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Journal of Digital Imaging Apr 2021Tasks which are scheduled at irregular intervals afford greater scheduling flexibility but are also more difficult to remember. Difficulty remembering clinical tasks not...
Tasks which are scheduled at irregular intervals afford greater scheduling flexibility but are also more difficult to remember. Difficulty remembering clinical tasks not only create potential inefficiencies in patient care but were also identified as a source of anxiety among our residents. We implemented RadRemind! an automated system of pager notifications in order to improve patient care and reduce residents' anxiety. RadRemind! utilizes only an external shared APACHE, MySQL, PHP server. A set of CRON jobs activate a PHP script which pulls information from our resident schedule as JSON data. It then identifies the appropriate residents to notify and then sends a cURL request to a web-based paging service to trigger notifications to residents' pagers. Each activation of the script was logged in an SQL database. An anonymous survey assessing multiple aspects of efficacy was sent to residents after 3 months of implementation. Seventeen of 29 residents responded to the survey. Residents reported a mean of 2 successful reminders (defined as responsibilities which had been otherwise forgotten prior to the page notification) in the last month which was found to be statistically significant via one-sample t test (t = 3.3, p < 0.01). Paired t test showed a statistically significant (t = 2.9, p = 0.01) decrease of 2 points in reported anxiety. Repeated measures analysis of variance found a statistically significant variation in reported utility (F(3,16) = 15.9, p < 0.01)) by type of reminder such that reminders for interventional radiology call were found to be more useful than reminders for other tasks. Use of an automated paging system is an effective method of reminding residents of irregularly scheduled responsibilities and is associated with reduced scheduling related anxiety.
Topics: Hospital Communication Systems; Humans; Internship and Residency; Patient Care; Radiography; Radiology
PubMed: 33742330
DOI: 10.1007/s10278-021-00437-2 -
Vaccines Feb 2021Varicella is a well-known infectious disease that can have severe complications, also in young children. The Universal Varicella Vaccination (UVV) program was...
Varicella is a well-known infectious disease that can have severe complications, also in young children. The Universal Varicella Vaccination (UVV) program was introduced in Tuscany (Italy) in 2003, with a two-dose vaccine schedule given to children between their 13th and 15th month, and at 5-6 years old, as a monovalent for varicella (V) or tetravalent (measles, mumps, rubella and varicella (MMRV)) formulation. Although varicella notifications have dramatically fallen in the last two decades, varicella disease underreporting remains a challenge. : A qualitative immunoenzymatic test (ELISA) was used to measure the presence of anti-varicella antibodies in 165 sera of subjects aged 1-18 years residing in the province of Florence (Italy). Information regarding the anamnestic and vaccination status (including disease notification) was also collected. Our study showed an overall varicella seropositivity of 75.8% (reaching the maximum at 96.3% in the 15-18 years age group). We found that varicella disease notification had been recorded for only 7/165 subjects; however, since 42/165 recalled having had the disease, we can hypothesize that some of them must have been underreported. Furthermore, our study showed that the presence of antibodies after the varicella vaccination remained over time, lasting up to 12 years. Although varicella seroprevalence is <95% in almost all our age groups (except for the 15-18 years age group), our data are encouraging and reflect the success of the introduction of the UVV program and the vaccination campaigns promoted in the Tuscany region.
PubMed: 33672915
DOI: 10.3390/vaccines9020152 -
European Heart Journal. Digital Health Mar 2021The 6-min-walk test (6MWT) is a validated proxy for frailty and a predictor of clinical outcomes, yet is not widely used due to implementation challenges. This...
AIMS
The 6-min-walk test (6MWT) is a validated proxy for frailty and a predictor of clinical outcomes, yet is not widely used due to implementation challenges. This comparative effectiveness study assesses the reliability and repeatability of a home-based 6MWT compared to in-clinic 6MWTs in patients with cardiovascular disease.
METHODS AND RESULTS
One hundred and ten (110) patients scheduled for cardiac or vascular surgery were enrolled during a study period from June 2018 to December 2019 at the Palo Alto VA Hospital. Subjects were provided with an Apple iPhone 7 and Apple Watch Series 3 loaded with the VascTrac research study application and performed a supervised in-clinic 6MWT during enrolment, at 2 weeks, 1, 3, and 6 months post-operatively. Subjects also received notifications to perform at-home smartphone-based 6MWTs once a week for a duration of 6 months. Test-retest reliability of in-clinic measurements and at-home measurements was assessed with an industry standard Cronbach's alpha reliability test. Test-retest reliability for in-clinic ground truth 6MWT steps vs. in-clinic iPhone 6MWT steps was 0·99, showing high reliability between the two tested measurements. When comparing for in-clinic ground truth 6MWT steps vs. neighbouring at-home iPhone 6MWT steps, reliability was 0·74.
