iPad use at the bedside: a tool for engaging patients in care processes during ward rounds?

BACKGROUND

Previous work has examined the impact of technology on information sharing and communication between doctors and patients in general practice consultations, but very few studies have explored this in hospital settings.

AIMS

To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events.

METHODS

Ten senior doctors were shadowed on ward rounds on general wards during interactions with 525 patients over 77.3 h, seven senior doctors were interviewed and 180 patients completed a short survey.

RESULTS

Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief.

CONCLUSIONS

Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.

Using robots in "Hands-on" academic activities: a case study examining speech-generating device use and required skills

PURPOSE

A 12-year-old girl, Emily, with complex communication needs and severe physical limitations, controlled a Lego robot from a speech-generating device (SGD) to do various "hands-on" academic activities. Emily's teacher and assistive technology (AT) team thought that controlling a robot would motivate Emily to "use her SGD more".

METHOD

A descriptive case study was used because the integration of communication and manipulation technologies is not yet understood. Target activities and goals were chosen by Emily's teacher and AT team. Emily performed several manipulative math activities and engaged in an "acting" activity aimed at increasing her message length. The competency skills needed to control a robot from the SGD were examined, as well as stakeholder satisfaction with the robot system.

RESULTS

Emily generated up to 0.4 communication events and 7 robot commands per minute in the activities. Her length of utterance was usually one-word long, but she generated two- and three-word utterances during some activities. Observations of Emily informed a framework to describe the competency skills needed to use SGDs to control robots. Emily and her teacher expressed satisfaction with robot use.

CONCLUSION

Robot use could motivate students to build SGD operational skills and learn educational concepts. Implications for Rehabilitation Controlling a robot from a speech-generating device (SGD) could increase students' motivation, engagement and understanding in learning educational concepts, because of the hands-on enactive approach. The robot and SGD system was acceptable to the participant and teacher and elicited positive comments from classmates. Thus, it may provide a way for children with disabilities to link with the curriculum and with other students in the classroom. Controlling a robot via SGD presents opportunities to improve augmentative and alternative communication operational, linguistic, social and strategic skills. Careful choice of activities will ensure that the activity requirements focus on the desired target skill, e.g. drawing or playing board games could be helpful to build operational skills and acting out stories could be helpful for building linguistic skills.

Using SMS as a tool to reduce exclusions experienced by caregivers of people with disabilities in a resource-limited Colombian community

PURPOSE

The community of El Codito, located in the mountainside on the perimeter of Bogota, Colombia, is considered one of the most vulnerable and resource-limited communities in the region. This community-based research (CBR) project used short message service (SMS) messaging as a tool for information access and social interaction with caregivers of people with disabilities (PWD).

METHOD

Using a focused ethnographic method, this research evaluated the experience of caregivers participating in the project. In addition to primarily qualitative methods, supplementary quantitative message data was also collected. This project utilized free and open source software for SMS message distribution.

RESULTS

Caregivers experienced the project as a window to possibility; the possibility of a social support network, the possibility of community participation and the possibility of change. During the three-month implementation, a total of 56 information messages were sent to caregivers, 20 question messages were received from caregivers and 30 social interaction messages were sent by caregivers to the group.

CONCLUSIONS

The proliferation of mobile phones in this resource-limited setting provided a feasible method for reducing the exclusion of PWD and caregivers. SMS was a useful tool for sharing information and reducing the isolation experienced by this socially excluded population. Implications for Rehabilitation Mobile phones are a prevalent technology in many resource-limited settings; short message service (SMS) is a feasible tool for sharing information and reducing isolation experienced by people with disabilities (PWD) and their families. When developing technology-based projects in resource-limited settings, the field of rehabilitation could apply principles from the field of Information and Communication Technology for Development (ICT4D). Projects in resource-limited settings could consider using a community-based research (CBR) approach. This collaborative approach can enhance the contextual relevance of the project. Caregivers of PWD found the project to be both useful and meaningful, and as a result of the project became more involved in their community.

