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Human Vaccines & Immunotherapeutics Mar 2020In Hong Kong, universal varicella vaccination was introduced in July 2014 with a two-dose schedule but the vaccines had been available in the private market since 1996....
In Hong Kong, universal varicella vaccination was introduced in July 2014 with a two-dose schedule but the vaccines had been available in the private market since 1996. With data from varicella notification and surveys on immunization coverage, we used the screening method to estimate dose-specific varicella vaccine effectiveness (VE) among preschool children in Hong Kong before universal vaccination. We estimated the VE of one- and two-dose varicella vaccination against all notified varicella as 69.4% (95% confidence interval (95% CI) 69.5-71.2) and 93.4% (95% CI 91.7-94.7), respectively. We found that VE did not decrease with time since receipt. Varicella vaccine was more effective against complications (85.4% [95% CI 48.8-95.8] for one dose and 100% [95% CI -Inf to 100] for two doses) and against hospital admission (75.2% [95% CI 53.4-86.8] for one dose and 93.1% [95% CI 47.1-99.1] for two doses). Lower protection of one-dose varicella vaccine resulted in breakthrough varicella. Under universal vaccination, second-dose varicella vaccine (given as combined measles, mumps, rubella and varicella vaccine) was first scheduled for children when they reach primary one (about 6 years of age) and was recently advanced to 18 months of age. Shortening the interval between the first dose and second dose of varicella vaccination should reduce breakthrough varicella and outbreaks in preschool.
Topics: Chickenpox; Chickenpox Vaccine; Child, Preschool; Hong Kong; Humans; Immunization Schedule; Infant; Measles-Mumps-Rubella Vaccine; Mumps; Vaccination; Vaccines, Combined
PubMed: 31642729
DOI: 10.1080/21645515.2019.1663121 -
Online Journal of Public Health... 2019Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in...
INTRODUCTION
Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is forgetfulness of caretakers to show up in vaccination schedules. This necessitates developing an automated reminder system with integration of mobile technologies.
OBJECTIVES
This paper aimed to develop and test an automated mobile text message reminder system in the local context of Ethiopia.
METHODS
This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Requirement gathering was done before development of the system. Front end application was developed using java technologies while back end applications were developed with oracle database. Finally, pilot testing of the automated reminder system was done on 30 participants.
RESULTS
The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2. SMS application for automatic SMS text messaging. In the pilot testing, all the text messages (100%) were dispatched from the automated system to the respective participants. Finally, the system has shown a notification that the text messages have been sent successfully.
CONCLUSION
Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message based mHealth interventions should be carefully designed, developed, tested and refined before actual implementation.
PubMed: 31632609
DOI: 10.5210/ojphi.v11i2.10244 -
Israel Journal of Health Policy Research Jul 2019The phenomenon of a patient missing a medical appointment without notification is called a "no-show". In contrast, "non-utilized appointments" are a broader phenomenon...
BACKGROUND
The phenomenon of a patient missing a medical appointment without notification is called a "no-show". In contrast, "non-utilized appointments" are a broader phenomenon including all appointments that didn't occur as registered - whether due to actions taken by providers or patients. Both no-shows and non-utilized appointments can lead to reduced quality of care, loss in productivity, financial losses and impaired patient outcomes.
METHODS
The study was carried out between August 2016 and January 2017 in the ENT, Orthopedics and General Surgery Departments of the Jerusalem-based Shaare Zedek Medical Center. The study team sought to examine the reasons for non-utilized appointments in elective operations. The study team also interviewed no-show ambulatory care patients regarding the causes of the no-show and reviewed medical records of no-show patients to determine the nature of the missed appointments.
RESULTS
The rate of non-utilization of appointments for elective operations was 6%. The leading reasons for non-utilization of these appointments were: patient health issues, patient surgery postponement and surgery schedule overload (together accounting for 52% of cases and 72% of known reasons). The no-show rate for ambulatory clinic appointments was approximately 15%. The leading reasons for ambulatory clinic no-shows were: administrative issues, illness and forgetfulness (together accounting for 58% of all reasons). The leading types of appointments missed were:post-operation follow-ups and chronic illness follow-up (together accounting for 46% of cases and 63% of known reasons).
CONCLUSIONS
In this study, the non-utilized appointment rate for elective operations was found to be lower than those noted in the medical literature, while the no-show rate for ambulatory visits was found to be similar to that found in the literature. There is room to question the necessity of certain types of postoperative follow-up appointments since they are at "high risk" for no-show. One promising way to reduce the no-show rate would involve improving the hospital's information and computing systems in order to identify patients who are susceptible to a no-show incident.
Topics: Ambulatory Care Facilities; Appointments and Schedules; Efficiency, Organizational; Elective Surgical Procedures; Hospital Departments; Humans; Israel; No-Show Patients; Surveys and Questionnaires; Tertiary Care Centers
PubMed: 31358060
DOI: 10.1186/s13584-019-0333-5 -
BMC Health Services Research Jul 2019Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used...
BACKGROUND
Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used to investigate the impact of pneumococcal-specific best-practice alerts (BPAs) with and without workflow redesign compared to health maintenance notifications only, on pneumococcal vaccination rates in at-risk and high-risk adults, and on series completion in immunocompetent adults aged 65+ years.
METHODS
This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis.
RESULTS
In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) (P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19-64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19-64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention).
CONCLUSIONS
A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19-64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates.
Topics: Adult; Aged; Cross-Sectional Studies; Electronic Health Records; Female; Health Services Research; Humans; Immunization Schedule; Male; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Practice Guidelines as Topic; Primary Health Care; Reminder Systems; Retrospective Studies; Risk Assessment; Vaccination; Young Adult
PubMed: 31291959
DOI: 10.1186/s12913-019-4263-2 -
JMIR Perioperative Medicine Jul 2019Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile...
