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De Micco F, De Benedictis A, Lettieri E, Tambone V. Editorial: Equitable digital medicine and home health care. Front Public Health 2023; 11:1251154. [PMID: 38192562 PMCID: PMC10773581 DOI: 10.3389/fpubh.2023.1251154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
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Turan Kavradim S, Yangöz ŞT, Ozer Z. Research Trends and Hot Topics on Virtual Reality in Nursing: A Bibliometric Analysis Using CiteSpace. ANS Adv Nurs Sci 2023; 46:363-380. [PMID: 36656108 DOI: 10.1097/ans.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This bibliometric analysis was conducted to provide a comprehensive overview of the development of virtual reality in nursing, and to identify the research trends and hot topics in this field. Data were collected from the Web of Science Core Collection database in May and June 2022, and analyses were performed using CiteSpace 6.1.R2. A total of 885 studies on virtual reality were included in the bibliometric analysis; 3570 authors from 1283 institutions and 60 countries contributed, and the studies were published in 356 different journals. It will be important for researchers and health professionals to determine the research trends, current issues, and research gaps on virtual reality in nursing.
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Affiliation(s)
- Selma Turan Kavradim
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey (Drs Turan Kavradim and Ozer); and Department of Internal Medicine Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey (Dr Yangöz)
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Stark S, Ewers M. Infrastructure- and workforce capacity for the provision of health care to people with invasive home mechanical ventilation: A scoping review of indicators and norms. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00037-5. [PMID: 37236850 DOI: 10.1016/j.zefq.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/31/2023] [Accepted: 02/24/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Both the availability and adequacy of infrastructure- and workforce capacity are critical to provide integrated and continuing care, especially to people with complex care needs such as those with invasive home mechanical ventilation (HMV). This review aims to synthesise indicators and norms that are available for assessing this infrastructure- and workforce capacity. METHODS A scoping review was conducted by searching PubMed, Livivo, the grey literature, specific registries, and the websites of relevant professional societies for international publications on specific infrastructure- and workforce capacity indicators or norms on HMV from January 2000 up to and including March 2021. Exclusion criteria comprised missing indicator/norm information, differing populations/care settings, and secondary literature. Indicators and norms were extracted, clustered, and analysed by applying the WHO Monitoring and Evaluation Framework and qualitative content analysis. RESULTS Fifteen publications met the inclusion criteria. Forty-five indicators and 44 norms on HMV-related infrastructure- and workforce capacity were synthesised. The synthesis revealed a heterogeneous set of indicators and norms (mainly from cross-sectional surveys and guidelines). The methodological information on their definition, rationales, disaggregation, and evidence is scarce. CONCLUSION To enable integrated care in HMV and comparable populations with complex care needs, the identified limitations in assessing infrastructure- and workforce capacity should be addressed.
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Affiliation(s)
- Susanne Stark
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany.
| | - Michael Ewers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Berlin, Germany
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Bente BE, Wentzel J, Schepers C, Breeman LD, Janssen VR, Pieterse ME, Evers AWM, van Gemert-Pijnen L. Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study. JMIR Cardio 2023; 7:e43781. [PMID: 36961491 PMCID: PMC10131764 DOI: 10.2196/43781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/26/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients' needs, it is necessary to account for these changes in needs and contexts of use. OBJECTIVE This study aimed to identify and monitor patients' needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: "How do novice and more advanced users experience an online health management platform?" "What user expectations support or hinder the adoption of an online health management platform, from a user perspective?" and "How does actual usage relate to user experiences and adoption?" METHODS A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. RESULTS After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. CONCLUSIONS Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients' needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology.
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Affiliation(s)
- Britt E Bente
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Department of Health Care and Social Work, University of Applied Sciences Windesheim, Zwolle, Netherlands
| | - Celina Schepers
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Linda D Breeman
- Unit of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Andrea W M Evers
- Unit of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
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Cardon C, Bernard CI, Chaniaud N, Loup-Escande E. Usability Evaluation of Connected Health Devices in Home Monitoring: Toward Devices Adapted to the Characteristics of Informal Caregivers. J Med Syst 2023; 47:25. [PMID: 36790529 DOI: 10.1007/s10916-023-01922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
While an increasing number of Informal CareGivers (ICGs) are assisting their dependent loved ones with the daily living tasks and medical care, they are rarely considered in the medical devices design process. The objective of this study is to identify the characteristics of ICGs impacting the use of the iHealth® Sense BP7 medical device, namely a connected wrist blood pressure monitor. For this purpose, user tests were conducted with 29 potential or actual ICGs. First, the participants filled out a socio-demographic questionnaire and then handled the blood pressure monitor. Finally, they completed the System Usability Scale questionnaire. The results revealed an impact of technophilia and age on usability dimensions. To conclude, the consideration of the ICG population in the design process of connected medical devices is discussed, particularly the age and level of technophilia.
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Affiliation(s)
- Claire Cardon
- CRP-CPO, University of Picardie Jules Verne, UR UPJV 7273, Amiens, France.
| | - Cécile I Bernard
- CRP-CPO, University of Picardie Jules Verne, UR UPJV 7273, Amiens, France
| | - Noémie Chaniaud
- Ecole Nationale Supérieure de Cognitique, Institut Polytechnique de Bordeaux, Talence, France
- IMS CNRS UMR5218 - Laboratoire de l'intégration, du matériau au système, Talence, France
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Niranjan B, de Courten MP, Iyngkaran P, Battersby M. Malthusian Trajectory for Heart Failure and Novel Translational Ambulatory Technologies. Curr Cardiol Rev 2023; 19:e240522205193. [PMID: 35611782 PMCID: PMC10280992 DOI: 10.2174/1573403x18666220524145646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been estimated that congestive heart failure (CHF) will reach epidemic proportions and contribute to large unsustainable impacts on health budgets for any cardiovascular condition. Against other major trends in cardiovascular outcomes, readmission and disease burden continue to rise as the demographics shift. METHODS The rise in heart failure with preserved ejection fraction (HFpEF) among elderly women will present new challenges. Gold standard care delivers sustainable and cost-effective health improvements using organised care programs. When coordinated with large hospitals, this can be replicated universally. RESULTS A gradient of outcomes and ambulatory care needs to be shifted from established institutions and shared with clients and community health services, being a sizeable proportion of CHF care. CONCLUSION In this review, we explore health technologies as an emerging opportunity to address gaps in CHF management.