Glucocorticoid receptor gene expression in adipose tissue and associated metabolic risk in black and white South African women

BACKGROUND

Black women have lower visceral adipose tissue (VAT) but are less insulin sensitive than white women; the mechanisms responsible are unknown.

OBJECTIVE

The study aimed to test the hypothesis that variation in subcutaneous adipose tissue (SAT) sensitivity to glucocorticoids might underlie these differences.

METHODS

Body fatness (dual energy X-ray absorptiometry) and distribution (computerized tomography), insulin sensitivity (SI, intravenous and oral glucose tolerance tests), and expression of 11β-hydroxysteroid dehydrogenase-1 (11HSD1), hexose-6-phosphate dehydrogenase and glucocorticoid receptor-α (GRα), as well as genes involved in adipogenesis and inflammation were measured in abdominal deep SAT, superficial SAT and gluteal SAT (GLUT) depots of 56 normal-weight or obese black and white premenopausal South African (SA) women. We used a combination of univariate and multivariate statistics to evaluate ethnic-specific patterns in adipose gene expression and related body composition and insulin sensitivity measures.

RESULTS

Although 11HSD1 activity and mRNA did not differ by ethnicity, GRα mRNA levels were significantly lower in SAT of black compared with white women, particularly in the GLUT depot (0.52±0.21 vs 0.91±0.26 AU, respectively, P<0.01). In black women, lower SAT GRα mRNA levels were associated with increased inflammatory gene transcript levels and abdominal SAT area, and reduced adipogenic gene transcript levels, VAT/SAT ratio and SI. Abdominal SAT 11HSD1 activity associated with increased VAT area and decreased SI in white, but not in black women.

CONCLUSIONS

In black SA women, downregulation of GRα mRNA levels with obesity and reduced insulin sensitivity, possibly via increased SAT inflammation, is associated with reduced VAT accumulation.

Access to hands-on mathematics measurement activities using robots controlled via speech generating devices: three case studies

PURPOSE

To examine how using a robot controlled via a speech generating device (SGD) influences the ways students with physical and communication limitations can demonstrate their knowledge in math measurement activities.

METHOD

Three children with severe physical disabilities and complex communication needs used the robot and SGD system to perform four math measurement lessons in comparing, sorting and ordering objects. The performance of the participants was measured and the process of using the system was described in terms of manipulation and communication events. Stakeholder opinions were solicited regarding robot use.

RESULTS

Robot use revealed some gaps in the procedural knowledge of the participants. Access to both the robot and SGD was shown to provide several benefits. Stakeholders thought the intervention was important and feasible for a classroom environment.

CONCLUSIONS

The participants were able to participate actively in the hands-on and communicative measurement activities and thus meet the demands of current math instruction methods.

IMPLICATIONS FOR REHABILITATION

Current mathematics pedagogy encourages doing hands-on activities while communicating about concepts. Adapted Lego robots enabled children with severe physical disabilities to perform hands-on length measurement activities. Controlling the robots from speech generating devices (SGD) enabled the children, who also had complex communication needs, to reflect and report on results during the activities. By using the robots combined with SGDs, children both exhibited their knowledge of and experienced the concepts of mathematical measurements.

Stapled transanal rectal resection (STARR) for obstructive defaecation syndrome: patients with previous pelvic floor surgery have poorer long-term outcome

AIM

Stapled transanal rectal resection (STARR) is used for patients with obstructive defaecation syndrome (ODS) not responding to conservative management. Reports indicate mixed results and there are no studies publishing the long-term outcome.

METHOD

Following full investigation, 37 patients with ODS underwent a STARR procedure by one of the authors (SP) between 2005 and 2010.

