1
|
Wosny M, Strasser LM, Hastings J. The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study. J Med Internet Res 2024; 26:e56095. [PMID: 39008341 DOI: 10.2196/56095] [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: 01/08/2024] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being. OBJECTIVE The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. METHODS Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. RESULTS Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. CONCLUSIONS Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.
Collapse
Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen, St.Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen, St.Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Choo YJ, Lee GW, Moon JS, Chang MC. Application of non-contact sensors for health monitoring in hospitals: a narrative review. Front Med (Lausanne) 2024; 11:1421901. [PMID: 38933102 PMCID: PMC11199382 DOI: 10.3389/fmed.2024.1421901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
The continuous monitoring of the health status of patients is essential for the effective monitoring of disease progression and the management of symptoms. Recently, health monitoring using non-contact sensors has gained interest. Therefore, this study aimed to investigate the use of non-contact sensors for health monitoring in hospital settings and evaluate their potential clinical applications. A comprehensive literature search was conducted using PubMed to identify relevant studies published up to February 26, 2024. The search terms included "hospital," "monitoring," "sensor," and "non-contact." Studies that used non-contact sensors to monitor health status in hospital settings were included in this review. Of the 38 search results, five studies met the inclusion criteria. The non-contact sensors described in the studies were radar, infrared, and microwave sensors. These non-contact sensors were used to obtain vital signs, such as respiratory rate, heart rate, and body temperature, and were then compared with the results from conventional measurement methods (polysomnography, nursing records, and electrocardiography). In all the included studies, non-contact sensors demonstrated a performance similar to that of conventional health-related parameter measurement methods. Non-contact sensors are expected to be a promising solution for health monitoring in hospital settings.
Collapse
Affiliation(s)
- Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Gun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| |
Collapse
|
3
|
Kant N, Garssen SH, Vernooij CA, Mauritz GJ, Koning MV, Bosch FH, Doggen CJM. Enhancing discharge decision-making through continuous monitoring in an acute admission ward: a randomized controlled trial. Intern Emerg Med 2024; 19:1051-1061. [PMID: 38619713 PMCID: PMC11186918 DOI: 10.1007/s11739-024-03582-y] [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: 01/23/2024] [Accepted: 03/10/2024] [Indexed: 04/16/2024]
Abstract
In Acute Admission Wards, vital signs are commonly measured only intermittently. This may result in failure to detect early signs of patient deterioration and impede timely identification of patient stability, ultimately leading to prolonged stays and avoidable hospital admissions. Therefore, continuous vital sign monitoring may improve hospital efficacy. The objective of this randomized controlled trial was to evaluate the effect of continuous monitoring on the proportion of patients safely discharged home directly from an Acute Admission Ward. Patients were randomized to either the control group, which received usual care, or the sensor group, which additionally received continuous monitoring using a wearable sensor. The continuous measurements could be considered in discharge decision-making by physicians during the daily bedside rounds. Safe discharge was defined as no unplanned readmissions, emergency department revisits or deaths, within 30 days after discharge. Additionally, length of stay, the number of Intensive Care Unit admissions and Rapid Response Team calls were assessed. In total, 400 patients were randomized, of which 394 completed follow-up, with 196 assigned to the sensor group and 198 to the control group. The proportion of patients safely discharged home was 33.2% in the sensor group and 30.8% in the control group (p = 0.62). No significant differences were observed in secondary outcomes. The trial was terminated prematurely due to futility. In conclusion, continuous monitoring did not have an effect on the proportion of patients safely discharged from an Acute Admission Ward. Implementation challenges of continuous monitoring may have contributed to the lack of effect observed. Trial registration: https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered: January 6, 2022.
