Feasibility, usability, and acceptability of psychoeducational videoconferencing interventions for informal caregivers: A systematic review of randomized controlled trials

Psychoeducational videoconferencing interventions bypass traditional in-person barriers to attendance and are effective in improving caregiving skills, self-care, and wellness among informal caregivers. Information on their feasibility, usability, and acceptability from the caregivers' perspective is needed to inform future designs and developments. This systematic review follows PRISMA 2020 guidelines to integrate this information. Five databases were systematically searched for relevant randomized control trials published between January 2012 and December 2022. Reference lists were cross-checked for additional studies. Relevant studies were appraised and had their data extracted. This review contains 14 randomized controlled trials. Retention rates ranged from 55.56% to 100%, and major reasons for withdrawing include deteriorating patient health, lack of interest, and technical difficulties (feasibility). Caregivers found the videoconference technology usable, although participants in one intervention experienced poor connectivity and persistent technical issues (usability). Most caregivers were satisfied with videoconferencing interventions, found their content applicable to their situation, and appreciated their structure (acceptability). Those in videoconferencing group interventions were satisfied with small caregiver group sizes (acceptability). Adding respite care to interventions and incorporating short and regular videoconferencing sessions may improve feasibility. Ensuring small group sizes in videoconferencing group interventions and using participatory design may enhance acceptability. Advocacy is needed for employees identifying as informal caregivers to receive employer support and for quality connectivity within underserved areas. This may improve the feasibility and usability of interventions, allowing caregivers to receive the support they need. In future studies, power analyses and recruiting more caregivers may better assess feasibility.

Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care

STUDY AIM

This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach.

BACKGROUND

Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described.

METHODS

We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements.

RESULTS

We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC.

CONCLUSION

This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study.

APPLICATION

We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.

A DATA-BASED PROPOSITION FOR THE CREATION OF NEW ICD-10 DIAGNOSIS CODES FOR POST-ACUTE SEPSIS SURVIVORS

Sepsis survivors have the second highest readmission rate among Medicare beneficiaries, next to heart failure. I-TRANSFER is an implementation science study to improve transitions and reduce readmissions among sepsis survivors transitioning from acute to home health care (HHC). A total of 63 semi-structured interviews were conducted with stakeholders among 12 hospitals and 5 affiliated home health agencies (HHAs). The purpose of this secondary analysis was to: 1) examine how the sepsis diagnosis is reflected in HHC documentation, 2) identify barriers in sepsis information transfer to HHC, 3) recommend a documentation strategy to enhance information transfer and HHC documentation. We analyzed the diagnosis coding within a national OASIS dataset and eight I-TRANSFER interviews with hospitalists, documentation specialists, and HHC coders. Findings include: a) sepsis diagnoses were nearly invisible in HHC records being documented for only 10% of 165,000 sepsis survivors transitioned to HHC, b) sepsis information in referral documentation can be unclear to HHC coders, c) the lack of sepsis diagnosis documentation might make HHC clinicians unaware of the patient’s risk for readmission, d) HHC coders recommended improved language in the acute care discharge summary to link the need for HHC to sepsis, thereby supporting the use of ICD-10 sepsis ‘A’ codes in HHC. The use of terms, such as “History of Sepsis” or “Sepsis Resolved,” leads to HHC using non-specific codes, thus is not recommended. We highlight the need for new ICD-10 codes for “Sepsis Aftercare” and “Post-Sepsis Syndrome” to clearly communicate and document the needs of sepsis survivors.

The East Africa Consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. KEY MESSAGESThe East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer.Collaborations have been established between researchers in North America and East African countries for these studies.Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.

mHealth platform improved health worker's compliance to WHO’s IMNCI guideline in Nairobi, Kenya

 

Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya.

Key messages

• WHO recommended IMNCI compliant mHealth platform enables health care providers to offer quality child health care.

• Using mHealth platform to ensure WHO’s IMNCI guideline implementation by health care providers might have potential impact on saving sick children’s lives from preventable deaths.

A functional genomics screen identifying blood cell development genes in Drosophila by undergraduates participating in a course-based research experience

Undergraduate students participating in the UCLA Undergraduate Research Consortium for Functional Genomics (URCFG) have conducted a two-phased screen using RNA interference (RNAi) in combination with fluorescent reporter proteins to identify genes important for hematopoiesis in Drosophila. This screen disrupted the function of approximately 3500 genes and identified 137 candidate genes for which loss of function leads to observable changes in the hematopoietic development. Targeting RNAi to maturing, progenitor, and regulatory cell types identified key subsets that either limit or promote blood cell maturation. Bioinformatic analysis reveals gene enrichment in several previously uncharacterized areas, including RNA processing and export and vesicular trafficking. Lastly, the participation of students in this course-based undergraduate research experience (CURE) correlated with increased learning gains across several areas, as well as increased STEM retention, indicating that authentic, student-driven research in the form of a CURE represents an impactful and enriching pedagogical approach.

Patterns and correlates of benzodiazepine use in nurses: A nationwide, population-based study

In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004-2008. The case group comprised 33 588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half-life. Older nurses (>45 years) and those with greater experience (≥5 years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses.

Genetics Education in Nurse Residency Programs: A Natural Fit

Scientific advances are shedding light on the genetic underpinning of common diseases. With such insight, the entire health care team is faced with the need to address patient questions regarding genetic risk, testing, and the psychosocial aspects of genetics information. Nurses are in a prime position to help with patient education about genetic conditions, yet they often lack adequate genetics education within their nursing curriculum to address patient questions and provide resources. One mechanism to address this knowledge deficit is the incorporation of a genetics-based curriculum into nurse residency programs. This article describes a novel genetics-based curriculum designed and implemented in the UCLA Health System Nurse Residency Program. J Contin Educ Nurs. 2017;48(8):379-384.

