenging. We report the results of a multidisciplinary patient‐navigator‐led telemedicine supportive care program in Mexico City. One‐hundred sixty‐three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient‐reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource‐limited settings.

Background. The early integration of supportive care in oncology improves patient-centered outcomes. However, data is lacking regarding how to achieve this in resourcelimited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. Materials and Methods. This randomized controlled trial was conducted between 08/17 and 04/2018 at a public hospital in Mexico City. Patients aged ≥18 with metastatic tumors ≤six weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. Results. 134 patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm vs. 24% in usual care (difference 0.50, 95% CI 0.34-0.62; p<0.0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared to 0% in usual care (p<0.0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10 vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = 0.006), without differences in quality of life between arms. Conclusions and Relevance. Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. The Oncologist 2020;9999:• •

This article discusses the simulation and evaluation of a traffic congestion detection system which combines inter-vehicular communications, fixed roadside infrastructure and infrastructure-to-infrastructure connectivity and big data. The system discussed in this article permits drivers to identify traffic congestion and change their routes accordingly, thus reducing the total emissions of CO2 and decreasing travel time. This system monitors, processes and stores large amounts of data, which can detect traffic congestion in a precise way by means of a series of algorithms that reduces localized vehicular emission by rerouting vehicles. To simulate and evaluate the proposed system, a big data cluster was developed based on Cassandra, which was used in tandem with the OMNeT++ discreet event network simulator, coupled with the SUMO (Simulation of Urban MObility) traffic simulator and the Veins vehicular network framework. The results validate the efficiency of the traffic detection system and its positive impact in detecting, reporting and rerouting traffic when traffic events occur.

Wellness is a term often used to talk about optimal health as "dynamic balance of physical, emotional, social, spiritual, and intellectual health." While healthcare is a term about care offered to patients for improving their health. We use both terms, as well as the Business Model Canvas (BMC) methodology, to design a digital ecosystem model for healthcare and wellness called DE4HW; the model considers economic, technological, and legal asymmetries, which are present on e-services beyond geographical regions. BMC methodology was embedded into the global project strategy called: IBOT (Initiate, Build, Operate and Transfer); it is a methodology to establish a functional, integrated national telemedicine network and virtual education network; of which we took its phases rationale. The results in this work illustrate the design of DE4HW model, into the first phase of IBOT, enriched with the BMC, which enables us to define actors, their interactions, rules and protocols, in order to build DE4HW, while IBOT strategy manages the project goal, up to the transfer phase, where an integral service platform of healthcare and wellness is turned over to stakeholders.

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