Collapse
Affiliation(s)
- Niels Kant
- Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH, Enschede, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Sjoerd H Garssen
- Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH, Enschede, The Netherlands
- Department of Patient Care and Monitoring, Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - Carlijn A Vernooij
- Department of Patient Care and Monitoring, Philips Research, High Tech Campus 34, 5656 AE, Eindhoven, The Netherlands
| | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Mark V Koning
- Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
- Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Carine J M Doggen
- Clinical Research Center, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
- Department of Health Technology and Services Research, Faculty of Behavioral, Management and Social Sciences, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH, Enschede, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| |
Collapse
|
4
|
Youn S, Ki MR, Abdelhamid MAA, Pack SP. Biomimetic Materials for Skin Tissue Regeneration and Electronic Skin. Biomimetics (Basel) 2024; 9:278. [PMID: 38786488 PMCID: PMC11117890 DOI: 10.3390/biomimetics9050278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Biomimetic materials have become a promising alternative in the field of tissue engineering and regenerative medicine to address critical challenges in wound healing and skin regeneration. Skin-mimetic materials have enormous potential to improve wound healing outcomes and enable innovative diagnostic and sensor applications. Human skin, with its complex structure and diverse functions, serves as an excellent model for designing biomaterials. Creating effective wound coverings requires mimicking the unique extracellular matrix composition, mechanical properties, and biochemical cues. Additionally, integrating electronic functionality into these materials presents exciting possibilities for real-time monitoring, diagnostics, and personalized healthcare. This review examines biomimetic skin materials and their role in regenerative wound healing, as well as their integration with electronic skin technologies. It discusses recent advances, challenges, and future directions in this rapidly evolving field.
Collapse
Affiliation(s)
- Sol Youn
- Department of Biotechnology and Bioinformatics, Korea University, Sejong-Ro 2511, Sejong 30019, Republic of Korea; (S.Y.); (M.A.A.A.)
| | - Mi-Ran Ki
- Department of Biotechnology and Bioinformatics, Korea University, Sejong-Ro 2511, Sejong 30019, Republic of Korea; (S.Y.); (M.A.A.A.)
- Institute of Industrial Technology, Korea University, Sejong-Ro 2511, Sejong 30019, Republic of Korea
| | - Mohamed A. A. Abdelhamid
- Department of Biotechnology and Bioinformatics, Korea University, Sejong-Ro 2511, Sejong 30019, Republic of Korea; (S.Y.); (M.A.A.A.)
- Department of Botany and Microbiology, Faculty of Science, Minia University, Minia 61519, Egypt
| | - Seung-Pil Pack
- Department of Biotechnology and Bioinformatics, Korea University, Sejong-Ro 2511, Sejong 30019, Republic of Korea; (S.Y.); (M.A.A.A.)
| |
Collapse
|
5
|
Babu M, Lautman Z, Lin X, Sobota MHB, Snyder MP. Wearable Devices: Implications for Precision Medicine and the Future of Health Care. Annu Rev Med 2024; 75:401-415. [PMID: 37983384 DOI: 10.1146/annurev-med-052422-020437] [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] [Indexed: 11/22/2023]
Abstract
Wearable devices are integrated analytical units equipped with sensitive physical, chemical, and biological sensors capable of noninvasive and continuous monitoring of vital physiological parameters. Recent advances in disciplines including electronics, computation, and material science have resulted in affordable and highly sensitive wearable devices that are routinely used for tracking and managing health and well-being. Combined with longitudinal monitoring of physiological parameters, wearables are poised to transform the early detection, diagnosis, and treatment/management of a range of clinical conditions. Smartwatches are the most commonly used wearable devices and have already demonstrated valuable biomedical potential in detecting clinical conditions such as arrhythmias, Lyme disease, inflammation, and, more recently, COVID-19 infection. Despite significant clinical promise shown in research settings, there remain major hurdles in translating the medical uses of wearables to the clinic. There is a clear need for more effective collaboration among stakeholders, including users, data scientists, clinicians, payers, and governments, to improve device security, user privacy, data standardization, regulatory approval, and clinical validity. This review examines the potential of wearables to offer affordable and reliable measures of physiological status that are on par with FDA-approved specialized medical devices. We briefly examine studies where wearables proved critical for the early detection of acute and chronic clinical conditions with a particular focus on cardiovascular disease, viral infections, and mental health. Finally, we discuss current obstacles to the clinical implementation of wearables and provide perspectives on their potential to deliver increasingly personalized proactive health care across a wide variety of conditions.