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Affiliation(s)
- Bidargaddi Niranjan
- Digital Health at College of Medicine and Public Health Flinders University & SAHMRI, Adelaide, Australia
| | - Maximilian P de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne, Australia
| | - Pupalan Iyngkaran
- Mitchell Institute, Victoria University, Melbourne, Australia and Werribee Mercy Sub School, School of Medicine Sydney, The University of Notre Dame Australia, Werribee, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, South Australian Health and Medical Research Institute, Southern Adelaide Local Health Network, Mental Health Division, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Chaniaud N, Sagnier C, Loup-Escande E. Translation and Validation Study of the French Version of the eHealth Literacy Scale: Web-Based Survey on a Student Population. JMIR Form Res 2022; 6:e36777. [PMID: 36044264 PMCID: PMC9475413 DOI: 10.2196/36777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth literacy is emerging as a crucial concept for promoting patient self-management in an overloaded hospital system. However, to the best of our knowledge, no tool currently exists to measure the level of eHealth literacy among French-speaking people. The eHealth Literacy Scale (eHEALS) is an easy-to-administer 8-item questionnaire (5-point Likert scale, ranging from strongly disagree to strongly agree) that has already been translated into many languages. Currently, it is the most cited questionnaire in the literature. OBJECTIVE The aim of this study was to translate eHEALS to French and validate the French version of eHEALS (F-eHEALS). METHODS The validation of the F-eHEALS scale followed the 5 steps of the transcultural validation method: double reverse translation, validation by a committee of experts (n=4), pretest measurement to check the clarity of the items (n=22), administration of the scale in French via a web-based quantitative study combined with two other questionnaires (Health Literacy Survey-Europe-16 and Patient Activation Measure-13; N=328 students), and finally test-retest (n=78) to check the temporal stability of the measurements obtained from the scale. RESULTS The results obtained for the measurement of factor structure, internal consistency, and temporal stability (intraclass correlation coefficient=0.84; 95% CI 0.76-0.9; F77,77=6.416; P<.001) prove the validity and fidelity of the proposed scale. The internal consistency of F-eHEALS was estimated by Cronbach α of .89. The factor analysis with varimax rotation used to validate the construct showed a 2-factor scale. The effect of the construct was analyzed using 3 hypotheses related to the theory. The F-eHEALS score was correlated with the Health Literacy Survey-Europe-16 score (r=0.34; P<.001) and the Patient Activation Measure-13 score (r=0.31; P<.001). CONCLUSIONS F-eHEALS is consistent with the original version. It presents adequate levels of validity and fidelity. This 2D scale will need to be generalized to other populations in a French-speaking context. Finally, a version taking into account collaborative applications (ie, Health 2.0; eg, Digital Health Literacy Instrument scale) should be considered on the basis of this study.
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Affiliation(s)
- Noémie Chaniaud
- Centre de Recherche en Psychologie : Cognition, Psychisme, Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
| | - Camille Sagnier
- Centre de Recherche en Psychologie : Cognition, Psychisme, Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
| | - Emilie Loup-Escande
- Centre de Recherche en Psychologie : Cognition, Psychisme, Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
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“The Devices Themselves Aren’t the Problem”—Views of Patients and Their Relatives on Medical Technical Aid Supply in Home Mechanical Ventilation: An Explorative Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081466. [PMID: 36011127 PMCID: PMC9407692 DOI: 10.3390/healthcare10081466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
(1) The supply of medical technical aids and the instructions on using them is critical for home-mechanically ventilated patients and their relatives. However, limited evidence exists on the needs-based nature of this care. (2) Aim: To gain insights into users’ views on this form of care, to identify key challenges, and to derive empirically sound preliminary recommendations for its future design. (3) Methods: An explorative qualitative interview study was performed in Germany. Semi-structured interviews were conducted with home-mechanically ventilated patients and their relatives. Patients were selected through purposive sampling. Interviews were audio-recorded, transcribed, and analysed using a content analysis approach. (3) Results: 27 patients and 9 relatives were interviewed. From their point of view, ventilation-specific equipment is generally reliable and is seen as a belonging of the patient. However, if the patient lacks competence in using the technology or if information or instructions are neglected, ambiguous and unsafe situations easily arise. (4) Conclusions: The present study is one of the first to provide insights into technical aid supply in home-mechanical ventilation from the users’ point of view. It highlights the need for continuous professional support and for evidence-based educational strategies that promote safety among the users of technical aids in home care.
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Yoshimatsu K, Nakatani H. Attitudes of home-visiting nurses toward risk management of patient safety incidents in Japan. BMC Nurs 2022; 21:139. [PMID: 35668490 PMCID: PMC9169385 DOI: 10.1186/s12912-022-00905-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In situations of home care, patients and their family members must address problems and emergencies themselves. For this reason, home-visiting nurses (HVNs) must practice risk management to ensure that patients can continue receiving care in the comfort of their homes. The purpose of this study was to examine HVNs' attitudes toward risk management. METHODS This study adopted a qualitative description approach. Semi-structured interviews were conducted to collect information on HVNs' risk management behavior and their attitudes toward it. Participants comprised 11 HVNs working at home-visiting nursing agencies in a prefecture of Japan. Transcribed interviews were analyzed using content analysis. RESULTS Nurses' attitudes toward risk management comprised the following themes: (i) predicting and avoiding risks, (ii) ensuring medical safety in home settings, (iii) coping with incidents, and (iv) playing the role of administrators in medical safety, which was answered only by administrators. CONCLUSIONS When practicing risk management, home-visiting nurses should first assess the level of understanding of the patient and family, followed by developing safety measures tailored to their everyday needs. These results further suggest that administrators should take actions to foster a working environment conducive to risk management. These actions include coordinating duties to mitigate risk and improve the process of reporting risks. This study provides a baseline for future researchers to assist patients and families requiring medical care services of this nature.