CONCLUSION
Running the test-reliability test on both measurements shows that an iPhone 6MWT test is reliable compared to an in-clinic ground truth measurement in patients with cardiovascular disease.
PubMed: 36711173
DOI: 10.1093/ehjdh/ztab018 -
Behavior Research Methods Aug 2021Undertaking an experience-sampling study via smartphones is complex. Scheduling and sending mobile notifications often requires the use of proprietary software that...
Undertaking an experience-sampling study via smartphones is complex. Scheduling and sending mobile notifications often requires the use of proprietary software that imposes limits on participants' operating systems (whether iOS or Android) or the types of questions that can be asked via the application. We have developed an open-source platform-Samply-which overcomes these limitations. Researchers can access the entire interface via a browser, manage studies, schedule and send notifications linking to online surveys or experiments created in any Internet-based service or software, and monitor participants' responses-all without the coding skills usually needed to program a native mobile application. Participants can download the Samply Research mobile application for free from Google Play or the App Store, join a specific study, receive notifications and web links to surveys or experiments, and track their involvement. The mobile application leverages the power of the React Native JavaScript library, which allows it to be rendered in the native code of Android and iOS mobile operating systems. We describe Samply, provide a step-by-step example of conducting an experience-sampling study, and present the results of two validation studies. Study 1 demonstrates how we improved the website's usability for researchers. Study 2 validates the mobile application's data recording ability by analyzing a survey's participation rate. The application's possible limitations and how mobile device settings might affect its reliability are discussed.
Topics: Computers, Handheld; Humans; Internet; Mobile Applications; Reproducibility of Results; Smartphone
PubMed: 33528818
DOI: 10.3758/s13428-020-01527-9 -
PloS One 2020An MSK model of care for hip and knee patients integrated with an electronic referral solution (eReferral) has been deployed within four subregions across Ontario....
An MSK model of care for hip and knee patients integrated with an electronic referral solution (eReferral) has been deployed within four subregions across Ontario. Referrals are sent from primary care offices to a central intake (CI), where the referral forms are reviewed and forwarded, if appropriate, to a rapid access clinic (RAC) where patients are assessed by an advanced practice clinician (APC). The pragmatic design of eReferral allows for a seamless flow of electronic orthopedic referrals from primary care to CI. It also enables CI to process and transcribe faxed referrals into the eReferral system for a smooth flow of data electronically to the RACs. In general, wait time is the time interval between receiving the patient's referral at CI or the surgeon's office until receiving the orthopedic surgeon's first consultation. Wait time is further broken down into wait 1 a and wait 1 b. Wait 1 a is the time between the receipt of the referral at CI until the date of the first initial assessment at the RAC. This study aimed at: a) assessing the processing time of orthopedic referrals at central intakes (CI) to be forwarded to the RAC, b) assessing the wait time (wait 1 a) of orthopedic referrals processed through the eReferral system to receive an initial assessment at the RACs. c) comparing the ability of the RACs to meet the target wait time for assessment (four weeks) by the method of referral (eReferrals vs. fax). d) evaluating patients' satisfaction with the length of time they waited to receive care at the RACs with eReferral. We used Ocean eReferral database to access MSK hip and knee referral data processed through the system. Patients whose referrals were initiated electronically through the system and opted to receive email notification of their referral status had the opportunity to take an online satisfaction survey embedded in the booked appointment notification message. There were 1,723 patients initially referred electronically for hip, and knee pain consults, while 13,780 referrals started as paper-based and transcribed into the system to be forwarded later electronically by CI to a RAC. Higher mean processing time at CI by 21.76 days for paper-based referral was detected as opposed to referrals received electronically (p<0.001). RACs took significantly less time to book appointments for referrals initiated electronically with a shorter average wait 1a of 21.42 days for eReferrals compared to paper-based referrals (p<0.001). RACs timeframe to book an appointment was significantly shorter for eReferrals versus fax referrals. A total of 393 patients completed the patient satisfaction survey with a response rate of 16%. Overall, 87.7% were satisfied with their experience with the eReferral process, and 81% agreed that they had waited a reasonable time to receive the needed care. eReferral can elicit faster processing of referrals and shorter wait time for patients, which improved patient satisfaction with the referral process.
Topics: Adult; Aged; Aged, 80 and over; Electronic Data Processing; Electronic Health Records; Hip; Humans; Knee; Middle Aged; Musculoskeletal Diseases; Ontario; Orthopedic Procedures; Referral and Consultation; Waiting Lists
PubMed: 33141866
DOI: 10.1371/journal.pone.0241624 -
Clinical Orthopaedics and Related... Feb 2021During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can...
BACKGROUND
During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can maintain and even improve life-saving capabilities. Evaluating nonaccidental and accidental trauma can highlight potential areas of improvement in societal behavior and hospital preparedness. These critical questions were proposed to better understand how healthcare leaders might adjust surgeon and team coverage of trauma services as well as prepare from a system standpoint what resources will be needed during a pandemic or similar crisis to maintain services.