Collapse
Affiliation(s)
- Mohan Babu
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Ziv Lautman
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Xiangping Lin
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Milan H B Sobota
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| |
Collapse
|
6
|
Wong AKC, Tso WC, Su JJ, Hui VCC, Chow KKS, Wong SM, Wong BB, Wong FKY. Effectiveness of support from community health workers on the sustained use of a wearable monitoring device among community-dwelling older adults: A randomized trial protocol. PLoS One 2023; 18:e0294517. [PMID: 38134126 PMCID: PMC10745171 DOI: 10.1371/journal.pone.0294517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Wearable monitoring devices, such as smartwatches and fitness bands, are health technologies for enhancing self-care management among community-dwelling older adults. While the evidence suggests that these devices can promote health, older adults often struggle to use them over the long term. Community health workers can effectively motivate older adults to change their health behaviors. This study proposes an intervention involving community health workers as peer supporters to promote sustained daily use of wearable monitoring devices among community-dwelling older adults. METHODS The intervention group in this randomized controlled trial will receive the Live with Wearable Monitoring Device program from trained community health workers with the support of a nurse and social workers through a one-time home visit and regular phone calls. The control group will receive only the wearable monitoring device. Data will be collected at baseline, 1 month, 3 months, and 6 months. DISCUSSION Merely providing older adults with wearable monitoring devices may not lead to the realization of the potential health benefits of these devices, as long-term usage can be challenging. The results of this trial can provide evidence for a new approach to enhancing self-management and community healthcare among community-dwelling older adults, ultimately improving their health outcomes. IMPACT Wearable monitoring devices not only enable real-time monitoring of vital signs, but can also support tailored messaging and facilitate virtual communication between users and healthcare professionals. Despite considerable health benefits, there is evidence showing that older adults largely stop using them after a few months. This study is the first to use a peer support approach to help older adults incorporate a wearable monitoring device in their daily routines in conjunction with goal setting and regular reminders. This will boost the self-care ability of the older adults, allowing them to continue physically functioning in the community. TRIAL REGISTRATION This study was prospectively registered at clinicaltrials.gov (identifier: NCT05269303). Registration date: 24/2/2022.
Collapse
Affiliation(s)
| | - Wai Chun Tso
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Karen Kit Sum Chow
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
| | - Siu Man Wong
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
| | - Bonnie Bo Wong
- Elderly Center Division, Hong Kong Lutheran Social Service, Ho Man Tin, Hong Kong
| | | |
Collapse
|
7
|
Wosny M, Strasser LM, Hastings J. Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review. JMIR Hum Factors 2023; 10:e50357. [PMID: 37847535 PMCID: PMC10618886 DOI: 10.2196/50357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The digitalization of health care has many potential benefits, but it may also negatively impact health care professionals' well-being. Burnout can, in part, result from inefficient work processes related to the suboptimal implementation and use of health information technologies. Although strategies to reduce stress and mitigate clinician burnout typically involve individual-based interventions, emerging evidence suggests that improving the experience of using health information technologies can have a notable impact. OBJECTIVE The aim of this systematic review was to collect evidence of the benefits and challenges associated with the use of digital tools in hospital settings with a particular focus on the experiences of health care professionals using these tools. METHODS We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to explore the experience of health care professionals with digital tools in hospital settings. Using a rigorous selection process to ensure the methodological quality and validity of the study results, we included qualitative studies with distinct data that described the experiences of physicians and nurses. A panel of 3 independent researchers performed iterative data analysis and identified thematic constructs. RESULTS Of the 1175 unique primary studies, we identified 17 (1.45%) publications that focused on health care professionals' experiences with various digital tools in their day-to-day practice. Of the 17 studies, 10 (59%) focused on clinical decision support tools, followed by 6 (35%) studies focusing on electronic health records and 1 (6%) on a remote patient-monitoring tool. We propose a theoretical framework for understanding the complex interplay between the use of digital tools, experience, and outcomes. We identified 6 constructs that encompass the positive and negative experiences of health care professionals when using digital tools, along with moderators and outcomes. Positive experiences included feeling confident, responsible, and satisfied, whereas negative experiences included frustration, feeling overwhelmed, and feeling frightened. Positive moderators that may reinforce the use of digital tools included sufficient training and adequate workflow integration, whereas negative moderators comprised unfavorable social structures and the lack of training. Positive outcomes included improved patient care and increased workflow efficiency, whereas negative outcomes included increased workload, increased safety risks, and issues with information quality. CONCLUSIONS Although positive and negative outcomes and moderators that may affect the use of digital tools were commonly reported, the experiences of health care professionals, such as their thoughts and emotions, were less frequently discussed. On the basis of this finding, this study highlights the need for further research specifically targeting experiences as an important mediator of clinician well-being. It also emphasizes the importance of considering differences in the nature of specific tools as well as the profession and role of individual users. TRIAL REGISTRATION PROSPERO CRD42023393883; https://tinyurl.com/2htpzzxj.