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Affiliation(s)
- Keiko Yoshimatsu
- Department of Nursing, Faculty of Nursing and Nutrition, The University of Shimane, 151 Nisihayasigi-cho, Izumo-shi, Shimane-ken, 693-8550, Japan.
| | - Hisae Nakatani
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan
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Silva KLD, Braga PP, Silva AE, Lopes LFL, Souza TDM. Discourses on technologies in home care: contributions between innovating, inventing, and investing. Rev Gaucha Enferm 2022; 43:e20200491. [PMID: 35613233 DOI: 10.1590/1983-1447.2022.20200491.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the discourses of health professionals about technologies in home care. METHOD Qualitative research conducted in four public home care services in Minas Gerais. Data obtained from interviews with 52 professionals submitted to Critical Discourse Analysis. Results: The results indicate the functional and economic-financial discourse about the technologies. The economic discourse is dominant and reveals the contradiction between investing in high-cost equipment and the insufficiency of basic inputs for care. There is a tendency to reproduce hospital-centered logic with high technological density. The inventiveness and a process of adaptation at home are evidenced. CONCLUSION The discourses of health professionals indicate that the circumstances of home care are determinants of the adaptations and improvisations that occur in this context and are due to the contradictions between innovating, inventing, and investing in technologies in home care.
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Affiliation(s)
- Kênia Lara da Silva
- Universidade Federal de Minas Gerais (UFMG), Escola de Enfermagem, Departamento de Enfermagem Aplicada. Belo Horizonte, Minas Gerais, Brasil
| | - Patrícia Pinto Braga
- Universidade Federal de São João del Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Curso de Enfermagem. Divinópolis, Minas Gerais, Brasil
| | - Alexandre Ernesto Silva
- Universidade Federal de São João del Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Curso de Enfermagem. Divinópolis, Minas Gerais, Brasil
| | | | - Thiago de Medeiros Souza
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Enfermagem, Programa de Pós-Graduação em Enfermagem. Juiz de Fora, Minas Gerais, Brasil
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Shimizu N, Kotani K. Health information exchange in relation to point-of-care testing in home care: Issues in Japan. Clin Chim Acta 2022; 532:10-12. [PMID: 35594920 DOI: 10.1016/j.cca.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laboratory tests, especially point-of-care testing (POCT), and related health information exchange (HIE) are necessary for patient management in the home care setting, where clinic-hospital cooperation and interprofessional collaboration are important. METHODS We raised the issues ahead of HIE in relation to POCT in home care in Japan, including issues in electronic medical record use, localized interprofessional collaboration networks with information and communication technology, personal health record use and open connectivity. RESULTS HIE system may depend on the initiatives of expert communities with non-expert partnership, as well as national healthcare policies. CONCLUSION We promote future challenges in this growing area.
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Affiliation(s)
- Nayuta Shimizu
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, Jichi Medical University, Shimotsuke-City, Japan.
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Senteio C, Murdock PJ. The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review. J Med Internet Res 2022; 24:e22124. [PMID: 35377331 PMCID: PMC9016513 DOI: 10.2196/22124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 01/23/2022] [Indexed: 12/26/2022] Open
Abstract
Background Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Paul Joseph Murdock
- Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Tanlamai U, Jaikengkit AO, Jarutach T, Rajkulchai S, Ritbumroong T. Use of daily posture and activity tracking to assess sedentary behavior, toss-and-turns, and sleep duration of independently living Thai seniors. Health Informatics J 2022; 28:14604582211070214. [DOI: 10.1177/14604582211070214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the postures and activities of elders using activity-monitoring device or diary booklet. The research focuses on using the tracked data to assess sedentary behaviors, toss-and-turns, and sleep duration. Fifty seniors participated in the study for 14 days to obtain anecdotal evidence: half of them wore Sookjai, a motion-tracking device; the other half recorded their activities manually via a diary. The results show that they spent most of their time in the sit/stand posture; they tossed and turned during naps and sleep. Both groups showed a similar pattern of activities: the higher level of sedentary behavior is related to a longer sleep duration. Sedentary behavior and naps increased the number of toss-and-turns at night; toss-and-turns did not affect sleep duration. These independent living adults rated themselves healthy regardless of the extent of their sedentary behaviors or tossing and turning. Although the device did not meet all expectations, the seniors did indicate a positive intention to use wearables.
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Affiliation(s)
- Uthai Tanlamai
- Chulalongkorn Business School, Chulalongkorn University, Thailand
| | | | - Trirat Jarutach
- Center of Excellence in Universal Design, Chulalongkorn University, Thailand
| | | | - Thanachart Ritbumroong
- Graduate School of Applied Statistics, National Institute of Development Administration, Thailand
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Page B, Lee ACH, Harrop EJ, Beale T, Sharrard A, Yeung N, Vincent CA. Coproducing a library of videos to support families caring for children with gastrostomies: A mixed-methods evaluation with family carers and clinicians. Health Expect 2022; 25:1038-1047. [PMID: 35141999 PMCID: PMC9122434 DOI: 10.1111/hex.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Many families now perform specialist medical procedures at home. Families need appropriate training and support to do this. The aim of this study was to evaluate a library of videos, coproduced with parents and healthcare professionals, to support and educate families caring for a child with a gastrostomy. Methods A mixed‐methods online survey evaluating the videos was completed by 43 family carers who care for children with gastrostomies and 33 healthcare professionals (community‐based nurses [n = 16], paediatricians [n = 6], dieticians [n = 6], hospital‐based nurses [n = 4], paediatric surgeon [n = 1]) from the United Kingdom. Participants watched a sample of videos, rated statements on the videos and reflected on how the videos could be best used in practice. Results Both family carers and healthcare professionals perceived the video library as a valuable resource for parents and strongly supported the use of videos in practice. All healthcare professionals and 98% (n = 42) of family carers agreed they would recommend the videos to other families. Family carers found the videos empowering and easy to follow and valued the mixture of healthcare professionals and families featured in the videos. Participants gave clear recommendations for how different video topics should fit within the existing patient pathway. Discussion Families and healthcare professionals perceived the videos to be an extremely useful resource for parents, supporting them practically and emotionally. Similar coproduced educational materials are needed to support families who perform other medical procedures at home. Patient or Public Contribution Two parent representatives attended the research meetings from conception of the project and were involved in the design, conduct and dissemination of the surveys. The videos themselves were coproduced with several different families.