QUESTIONS/PURPOSES
(1) How did the total observed number of trauma activations, defined as patients who meet mechanism of injury requirements which trigger the notification and aggregation of the trauma team upon entering the emergency department, change during a pandemic and stay-at-home order? (2) How did the proportion of major mechanisms of traumatic injury change during this time period? (3) How did the proportion and absolute numbers of accidental versus nonaccidental traumatic injury in children and adults change during this time period?
METHODS
This was a retrospective study of trauma activations at a Level I trauma center in New Orleans, LA, USA, using trauma registry data of all patients presenting to the trauma center from 2017 to 2020. The number of trauma activations during a government mandated coronavirus 2019 (COVID-19) stay-at-home order (from March 20, 2020 to May 14, 2020) was compared with the expected number of activations for the same time period from 2017 to 2019, called "predicted period". The expected number (predicted period) was assumed based on the linear trend of trauma activations seen in the prior 3 years (2017 to 2019) for the same date range (March 20, 2020 to May 14, 2020). To define the total number of traumatic injuries, account for proportion changes, and evaluate fluctuation in accidental verses nonaccidental trauma, variables including type of traumatic injury (blunt, penetrating, and thermal), and mechanism of injury (gunshot wound, fall, knife wound, motor vehicle collision, assault, burns) were collected for each patient.
RESULTS
There were fewer total trauma activations during the stay-at-home period than during the predicted period (372 versus 532 [95% CI 77 to 122]; p = 0.016). The proportion of penetrating trauma among total activations was greater during the stay-at-home period than during the predicted period (35% [129 of 372] versus 26% [141 of 532]; p = 0.01), while the proportion of blunt trauma was lower during the stay-at-home period than during the predicted period (63 % [236 of 372] versus 71% [376 of 532]; p = 0.02). The proportion of gunshot wounds in relation to total activations was greater during the stay-at-home period than expected (26% [97 of 372] versus 18% [96 of 532]; p = 0.004). There were fewer motor vehicle collisions in relation to total activations during the stay-at-home period than expected (42% [156 of 372] versus 49% [263 of 532]; p = 0.03). Among total trauma activations, the stay-at-home period had a lower proportion of accidental injuries than the predicted period (55% [203 of 372] versus 61% [326 of 532]; p = 0.05), and there was a greater proportion of nonaccidental injuries than the predicted period (37% [137 of 372] versus 27% [143 of 532]; p < 0.001). In adults, the stay-at-home period had a greater proportion of nonaccidental injuries than the predicted period (38% [123 of 328] versus 26% [123 of 466]; p < 0.001). There was no difference between the stay-at-home period and predicted period in nonaccidental and accidental injuries among children.
CONCLUSION
Data from the trauma registry at our region's only Level I trauma center indicate that a stay-at-home order during the COVID-19 pandemic was associated with a 70% reduction in the number of traumatic injuries, and the types of injuries shifted from more accidental blunt trauma to more nonaccidental penetrating trauma. Non-accidental trauma, including gunshot wounds, increased during this period, which suggest community awareness, crisis de-escalation strategies, and programs need to be created to address violence in the community. Understanding these changes allows for adjustments in staffing schedules. Surgeons and trauma teams could allow for longer shifts between changeover, decreasing viral exposure because the volume of work would be lower. Understanding the shift in injury could also lead to a change in specialists covering call. With the often limited availability of orthopaedic trauma-trained surgeons who can perform life-saving pelvis and acetabular surgery, this data may be used to mitigate exposure of these surgeons during pandemic situations.
LEVEL OF EVIDENCE
Level III, therapeutic study.
Topics: Adolescent; Adult; Aged; COVID-19; Child; Child, Preschool; Cross-Sectional Studies; Emergency Service, Hospital; Female; Health Services Needs and Demand; Humans; Infant; Infant, Newborn; Infection Control; Male; Middle Aged; Needs Assessment; New Orleans; Registries; Retrospective Studies; Time Factors; Trauma Centers; Wounds and Injuries; Young Adult
PubMed: 32969846
DOI: 10.1097/CORR.0000000000001484 -
JMIR Pediatrics and Parenting Aug 2020Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth)...
Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic.
BACKGROUND
Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide.
OBJECTIVE
This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs.
METHODS
Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes.
RESULTS
All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding.
CONCLUSIONS
There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.
PubMed: 32821063
DOI: 10.2196/20312 -
Disability and Rehabilitation.... Apr 2022Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and...