Collapse
Affiliation(s)
- Marie Wosny
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
| | | | - Janna Hastings
- School of Medicine, University of St Gallen (HSG), St Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich (UZH), Zurich, Switzerland
| |
Collapse
|
8
|
Cole KL, Gautam D, Findlay MC, Lucke-Wold B. Biophysiologic Monitoring for the Neurosurgical Patient. FUTURE INTEGRATIVE MEDICINE 2023; 2:148-158. [PMID: 37901290 PMCID: PMC10611426 DOI: 10.14218/fim.2023.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Biophysiologic monitoring exists as a method of collecting objective information about the neurosurgical patient throughout their treatment and recovery process. Such data is crucial for an improved understanding of the disease processes while providing the surgeon additional clarity as they decipher the next best steps in decision-making and medical recommendations. In the current review article, the authors discuss the commonly used wearable and placeable monitoring devices and the biophysiological data that can be collected to monitor, as well as, assess the neurosurgical patient. Special focus is placed on invasive and non-invasive neurologic monitoring devices, but important and commonly used monitors for the rest of the body are also discussed as they relate to the neurosurgical patient. Last, the authors review new, as well as, upcoming devices and measurements to better analyze the neurosurgical patient's bodily function and physiologic status as needed. The synthesis of methods contained herein may provide meaningful guidance for neurosurgeons in effectively monitoring and treating their patients while also helping to guide their future efforts in patient biophysiologic monitoring developments within neurosurgery.
Collapse
Affiliation(s)
- Kyril L. Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Diwas Gautam
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | |
Collapse
|
9
|
Turan A, Khanna AK, Brooker J, Saha AK, Clark CJ, Samant A, Ozcimen E, Pu X, Ruetzler K, Sessler DI. Association Between Mobilization and Composite Postoperative Complications Following Major Elective Surgery. JAMA Surg 2023; 158:825-830. [PMID: 37256591 PMCID: PMC10233451 DOI: 10.1001/jamasurg.2023.1122] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/21/2023] [Indexed: 06/01/2023]
Abstract
Importance Mobilization after surgery is a key component of Enhanced Recovery after Surgery (ERAS) pathways. Objective To evaluate the association between mobilization and a collapsed composite of postoperative complications in patients recovering from major elective surgery as well as hospital length of stay, cumulative pain scores, and 30-day readmission rates. Design, Setting, and Participants This retrospective observational study conducted at a single quaternary US referral center included patients who had elective surgery between February 2017 and October 2020. Mobilization was assessed over the first 48 postoperative hours with wearable accelerometers, and outcomes were assessed throughout hospitalization. Patients who had elective surgery lasting at least 2 hours followed by at least 48 hours of hospitalization were included. A minimum of 12 hours of continuous accelerometer monitoring was required without missing confounding variables or key data. Among 16 203 potential participants, 8653 who met inclusion criteria were included in the final analysis. Data were analyzed from February 2017 to October 2020. Exposures Amount of mobilization per hour for 48 postoperative hours. Outcomes The primary outcome was a composite of myocardial injury, ileus, stroke, venous thromboembolism, pulmonary complications, and all-cause in-hospital mortality. Secondary outcomes included hospital length of stay, cumulative pain scores, and 30-day readmission. Results Of 8653 included patients (mean [SD] age, 57.6 [16.0] years; 4535 [52.4%] female), 633 (7.3%) experienced the primary outcome. Mobilization time was a median (IQR) of 3.9 (1.7-7.8) minutes per monitored hour overall, 3.2 (0.9-7.4) in patients who experienced the primary outcome, and 4.1 (1.8-7.9) in those who did not. There was a significant association between postoperative mobilization and the composite outcome (hazard ratio [HR], 0.75; 95% CI, 0.67-0.84; P < .001) for each 4-minute increase in mobilization. Mobilization was associated with an estimated median reduction in the duration of hospitalization by 0.12 days (95% CI, 0.09-0.15; P < .001) for each 4-minute increase in mobilization. The were no associations between mobilization and pain score or 30-day readmission. Conclusions and Relevance In this study, mobilization measured by wearable accelerometers was associated with fewer postoperative complications and shorter hospital length of stay.