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Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alex C H Lee
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Alison Sharrard
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nick Yeung
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Nourse R, Lobo E, McVicar J, Kensing F, Islam SMS, Kayser L, Maddison R. Characteristics of smart health ecosystems that support self-care among people with heart failure: A scoping review (Preprint). JMIR Cardio 2022; 6:e36773. [DOI: 10.2196/36773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
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Tennant R, Allana S, Mercer K, Burns CM. Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study. JMIR Form Res 2022; 6:e28895. [PMID: 34989692 PMCID: PMC8771348 DOI: 10.2196/28895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/25/2021] [Accepted: 11/17/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child's health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child's health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. OBJECTIVE The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. METHODS This research is part of a broader study to explore caregivers' perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. RESULTS We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child's status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children's educators. Beyond the scope of managing their child's health information, family caregivers also navigated bureaucratic processes for their child's home care. CONCLUSIONS Family caregivers' experiences of caring for CSHCN differ contextually and evolve as their child's condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child's health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings.
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Affiliation(s)
- Ryan Tennant
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Sana Allana
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Kate Mercer
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada.,Library, University of Waterloo, Waterloo, ON, Canada
| | - Catherine M Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
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Smith S, Tallon M, Clark C, Jones L, Mörelius E. "You Never Exhale Fully Because You're Not Sure What's NEXT": Parents' Experiences of Stress Caring for Children With Chronic Conditions. Front Pediatr 2022; 10:902655. [PMID: 35832577 PMCID: PMC9271768 DOI: 10.3389/fped.2022.902655] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Children with chronic conditions are experiencing improved survival worldwide, and it is well-known that their parents are stressed. Yet, despite this knowledge, parents continue to experience stress. Our study explored the lived experience of parental stress when caring for children with various chronic conditions to identify opportunities to potentially reduce stress for these parents. This was an exploratory qualitative study using semi-structured interviews. To ensure appropriate research priorities were addressed, the study was co-designed with consumer and stakeholder involvement. Twenty parents were interviewed. Parents were recruited through a recognized family support organization for children with various care needs in Western Australia. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological Analysis. Two superordinate themes were identified: (1) Gut instinct to tipping point included parents as unheard experts and their experiences of stress and becoming overwhelmed. (2) Losses and gains covered the parents' identity and relationship challenges and coping strategies with their children's unpredictable conditions. Parents' experiences of stress caring for children with chronic conditions can be applied to the Job-Demand Control-Support Model for occupational stress. Not only does this application provide a useful framework for practitioners but it adds a unique perspective that reflects the dual role of parents in caring for their children with chronic conditions as a parent but also a professional with a 24/7 workload. The parents' experiences highlight a need for improved support access, effective communication between parents and health care professionals, discharge preparation and information provision, and regular screening of parental stress with a referral pathway.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
| | - Mary Tallon
- School of Nursing, Curtin University, Bentley, WA, Australia
| | - Carrie Clark
- Kalparrin, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondaulup, WA, Australia.,Perth Children's Hospital, Nursing Research Department, Nedlands, WA, Australia
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Silva KLD, Braga PP, Silva AE, Lopes LFL, Souza TDM. Discursos sobre tecnologias na atenção domiciliar: contribuições entre inovar, inventar e investir. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20200491.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Analisar discursos de profissionais de saúde sobre as tecnologias na atenção domiciliar. Método: Pesquisa qualitativa realizada em quatro serviços públicos de atenção domiciliar de Minas Gerais. Dados obtidos de entrevistas com 52 profissionais, submetidas à Análise de Discurso Crítica. Resultados: Os resultados indicam o discurso funcional e econômico-financeiro sobre as tecnologias. O discurso econômico é dominante e revela a contradição entre investir em equipamentos de alto custo e a insuficiência de insumos básicos para o cuidado. Há uma tendência de reprodução da lógica hospitalocêntrica com alta densidade tecnológica. Evidencia-se a inventividade e um processo de adaptação no domicílio. Conclusão: Os discursos dos profissionais de saúde indicam que as circunstâncias do cuidado domiciliar são determinantes das adaptações e improvisos que ocorrem neste contexto e são decorrentes das contradições entre inovar, inventar e investir nas tecnologias na AD.
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Franz N, Rapp H, Hansen RN, Gold LS, Goss CH, Lechtzin N, Kessler L. Health care costs related to home spirometry in the eICE randomized trial. J Cyst Fibros 2022; 21:61-69. [PMID: 33715993 PMCID: PMC8433261 DOI: 10.1016/j.jcf.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Home spirometry with regular symptom assessment is one strategy to track lung health to intervene early in episodes of pulmonary exacerbations (PE). In a multi-center randomized controlled trial home spirometry and symptom tracking demonstrated no significant differences regarding the primary clinical endpoint, FEV1, compared to usual care, but did identify differences in healthcare utilization. We used data from the Early Intervention in Cystic Fibrosis Exacerbation (eICE) study to evaluate whether home monitoring of PE is a cost-minimizing intervention in the context of this randomized trial. METHODS We reviewed healthcare resource utilization of all 267 eICE participants, including outpatient visits, antibiotics and hospitalizations. Prices were identified in the IBM/Watson MarketScanⓇ Commercial Claims and Encounters Databases and averaged over the 2014-2017 period. Using total healthcare utilization costs, we generated summary statistics by intervention and protocol arm (total cost, mean cost, standard deviation). We performed Welch Two Sample t-tests to determine if total costs and cost by type of utilization differed significantly between groups. RESULTS Outpatient visit costs were significantly higher by 13% in the Early Intervention (EI) than in the usual care (UC) arm ($3,345 vs. $2,966). We found no significant differences in outpatient antibiotic, hospitalization, or total health care costs between the arms. CONCLUSIONS Within the context of the eICE trial, outpatient visits were significantly higher in those with experimental home spirometry care, but that did not translate into statistically significant differences of overall health care costs between the two arms.