RESULTS

The median (range) patient age was 53.0 (28-79) years and all were female. Median (range) follow up was 13 (0-57) months, and nine (24.3%) patients were followed for longer than 24 months. Eighteen patients had undergone at least one (and often multiple) previous gynaecological procedures, including hysterectomy (n = 14), colposuspension (n = 3), vaginal rectocele repair (n = 4) and pelvic floor repair (n = 5). Four patients had had at least one previous rectal operation [stapled anopexy (n = 3) and Delorme's procedure (n = 2)]. One patient did not attend for postoperative follow up. Of the remaining 36 patients, 18 had resolution of obstructive symptoms. Of the 18 with residual symptoms, 17 eventually reported the same level of symptoms as before the STARR procedure. There was a significant correlation between the presence of residual symptoms and long-term ODS recurrence (P < 0.0005). For those with residual symptoms, the mean (95% CI) time to symptom recurrence was 3 (2.86-11.81) months. Twenty (56%) patients were satisfied with the outcome from the STARR procedure.

CONCLUSION

Residual symptoms are a strong indicator of long-term failure. STARR was effective for symptom resolution in 50% of patients. Those who had undergone pelvic floor or rectal prolapse surgery were significantly more likely to experience recurrent symptoms.

The role of assisted manipulation in cognitive development

OBJECTIVE

Motor experience plays a central role in cognitive development. Assistive technologies can thus provide augmentative manipulation for children with motor disabilities. This paper explores the use of robots to this end.

METHOD

A revision of studies conducted with typically-developing children and children with disabilities regarding the use of robots is presented. This revision provides a description of the cognitive skills required and revealed by the child when using a robot. Opportunities for participation and exploration were identified and further research is discussed.

RESULTS

Robots provide insight into the cognitive skills of children with motor disabilities. Robots also provide means for independent exploration and participation in learning and play activities. Integration of augmentative manipulation and communication increases interest and participation of children with disabilities.

CONCLUSION

Children with disabilities can use augmentative manipulation systems to independently explore and interact with their environment. Children can use robots as tools providing them with opportunities to reveal and further develop their cognitive skills. Alternative access methods can increase access for children with severe motor disabilities.

Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology

INTRODUCTION

This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery.

METHODS

Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme.

RESULTS

According to the survey, 62% of surgeons perform perineal dissection in the supine position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (p<0.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates. Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme.

CONCLUSIONS

There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.

P1-10-07: Comparing Breast Cancer Screening Guidelines: A Stage-Survival-Cost Model in a Public Hospital

Background: Despite advances in diagnosis and treatment of breast cancer in the United States, racial disparities in survival persist. Female breast cancer represented the costliest cancer site in 2010 with further increases projected to 2020. Mammography screening guidelines reflect the inherent difficulty in reconciling mortality reduction with potential harms to patients and cost-effectiveness concerns. Controversy still surrounds the 2009 updated USPSTF recommendations, as critics and advocates alike evaluate lives saved, costs, and how best to compare screening strategies. This study simulates USPSTF and ACS guidelines’ effects on stage, 5-year survival, and cost of treatment vs. usual practice in women treated in an urban public hospital.

Methods: Charts of 84 patients diagnosed with Stage I-III breast cancer in 2008 were reviewed. Published tumor doubling times guided a retrospective model to predict size at diagnosis by simulated ACS or USPSTF guidelines. AJCC-7 stages were then assigned to produce 3 distributions: 1) actual stage; 2) stage under ACS; and 3) stage under USPSTF. Survival estimates by stage and year from diagnosis were drawn from NCDB statistics and applied to each stage distribution, yielding average predicted survival for the actual and hypothetical scenarios. Finally, treatment costs for women continuously enrolled in Medicaid for 18 months were calculated from merged claims and registry data and similarly applied.

Results: Study patients averaged 55 years; 85% were African American. Forty-nine percent were covered by Medicaid and 23% by Medicare. Comparing actual and predicted stages at diagnosis showed significant shifts in stage distribution between all three scenarios (Table 1).