Collapse
Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Ashish K. Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
| | - Jack Brooker
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Amit K. Saha
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
- Department of Anesthesiology, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Clancy J. Clark
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anusha Samant
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, North Carolina
- Department of Anesthesiology, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Xuan Pu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
10
|
Garssen SH, Kant N, Vernooij CA, Mauritz GJ, Koning MV, Bosch FH, Doggen CJM. Continuous monitoring of patients in and after the acute admission ward to improve clinical pathways: study protocol for a randomized controlled trial (Optimal-AAW). Trials 2023; 24:405. [PMID: 37316919 DOI: 10.1186/s13063-023-07416-8] [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: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Because of high demand on hospital beds, hospitals seek to reduce patients' length of stay (LOS) while preserving the quality of care. In addition to usual intermittent vital sign monitoring, continuous monitoring might help to assess the patient's risk of deterioration, in order to improve the discharge process and reduce LOS. The primary aim of this monocenter randomized controlled trial is to assess the effect of continuous monitoring in an acute admission ward (AAW) on the percentage of patients who are discharged safely. METHODS A total of 800 patients admitted to the AAW, for whom it is equivocal whether they can be discharged directly after their AAW stay, will be randomized to either receive usual care without (control group) or with additional continuous monitoring of heart rate, respiratory rate, posture, and activity, using a wearable sensor (sensor group). Continuous monitoring data are provided to healthcare professionals and used in the discharge decision. The wearable sensor keeps collecting data for 14 days. After 14 days, all patients fill in a questionnaire to assess healthcare use after discharge and, if applicable, their experience with the wearable sensor. The primary outcome is the difference in the percentage of patients who are safely discharged home directly from the AAW between the control and sensor group. Secondary outcomes include hospital LOS, AAW LOS, intensive care unit (ICU) admissions, Rapid Response Team calls, and unplanned readmissions within 30 days. Furthermore, facilitators and barriers for implementing continuous monitoring in the AAW and at home will be investigated. DISCUSSION Clinical effects of continuous monitoring have already been investigated in specific patient populations for multiple purposes, e.g., in reducing the number of ICU admissions. However, to our knowledge, this is the first Randomized Controlled Trial to investigate effects of continuous monitoring in a broad patient population in the AAW. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered on 6 January 2022. Start of recruitment: 7 December 2021.
Collapse
Affiliation(s)
- Sjoerd H Garssen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Niels Kant
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carlijn A Vernooij
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
| | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark V Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Carine J M Doggen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands.
| |
Collapse
|
11
|
Paulauskaite-Taraseviciene A, Siaulys J, Sutiene K, Petravicius T, Navickas S, Oliandra M, Rapalis A, Balciunas J. Geriatric Care Management System Powered by the IoT and Computer Vision Techniques. Healthcare (Basel) 2023; 11:healthcare11081152. [PMID: 37107987 PMCID: PMC10138364 DOI: 10.3390/healthcare11081152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The digitalisation of geriatric care refers to the use of emerging technologies to manage and provide person-centered care to the elderly by collecting patients' data electronically and using them to streamline the care process, which improves the overall quality, accuracy, and efficiency of healthcare. In many countries, healthcare providers still rely on the manual measurement of bioparameters, inconsistent monitoring, and paper-based care plans to manage and deliver care to elderly patients. This can lead to a number of problems, including incomplete and inaccurate record-keeping, errors, and delays in identifying and resolving health problems. The purpose of this study is to develop a geriatric care management system that combines signals from various wearable sensors, noncontact measurement devices, and image recognition techniques to monitor and detect changes in the health status of a person. The system relies on deep learning algorithms and the Internet of Things (IoT) to identify the patient and their six most pertinent poses. In addition, the algorithm has been developed to monitor changes in the patient's position over a longer period of time, which could be important for detecting health problems in a timely manner and taking appropriate measures. Finally, based on expert knowledge and a priori rules integrated in a decision tree-based model, the automated final decision on the status of nursing care plan is generated to support nursing staff.