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Affiliation(s)
- Natalie Franz
- Department of Health Services, University of Washington, Seattle, Washington, United States
| | - Hannah Rapp
- Department of Health Services, University of Washington, Seattle, Washington, United States
| | - Ryan N. Hansen
- School of Pharmacy, University of Washington, Seattle, Washington, United States
| | - Laura S. Gold
- Department of Radiology, University of Washington, Seattle, Washington, United States
| | - Christopher H. Goss
- Department of Medicine, University of Washington, Seattle, Washington, United States;,Department of Pediatrics, University of Washington, Seattle, Washington, United States
| | - Noah Lechtzin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Larry Kessler
- Department of Health Services, University of Washington, Seattle, Washington, United States
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Abstract
Sustainable technologies are being increasingly used in various areas of human life. While they have a multitude of benefits, they are especially useful in health monitoring, especially for certain groups of people, such as the elderly. However, there are still several issues that need to be addressed before its use becomes widespread. This work aims to clarify the aspects that are of great importance for increasing the acceptance of the use of this type of technology in the elderly. In addition, we aim to clarify whether the technologies that are already available are able to ensure acceptable accuracy and whether they could replace some of the manual approaches that are currently being used. A two-week study with people 65 years of age and over was conducted to address the questions posed here, and the results were evaluated. It was demonstrated that simplicity of use and automatic functioning play a crucial role. It was also concluded that technology cannot yet completely replace traditional methods such as questionnaires in some areas. Although the technologies that were tested were classified as being “easy to use”, the elderly population in the current study indicated that they were not sure that they would use these technologies regularly in the long term because the added value is not always clear, among other issues. Therefore, awareness-raising must take place in parallel with the development of technologies and services.
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Chaniaud N, Sagnier C, Megalakaki O, Loup-Escande E. Relationship Between Efficiency, Effectiveness, and Learnability of Home Connected Medical Device in Ambulatory Surgery. Telemed J E Health 2021; 28:904-911. [PMID: 34652223 DOI: 10.1089/tmj.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, usability assessments of home connected medical devices do not systematically take into account learnability metrics. In case of the Smart Angel device-designed for monitoring ambulatory surgery patients-users are trained at the hospital and have to use the device at home to monitor their health remotely. Objective: The aim of this study was to better understand the relationships between two metrics of usability-efficiency and effectiveness-and learnability of the Smart Angel device. Materials and Methods: Twenty-eight participants were trained in a simulated hospital (SimUsanté), and then we filmed the participant using the device three times. Between each session, the participant had to complete questionnaires (sociodemographic and health literacy). Results: The results of a between-subject analysis [χ2(2) = 18.969, p < 0.001] and a within-subject analysis [F(2.28) = 13.34, p < 0.001, η2 = 0.35] showed that efficiency (manipulation time) significantly improved with learnability (number of sessions). Conversely, effectiveness (number of manipulation errors) stagnated over the three sessions with a between-subject analysis [F(2.75) = 1.628, p = 0.203], while the within-subject analysis revealed that users seemed to significantly correct their errors with the number of sessions [F(2.28) = 6, p = 0.005, η2 = 0.19]. By analyzing the errors, we observed that some errors could appear at any time (e.g., moving during the measurement) and others were systematic (e.g., the wrist blood pressure on the right arm). Conclusions: While the "first attempt" at using a home medical device is a major revealing step for the study of manipulation errors, learnability is an equally useful metric to include in usability studies, as well as in the very definition itself of usability.
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Affiliation(s)
- Noémie Chaniaud
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
| | - Camille Sagnier
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
| | - Olga Megalakaki
- CRP-CPO UR UPJV 7273, Université de Jules Verne Picardie, Amiens, France
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Christie M, Coyne E, Mitchell M. The educational experiences and needs of patients with an internal cardiac defibrillator: An interpretive phenomenological study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ten Haken I, Ben Allouch S, van Harten WH. Education and training of nurses in the use of advanced medical technologies in home care related to patient safety: A cross-sectional survey. NURSE EDUCATION TODAY 2021; 100:104813. [PMID: 33662675 DOI: 10.1016/j.nedt.2021.104813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To use advanced medical technologies (AMTs) correctly and safely requires both specialist knowledge and skills, and an awareness of risks and how those can be minimized. Reporting safety concerns about AMTs in home care can contribute to an improved quality of care. The extent to which a health care organization has integrated the reporting, evaluation and learning from incidents is a key element of that organization's patient safety culture. OBJECTIVES To explore nurses' experiences regarding the education followed in the use of AMTs in the home setting, and their organizations' systems of reporting. DESIGN Descriptive cross-sectional design. METHODS 209 home care nurses from across the Netherlands who worked with infusion therapy, parenteral nutrition and/or morphine pumps responded to the online questionnaire between July 2018 and February 2019. The analysis of the data was mainly descriptive. RESULTS Educational interventions that are most often used to learn how to use AMTs were, as an average over the three AMTs, instruction by a nurse (71%), practical training in the required skills (71%) and acquiring information to increase theoretical knowledge (69%). Considerable attention is paid to patient safety (88%) and the home setting (89%). However, a substantial proportion of the nurses (up to 29%) use AMTs even though they had not been tested on their skills. 95% of the respondents were well acquainted with the incident reporting protocol of their organization, but only 49% received structural or regular feedback on any actions taken as a result of event reporting. CONCLUSIONS This study revealed aspects of nurses' education that imply risk factors for patient safety. Practical training is not always given, additional or retraining is often voluntary, and the required skills are not always tested. However, the results show that nurses do have a good awareness of patient safety. Incidents are mainly discussed within the team, but less at the organizational level.
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Affiliation(s)
- Ingrid Ten Haken
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, P.O. Box 70.000, 7500 KB Enschede, the Netherlands.
| | - Somaya Ben Allouch
- Research Group Digital Life, Amsterdam University of Applied Sciences, Wibautstraat 2-4, 1091 GM Amsterdam, the Netherlands; Informatics Institute, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, the Netherlands.
| | - Wim H van Harten
- Faculty Behavioural, Management and Social Sciences (BMS), Department Health Technology & Services Research (HT&SR), University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands; Rijnstate General Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands.