Task shifting in HIV clinics, Western Kenya

BACKGROUND

United states Agency for International development-Academic Model for Providing Accesses to Healthcare (USAID-AMPATH) cares for over 80,000 HIV-infected patients. Express care (EC) model addresses challenges of: clinically stable patient's adherent to combined-antiretroviral-therapy with minimal need for clinician intervention and high risk patients newly initiated on cART with CD4 counts < or = 100 cells/mm3 with frequent need for clinician intervention.

OBJECTIVE

To improve patient outcomes without increasing clinic resources.

DESIGN

A descriptive study of a clinician supervised shared nurse model.

SETTING

USAID-AMPATH clinics, Western Kenya.

RESULTS

Four thousand eight hundred and twenty four patients were seen during the pilot period, 90.4% were eligible for EC of whom 34.6% were enrolled. Nurses performed all traditional roles and attended to two thirds and three quarters of stable and high risk patient visits respectively. Clinicians attended to one third and one quarter of stable and high risk patient visits respectively and all visits ineligible for express care.

CONCLUSION

The EC model is feasible. Task shifting allowed stable patients to receive visits with nurses, while clinicians had more time to concentrate on patients that were new as well as more acutely ill patients.

Metabolic profiles of dystrophin and utrophin expression in mouse models of Duchenne muscular dystrophy

Metabolic profiles from (1)H nuclear magnetic resonance spectroscopy have been used to describe both one and two protein systems in four mouse models related to Duchenne muscular dystrophy using the pattern recognition technique partial least squares. Robust statistical models were built for extracts and intact cardiac tissue, distinguishing mice according to expression of dystrophin. Using metabolic profiles of diaphragm, models were built describing dystrophin and utrophin, a dystrophin related protein, expression. Increased utrophin expression counteracted some of the deficits associated with dystrophic tissue. This suggests the method may be ideal for following treatment regimes such as gene therapy.

Abnormal lipid profile of dystrophic cardiac tissue as demonstrated by one- and two-dimensional magic-angle spinning (1)H NMR spectroscopy

Dystrophin, a protein associated with sarcolemma and cell membranes, is not expressed in sufferers of Duchenne muscular dystrophy (DMD), or in the mdx mouse. DMD is a fatal disorder, with a significant proportion of fatalities associated with cardiac failure ( approximately 40% having dilated cardiomyopathy and >90% clinically significant cardiac defects at death). In this study, the metabolic composition of intact dystrophic cardiac tissue was investigated using high-resolution magic-angle spinning (HRMAS) (1)H NMR spectroscopy with both 1- and 2D pulse sequences coupled with pattern recognition (PR). While conventional solvent presaturation spectra indicated increases in CH(2) chain length in lipids, PR analysis of correlation spectroscopy (COSY) spectra demonstrated that this was also accompanied by an increase in concentration of lactate or threonine along with a relative decrease in CH = CHCH(2)CO groups in these lipids. To investigate the physical environment of these lipids, T(2)- and diffusion-weighted (1)H MAS NMR spectra were acquired on whole-tissue samples. The relatively increased lipid signal intensity in dystrophic tissue was due to an increase in molecules with long T(2) and short diffusion rates. The use of a range of pulse programs allowed the direct probing of the biochemical environment in which the lipid infiltration occurred, and by coupling the experiments to PR the significance of lipid infiltration and accumulation was also assessed.

Metabolic Profiling of Genetic Disorders: A Multitissue 1H Nuclear Magnetic Resonance Spectroscopic and Pattern Recognition Study into Dystrophic Tissue

A principal problem in understanding the functional genomics of a pathology is the wide-reaching biochemical effects that occur when the expression of a given protein is altered. To complement the information available to bioinformatics through genomic and proteomic approaches, a novel method of providing metabolite profiles for a disease is suggested, using pattern recognition coupled with (1)H NMR spectroscopy. Using this technique the mdx mouse, a model of Duchenne muscular dystrophy (DMD) was examined. Dystrophic tissue had distinct metabolic profiles not only for cardiac and other muscle tissues, but also in the cerebral cortex and cerebellum, where the role of dystrophin is still controversial. These metabolic ratios were expressed crudely as biomarker ratios to demonstrate the effectiveness of the approach at separating dystrophic from control tissue (cardiac (taurine/creatine): mdx = 2.08 +/- 0.04, control 1.55 +/- 0.04, P < 0.005; cortex (phosphocholine/taurine): mdx = 1.28 +/- 0.12, control = 0.83 +/- 0.05, P < 0.01; cerebellum (glutamate/creatine): mdx = 0.49 +/- 0.03, control = 0.34 +/- 0.03, P < 0.01). This technique produced new metabolic biomarkers for following disease progression but also demonstrated that many metabolic pathways are perturbed in dystrophic tissue.

Antemortem diagnosis of human rabies

Human rabies is a rare but fatal disease. In the United States, the majority of people infected with rabies contract the disease by being bitten by a wild animal, most commonly bats. Because rabies is so rarely seen, it is often not diagnosed until after death, at which time exposed health care workers will require rabies prophylaxis. We describe a case for which the diagnosis was made before death. The prompt consideration of this diagnosis allowed early isolation of the patient and prevented unnecessary risk to health care workers.