Collapse
Affiliation(s)
| | - Julius Siaulys
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Kristina Sutiene
- Department of Mathematical Modeling, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Titas Petravicius
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Skirmantas Navickas
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Marius Oliandra
- Faculty of Informatics, Kaunas University of Technology, Studentu 50, 51368 Kaunas, Lithuania
| | - Andrius Rapalis
- Biomedical Engineering Institute, Kaunas University of Technology, K. Barsausko 59, 51423 Kaunas, Lithuania
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Studentu 48, 51367 Kaunas, Lithuania
| | - Justinas Balciunas
- Faculty of Medicine, Vilnius University, Universiteto 3, 01513 Vilnius, Lithuania
| |
Collapse
|
12
|
Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. FRONTIERS IN PAIN RESEARCH 2022; 3:896276. [PMID: 35721658 PMCID: PMC9201034 DOI: 10.3389/fpain.2022.896276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.
Collapse
Affiliation(s)
- Sara E. Berger
- Responsible and Inclusive Technologies Research, Exploratory Sciences Division, IBM Thomas J. Watson Research Center, Yorktown Heights, NY, United States
| | | |
Collapse
|
13
|
Huh KY, Jeong SI, Yoo H, Piao M, Ryu H, Kim H, Yoon YR, Seong SJ, Lee S, Kim KH. Lessons from a multicenter clinical trial with an approved wearable electrocardiogram: issues and practical considerations. Transl Clin Pharmacol 2022; 30:87-98. [PMID: 35800668 PMCID: PMC9253449 DOI: 10.12793/tcp.2022.30.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/29/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
Although wearable electrocardiograms (ECGs) are being increasingly applied in clinical settings, validation methods have not been standardized. As an exploratory evaluation, we performed a multicenter clinical trial implementing an approved wearable patch ECG. Healthy male adults were enrolled in 2 study centers. The approved ECGs were deployed for 6 hours, and pulse rates were measured independently with conventional pulse oximetry at selected time points for correlation analyses. The transmission status of the data was evaluated by heart rates and classified into valid, invalid, and missing. A total of 55 subjects (40 in center 1 and 15 in center 2) completed the study. Overall, 77.40% of heart rates were within the valid range. Invalid and missing data accounted for 1.42% and 21.23%, respectively. There were significant differences in valid and missing data between centers. The proportion of missing data in center 1 (24.77%) was more than twice center 2 (11.77%). Heart rates measured by the wearable ECG and conventional pulse oximetry showed a poor correlation (intraclass correlation coefficient = 0.0454). In conclusion, we evaluated the multicenter feasibility of implementing wearable ECGs. The results suggest that systems to mitigate multicenter discrepancies and remove artifacts should be implemented prior to performing a clinical trial.
Collapse
Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 03080, Korea
| | - Sae Im Jeong
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 03080, Korea
| | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
| | - Meihua Piao
- Office of Hospital Information, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyeongju Ryu
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Heejin Kim
- Clinical Trials Center, Seoul National University Hospital, Seoul 03080, Korea
| | - Young-Ran Yoon
- School of Medicine, Kyungpook National University and Department of Clinical Pharmacology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - Sook Jin Seong
- School of Medicine, Kyungpook National University and Department of Clinical Pharmacology, Kyungpook National University Hospital, Daegu 41944, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Seoul National University Hospital, Seoul 03080, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul 03080, Korea
| |
Collapse
|