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Page B, Butler S, Smith C, Lee AC, Vincent CA. Training and support for caring for a child's gastrostomy: a survey with family carers. BMJ Paediatr Open 2021; 5:e001068. [PMID: 34395927 PMCID: PMC8317118 DOI: 10.1136/bmjpo-2021-001068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore family carers' experiences of training and ongoing support for caring for their child's gastrostomy, and to get their views on how this could be improved. METHODS A mixed-methods online survey with 146 family carers (eg, parents, grandparents) who care for a child with a gastrostomy. Family carers rated their own experience of training and support and made recommendations for how training and support could be improved for future families. RESULTS The nature and extent of the training family carers reported receiving varied considerably. Many felt that the demonstrations they received in hospital were too brief. Two in five family carers rated their confidence caring for their child's gastrostomy as very low in the first few weeks after surgery. Parents valued ongoing learning and support from other parents and support from community nurses. Videos and simulation practice were rated as useful formats of training, in addition to face-to-face supervised practice with a clinician. Parents liked how real life the example video shown was, and rated nearly all suggested video topics as 'very helpful', especially troubleshooting topics. CONCLUSIONS Our study found substantial variability in family carers' descriptions of the training and support they received to care for their child's gastrostomy. Training often did not meet family carers' needs. We need to invest in better training and support for families and learn from their recommendations. Improvements to training and support for families (eg, through instructional videos) have the potential to improve family carers' confidence and competence, and reduce the risk of problems and complications which cause harm to children and increase demand on National Health Service (NHS) resources.
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Affiliation(s)
- Bethan Page
- Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
| | | | | | - Alex Ch Lee
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charles A Vincent
- Experimental Psychology, University of Oxford, Oxford, Oxfordshire, UK
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Page BF, Hinton L, Harrop E, Vincent C. The challenges of caring for children who require complex medical care at home: 'The go between for everyone is the parent and as the parent that's an awful lot of responsibility'. Health Expect 2020; 23:1144-1154. [PMID: 32542954 PMCID: PMC7696130 DOI: 10.1111/hex.13092] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Increasing numbers of children with complex health-care needs are cared for at home by their family. The aim of this qualitative study was to explore the challenges experienced by families caring for children who need complex medical care at home. METHODS We conducted a thematic analysis of eleven in-depth interviews with parents who carry out specialist medical procedures (eg, enteral feeding, bowel washouts and tracheostomy care) for their children at home. Participants were purposely selected from an existing sample of interviews with parents whose child had abdominal surgery in the first year of life. RESULTS We identified three overarching themes: (a) responsibilities of the parent, (b) impact on daily life and (c) the parent journey over time. Parents have substantial responsibilities, including performing medical procedures, managing emergencies (sometimes life-threatening), co-ordinating care and advocating for their child. Their responsibilities have an enormous impact on the family: going out of the home becomes a challenge, there are constant constraints on time, parents are sleep-deprived and there are wider impacts on siblings. The third theme explores the parent journey over time as parents become experts and make sense of the new normal. DISCUSSION The burden of care on families caring for children with complex medical needs is much greater than is generally understood by either multidisciplinary health-care teams or the general public. Families need to be better prepared and supported for the responsibilities they take on and the burden of care needs to be shared by others.
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Affiliation(s)
- Bethan F. Page
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
- Present address:
The Healthcare Improvement Studies Institute (THIS)University of CambridgeCambridgeUK
| | - Emily Harrop
- Helen and Douglas HouseOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Charles Vincent
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
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Stark S, Ewers M. Long-Term Care for Tracheotomised Patients With or Without Invasive Ventilation. Lessons Learned from a Scoping Review of International Concepts. Int J Integr Care 2020; 20:3. [PMID: 32742249 PMCID: PMC7366865 DOI: 10.5334/ijic.5429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/29/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients with long-term tracheostomies, with or without mechanical ventilation have complex and comprehensive healthcare needs. The number of patients is increasing internationally. Evidence suggests poor healthcare quality and outcomes, especially in Germany. Against this background, we searched for international concepts tailoring healthcare to these special needs, their key characteristics and results from their evaluations. METHODS A scoping review was performed in 2018 based on a systematic search of scientific databases and grey literature without restrictions to publication type. Key information was charted and thematically analysed based on the taxonomy of integrated care. Evaluations were analysed descriptively. RESULTS Seventy-nine publications related to 25 programmes from five countries were included. Healthcare concepts are usually regionally adapted and tertiary sector-based with a cross-sectoral approach. Care coordination responsibility is usually assigned to advanced nurse practitioners, embedded in multi-professional programme teams. Interventions consist of specialised needs-based clinical services combined with care coordination, homecare support and education. Evaluation of concepts is scarce, but existing results indicate beneficial effects on patient-related outcomes, care coordination, healthcare utilisation and costs. CONCLUSIONS The concepts available in the literature are often poorly described and rarely evaluated. Research is needed on their impact on healthcare quality and outcomes. However, several key characteristics were identified, which should be considered when developing and implementing integrated and needs-based approaches for the patient group in Germany and beyond.
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Affiliation(s)
- Susanne Stark
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, DE
| | - Michael Ewers
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, DE
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Javaid M, Haleem A. Impact of industry 4.0 to create advancements in orthopaedics. J Clin Orthop Trauma 2020; 11:S491-S499. [PMID: 32774017 PMCID: PMC7394797 DOI: 10.1016/j.jcot.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
Scientists and health professional are focusing on improving the medical sciences for the betterment of patients. The fourth industrial revolution, which is commonly known as Industry 4.0, is a significant advancement in the field of engineering. Industry 4.0 is opening a new opportunity for digital manufacturing with greater flexibility and operational performance. This development is also going to have a positive impact in the field of orthopaedics. The purpose of this paper is to present various advancements in orthopaedics by the implementation of Industry 4.0. To undertake this study, we have studied the available literature extensively on Industry 4.0, technologies of Industry 4.0 and their role in orthopaedics. Paper briefly explains about Industry 4.0, identifies and discusses the major technologies of Industry 4.0, which will support development in orthopaedics. Finally, from the available literature, the paper identifies twelve significant advancements of Industry 4.0 in orthopaedics. Industry 4.0 uses various types of digital manufacturing and information technologies to create orthopaedics implants, patient-specific tools, devices and innovative way of treatment. This revolution is to be useful to perform better spinal surgery, knee and hip replacement, and invasive surgeries.