BACKGROUND
Smartphone reminding applications can help overcome memory difficulties experienced by people with acquired brain injury (ABI). Cognitive difficulties with memory and attention make entering reminders into a device, and remembering to set reminders, challenging for this group. ApplTree is a reminding app with features that aim to address challenges. One app feature was push notifications (asking "Do you need to set any reminders?") to support people to initiate use of the app to set reminders. Another app feature was a customisable user interface design to support attention and short term memory during reminder setting.
METHODS
In a mixed-methods user study, five people with self or other reported memory impairment following ABI used ApplTree for at least 4 months. They received push notifications for at least 2 months and no push notifications for at least 2 months. Monthly participant interviews provided insight into user interface preference, app use, and push notification acceptability.
RESULTS
Receiving four Push notifications per day doubled number of daily reminders set and four of the five participants found receiving them to be acceptable. This long-term field study uncovered issues relevant for clinicians and designers, including insights into the potential benefits of different user interface designs, the impact of family members on app use, and the importance of perceived need influencing use and acceptance.
CONCLUSIONS
Feedback provided insight into future considerations when designing reminding apps and using them in neuropsychological rehabilitation. This work highlights the benefit of user-led research into accessible design and use of assistive technologies.IMPLICATIONS FOR REHABILITATION"Unsolicited" push prompts are an easy to implement feature of reminding technology that is useful and acceptable for people with ABI in community rehabilitation.Observations provide insights about how people with ABI make use of reminding apps over time. This can inform those designing apps or providing reminding technology as part of neuropsychological rehabilitation.Participants differed on their preference of the two user-interface designs available in ApplTree. This highlights an area for future research because currently available reminding apps have a broad-shallow design which may not always be appropriate for people with ABI.
Topics: Cognitive Dysfunction; Humans; Mobile Applications
PubMed: 32633592
DOI: 10.1080/17483107.2020.1785560 -
Human Vaccines & Immunotherapeutics Jan 2021The combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and b (DTPa-HBV-IPV/Hib, Infanrix Hexa, GSK) has been used for childhood...
The combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and b (DTPa-HBV-IPV/Hib, Infanrix Hexa, GSK) has been used for childhood immunization in Australia according to a two-, four-, six-month schedule since 2009. We reviewed data available in the Australian National Notifiable Diseases Surveillance System, annual vaccination coverage reports, the Database of Adverse Event Notifications, and peer-reviewed literature to assess vaccine coverage rates, incidence of all six vaccine preventable diseases, and the safety profile of DTPa-HBV-IPV/Hib vaccine in Australian infants over a period of ten years of exclusive use. Between 2009 and 2018 vaccine coverage for infants aged 12 months increased from 91.7% to 94.0% and from 84.9% to 92.6% for all and for Indigenous infants, respectively. Over the same time period, there were no reports of poliomyelitis, diphtheria or tetanus in infants <12 months of age. The incidence of hepatitis B among Australian infants <12 months of age remains 10 to 20-fold lower than the national average. Control of b (Hib) and pertussis disease has continued to be challenging. Timely administration of the primary series, as well as increasing coverage rates, particularly among Indigenous children, has contributed to improvements in Hib and pertussis disease control. The incorporation of additional strategies such as adjustment of the first vaccination encounter to six weeks of age, parental cocooning, and most recently maternal vaccination has further reduced the burden of pertussis, particularly during the first six months of life. The frequency of the ten most common adverse events related to the DTPa-HBV-IPV/Hib vaccine demonstrates an acceptable safety profile. Data collected over ten years of consistent, exclusive use of the DTPa-HBV-IPV/Hib vaccine in Australia highlights combination vaccination as a cornerstone in maintaining infant health.
Topics: Australia; Child; Diphtheria-Tetanus-Pertussis Vaccine; Haemophilus Vaccines; Haemophilus influenzae type b; Hepatitis B Vaccines; Hepatitis B virus; Humans; Immunization Schedule; Infant; Poliovirus Vaccine, Inactivated; Vaccine-Preventable Diseases; Vaccines, Combined
PubMed: 32573398
DOI: 10.1080/21645515.2020.1764826 -
BMC Public Health May 2020Globally only 79% of adults living with HIV (human immunodeficiency virus) know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach...
BACKGROUND
Globally only 79% of adults living with HIV (human immunodeficiency virus) know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples' perspectives.
METHODS
Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process.
RESULTS
Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) provided privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers.
CONCLUSIONS
The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men's access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services.
TRIAL REGISTRATION
Clinicaltrials.gov registry: NCT01784783. Registered prospectively on June 15, 2012.
Topics: Adult; Contact Tracing; Disclosure; Female; HIV Infections; Health Services Accessibility; Home Care Services; Humans; Kenya; Male; Mass Screening; Maternal Serum Screening Tests; Men; Motivation; Pregnancy; Pregnant Women; Qualitative Research; Serologic Tests; Sexual Partners; Young Adult
PubMed: 32429879
DOI: 10.1186/s12889-020-08878-0