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Affiliation(s)
- Mohd Javaid
- Corresponding author., https://scholar.google.co.in/citations?user=rfyiwvsAAAAJ&hl=en
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Ten Haken I, Ben Allouch S, van Harten WH. Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross-sectional survey and an analysis of registration data. BMJ Qual Saf 2020; 30:bmjqs-2019-010510. [PMID: 32546591 PMCID: PMC8070619 DOI: 10.1136/bmjqs-2019-010510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically. OBJECTIVES To identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents. METHODS A cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used. RESULTS We identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation's protocol. CONCLUSIONS Most incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
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Affiliation(s)
- Ingrid Ten Haken
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Somaya Ben Allouch
- Research Group Digital Life, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim H van Harten
- Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
- CEO, Rijnstate General Hospital, Arnhem, The Netherlands
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Nawaz RF, Page B, Harrop E, Vincent CA. Analysis of paediatric long-term ventilation incidents in the community. Arch Dis Child 2020; 105:446-451. [PMID: 31848150 PMCID: PMC7212935 DOI: 10.1136/archdischild-2019-317965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 01/16/2023]
Abstract
AIM To describe the nature and causes of reported patient safety incidents relating to care in the community for children dependent on long-term ventilation with the further aim of improving safety. METHODS We undertook an analysis of patient safety incident data relating to long-term ventilation in the community using incident reports from England and Wales' National Reporting and Learning System occurring between January 2013 and December 2017. Manual screening by two authors identified 220 incidents which met the inclusion criteria. The free text for each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome. RESULTS Common problems in the delivery of care included issues with faulty equipment and the availability of equipment, and concerns around staff competency. There was a clearly stated harm to the child in 89 incidents (40%). Contributory factors included staff shortages, out of hours care, and issues with packaging and instructions for equipment. CONCLUSIONS This study identifies a range of problems relating to long-term ventilation in the community, some of which raise serious safety concerns. The provision of services to support children on long-term ventilation and their families needs to improve. Priorities include training of staff, maintenance and availability of equipment, support for families and coordination of care.
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Affiliation(s)
- Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, UK,Patient Safety Collaborative, Oxford Academic Health Science Network, Oxford, UK
| | - Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Page B, Nawaz R, Haden S, Vincent C, Lee ACH. Paediatric enteral feeding at home: an analysis of patient safety incidents. Arch Dis Child 2019; 104:1174-1180. [PMID: 31201158 PMCID: PMC6900243 DOI: 10.1136/archdischild-2019-317090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 12/25/2022]
Abstract
AIMS To describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices. METHODS We analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales' National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome. RESULTS The most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer. CONCLUSIONS There are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.
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Affiliation(s)
- Bethan Page
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Rasanat Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, UK,Oxford Academic Health Science Network, Oxford, UK
| | - Sarah Haden
- John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alex C H Lee
- Oxford Academic Health Science Network, Oxford, UK,John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Coravos A, Goldsack JC, Karlin DR, Nebeker C, Perakslis E, Zimmerman N, Erb MK. Digital Medicine: A Primer on Measurement. Digit Biomark 2019; 3:31-71. [PMID: 32095767 DOI: 10.1159/000500413] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/15/2019] [Indexed: 01/17/2023] Open
Abstract
Technology is changing how we practice medicine. Sensors and wearables are getting smaller and cheaper, and algorithms are becoming powerful enough to predict medical outcomes. Yet despite rapid advances, healthcare lags behind other industries in truly putting these technologies to use. A major barrier to entry is the cross-disciplinary approach required to create such tools, requiring knowledge from many people across many fields. We aim to drive the field forward by unpacking that barrier, providing a brief introduction to core concepts and terms that define digital medicine. Specifically, we contrast "clinical research" versus routine "clinical care," outlining the security, ethical, regulatory, and legal issues developers must consider as digital medicine products go to market. We classify types of digital measurements and how to use and validate these measures in different settings. To make this resource engaging and accessible, we have included illustrations and figures throughout that we hope readers will borrow from liberally. This primer is the first in a series that will accelerate the safe and effective advancement of the field of digital medicine.
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Affiliation(s)
- Andrea Coravos
- Elektra Labs, Boston, Massachusetts, USA.,Harvard-MIT Center for Regulatory Science, Boston, Massachusetts, USA.,The Digital Medicine Society (DiMe), Boston, Massachusetts, USA
| | - Jennifer C Goldsack
- The Digital Medicine Society (DiMe), Boston, Massachusetts, USA.,monARC Bionetworks, San Francisco, California, USA
| | - Daniel R Karlin
- The Digital Medicine Society (DiMe), Boston, Massachusetts, USA.,HealthMode, New York, New York, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA.,Center for Wireless and Population Health Systems, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Eric Perakslis
- Rubenstein Fellow - Duke Forge, Durham, North Carolina, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Zimmerman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Kelley Erb
- Digital Medicine and Translational Imaging, Worldwide Research, Development, and Medical, Pfizer Inc., Cambridge, Massachusetts, USA
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Norell Pejner M, Ourique de Morais W, Lundström J, Laurell H, Skärsäter I. A Smart Home System for Information Sharing, Health Assessments, and Medication Self-Management for Older People: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e12447. [PMID: 31038459 PMCID: PMC6658282 DOI: 10.2196/12447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/05/2019] [Accepted: 03/19/2019] [Indexed: 01/07/2023] Open
Abstract
Background Older adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people’s independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their own care. It is also a challenge to perform adequate health assessments and to engage in appropriate communication between health care professionals. Objective The purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information-sharing among care providers and care receivers in order to support and promote medication self-management among older people. Methods The authors used a participatory design approach for this mixed-methods project, which was divided into four phases. Phase I, Conceptualization, consists of the conceptualization of a system to support medication self-management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consists of building and bringing together the conceptualized systems from Phase I. Phase III, Pilot Study, and Phase IV, Full-Scale Intervention, are described briefly. Results Participants in Phase I were people who were involved in some way in the care of older adults and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from Phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The systems will also encourage information-sharing between care providers and care receivers. The first is the concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason, and act in response to individuals’ needs, preferences, and behaviors as these change over time. The second concept is the Medication safety, Objective assessments of health-related behaviors, and Personalized medication reminders (MedOP) system, a system that would be supported by the IAFH, and which consists of three related components: one that assesses health behaviors, another that communicates health data, and a third that promotes medication self-management. Conclusions The participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication, and medication self-management: the IAFH and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management among older people. International Registered Report Identifier (IRRID) DERR1-10.2196/12447
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Affiliation(s)
- Margaretha Norell Pejner
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | | - Jens Lundström
- Technical Science, School of Information Technology, Halmstad University, Halmstad, Sweden
| | - Hélène Laurell
- Innovation Science, School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
| | - Ingela Skärsäter
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Huang SHS, MacRae J, Ross D, Imtiaz R, Hollingsworth B, Nesrallah GE, Copland MA, McFarlane PA, Chan CT, Zimmerman D. Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial. Clin J Am Soc Nephrol 2019; 14:403-410. [PMID: 30659057 PMCID: PMC6419275 DOI: 10.2215/cjn.08310718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Canadian home hemodialysis guidelines highlight the potential differences in complications associated with arteriovenous fistula (AVF) cannulation technique as a research priority. Our primary objective was to determine the feasibility of randomizing patients with ESKD training for home hemodialysis to buttonhole versus stepladder cannulation of the AVF. Secondary objectives included training time, pain with needling, complications, and cost by cannulation technique. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients training for home hemodialysis at seven Canadian hospitals were assessed for eligibility, and demographic information and access type was collected on everyone. Patients who consented to participate were randomized to buttonhole or stepladder cannulation technique. Time to train for home hemodialysis, pain scores on cannulation, and complications over 12 months was recorded. For eligible but not randomized patients, reasons for not participating in the trial were documented. RESULTS Patient recruitment was November 2013 to November 2015. During this time, 158 patients began training for home hemodialysis, and 108 were ineligible for the trial. Diabetes mellitus as a cause of ESKD (31% versus 12%) and central venous catheter use (74% versus 6%) were more common in ineligible patients. Of the 50 eligible patients, 14 patients from four out of seven sites consented to participate in the study (28%). The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method. Data linkages for a formal cost analysis were not conducted. CONCLUSIONS We were unable to demonstrate the feasibility of conducting a randomized, controlled trial of buttonhole versus stepladder cannulation in Canada with a sufficient number of patients on home hemodialysis to be able to draw meaningful conclusions.
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Affiliation(s)
- Shih-Han S. Huang
- Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Jennifer MacRae
- Department of Medicine, Division of Nephrology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dana Ross
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rameez Imtiaz
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Brittany Hollingsworth
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gihad E. Nesrallah
- Faculty of Medicine, Division of Nephrology, Humber River Hospital, Toronto, Ontario, Canada
| | - Michael A. Copland
- Department of Medicine, Division of Nephrology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Christopher T. Chan
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Abstract
Inexpensive embedded computing and the related Internet of Things technologies enable the recent development of smart products that can respond to human needs and improve everyday tasks in an attempt to make traditional environments more “intelligent”. Several projects have augmented mirrors for a range of smarter applications in automobiles and homes. The opportunity to apply smart mirror technology to healthcare to predict and to monitor aspects of health and disease is a natural but mostly underdeveloped idea. We envision that smart mirrors comprising a combination of intelligent hardware and software could identify subtle, yet clinically relevant changes in physique and appearance. Similarly, a smart mirror could record and evaluate body position and motion to identify posture and movement issues, as well as offer feedback for corrective actions. Successful development and implementation of smart mirrors for healthcare applications will require overcoming new challenges in engineering, machine learning, computer vision, and biomedical research. This paper examines the potential uses of smart mirrors in healthcare and explores how this technology might benefit users in various medical environments. We also provide a brief description of the state-of-the-art, including a functional prototype concept developed by our group, and highlight the directions to make this device more mainstream in health-related applications.
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Sánchez López JD, Cambil Martín J, Villegas Calvo M, Toledo Páez MA, Cariati P, Moreno Martín ML. [Management of adverse events in an Oral and Maxillofacial Surgery Unit]. J Healthc Qual Res 2018; 33:256-263. [PMID: 30361103 DOI: 10.1016/j.jhqr.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Patient safety in oral and maxillofacial surgery is oriented towards providing patient care by means of adequate risk management that minimises adverse events and fosters a culture of safe clinical practices as the fundamental basis of quality health care. To implement preventive actions are implemented in order to improve patient safety and to reduce the incidence of adverse events, as well as to improve the quality of care. The aim of this report is to implement preventive measures in order to improve the health care of the patient in an Oral and Maxillofacial Surgery Unit by reducing the Adverse Events and proving good quality healthcare. MATERIALS AND METHODS A longitudinal, prospective, single centre study was conducted using a methodology of analysis of modes of failure and effects of the management of potentially serious adverse events in the Oral and Maxillofacial surgical unit of the University Hospital of Granada (June-November 2017), as well as the preparation and implementation of a series of corrective measures. RESULTS A total of 33 adverse events were recorded, with 10 of them considered as critical, distributed in different areas of care, and referred from Primary Health Care and from other hospitals. Seven preventive actions were implemented: information to the patient, training actions, improvements in the protocols and procedures, in the care process and clinical practice, as well as the need to set up an adequate checklist, and other miscellaneous. DISCUSSION The implementation of preventive measures represent a notable advance in the prevention of harm to the patient and the organisation, involving healthcare staff in a safety culture oriented towards quality care.
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Affiliation(s)
- J D Sánchez López
- Facultativo especialista de Área de Cirugía Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - J Cambil Martín
- Enfermero, profesor del Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, España
| | - M Villegas Calvo
- Enfermera, supervisora de Enfermería, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M A Toledo Páez
- Enfermera, jefa de Bloque de Área Quirúrgica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - P Cariati
- Médico residente de Cirugía Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M L Moreno Martín
- Enfermera, Práctica Asistencial en el área de Reanimación. Parque Tecnológico de la Salud, Granada, España
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