BACKGROUND
Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child's pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting.
OBJECTIVE
The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents' satisfaction.
METHODS
Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child's pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user's adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app's ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round.
RESULTS
Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts.
CONCLUSIONS
It is feasible for parents or guardians to use Panda at home to manage their child's medication schedule and track their pain. Simple modifications to the app's alert sounds and user interface improved response times.
PubMed: 33393928
DOI: 10.2196/12305 -
Journal of Medical Internet Research Jun 2019Restroom cleanliness is an important factor in hospital quality. Due to its dynamic process, it can be difficult to detect the presence of dirty restrooms that need to...
BACKGROUND
Restroom cleanliness is an important factor in hospital quality. Due to its dynamic process, it can be difficult to detect the presence of dirty restrooms that need to be cleaned. Using an Internet of Things (IoT) button can permit users to designate restrooms that need cleaning and in turn, allow prompt response from housekeeping to maintain real-time restroom cleanliness.
OBJECTIVE
This study aimed to describe the deployment of an IoT button-based notification system to measure hospital restroom cleanliness reporting system usage and qualitative feedback from housekeeping staff on IoT button use.
METHODS
We deployed IoT buttons in 16 hospital restrooms. Over an 8-month period, housekeeping staff received real-time notifications and responded to button presses for restroom cleaning. All button presses were recorded. We reported average button usage by hospital area, time of day, and day of week. We also conducted interviews with housekeeping supervisors and staff to understand their acceptance of and experience with the system.
RESULTS
Over 8 months, 1920 requests to clean restrooms in the main hospital lobby and satellite buildings were received. The hospital lobby IoT buttons received over half (N=1055, 55%) of requests for cleaning. Most requests occurred in afternoon hours from 3 PM to midnight. Requests for cleaning remained stable throughout the work week with fewer requests occurring over weekends. IoT button use was sustained throughout the study period. Interviews with housekeeping supervisors and staff demonstrated acceptance of the IoT buttons; actual use was centered around asynchronous communication between supervisors and staff in response to requests to clean restrooms.
CONCLUSIONS
An IoT button system is a feasible method to generate on-demand request for restroom cleaning that is easy to deploy and that users will consistently engage with. Data from this system have the potential to enable responsive scheduling for restroom service and anticipate periods of high restroom utilization in a hospital.
Topics: Hospitals; Humans; Internet of Things; Toilet Facilities
PubMed: 31219046
DOI: 10.2196/13588 -
International Journal of Cardiology.... Sep 2019Device interrogation and management are time consuming, representing a relevant burden for pacing centers. In several situations, patients' management requires... (Review)
Review
Device interrogation and management are time consuming, representing a relevant burden for pacing centers. In several situations, patients' management requires additional follow up visits. Remote Monitoring (RM) allows an optimal recall management and a rapid diagnosis of device or lead failure, without the need of additional in office visits. Further it allows a significant delay reduction between the adverse event and the reaction to the alarm, shortening the time needed to make a clinical decision. A role in risk-predicting patient-related outcomes has also been shown. RM permits detection of the arrhythmia from 1 to 5 months in advance compared to in-office visits. Importantly, by using specific algorithms with multiparametric analysis, RM has been studied as a potential instrument to identify early patients on risk of worsening HF using specific algorithms. Although the use of RM in HF setting remains controversial, it has been proposed to improve HF clinical outcomes and survival in clinical trials. In this sense, RM success could require a standardization of process within a management model, that may involve different health care professionals. In this review, we examine recent advances of RM providing an update of this tool through different clinical scenarios.
PubMed: 31193998
DOI: 10.1016/j.ijcha.2019.100380 -
International Journal of Therapeutic... Jun 2019Pain during labor is one of the worst pains experienced by women. If the woman cannot adapt to it, it may lead to uncoordinated uterine contractions causing a...
BACKGROUND
Pain during labor is one of the worst pains experienced by women. If the woman cannot adapt to it, it may lead to uncoordinated uterine contractions causing a long-complicated labor with the possibility of death of the mother and baby.
PURPOSE
The aim of the study is to observe the effect of massage treatment using frangipani aromatherapy oil to reduce the childbirth pain intensity.
SETTING
Pembantu Dauh Puri Health Center Denpasar, Bali, Indonesia.
PARTICIPANTS
Pregnant women in labor.
RESEARCH DESIGN
A quasi-experimental research design was used with pretreatment and posttreatment groups and a control. The respondents were 70 pregnant women in labor in Pembantu Dauh Puri Health Center Denpasar, Bali, Indonesia. Data were collected during scheduled observation and were analyzed using the Mann-Whitney statistical test.
INTERVENTION
The participants in the treatment group were massaged with frangipani aromatherapy oil by rubbing and pressing the hand palms to the back region at thoracic vertebrae 10, 11, 12 and lumbar 1 levels. The women in the control group were massaged with virgin coconut oil in the same manner as that done to the treatment group.
MAIN OUTCOME MEASURE
This study aimed to investigate the potential of frangipani aromatherapy oil to be used as maternity care in helping pregnant women become more comfortable in the process of normal birthing, based on modified midwife examination form, which contain Numeric Rating Score (NRS), and interviews with the participants to measure the pain intensity.
RESULT
Before the massage treatment, most of the respondents experienced severe pain. While receiving massage without aromatherapy, respondents mostly still experienced severe pain. However, after a massage treatment using frangipani oil aromatherapy, most respondents experienced reduced pain. There was a statistically significant effect of massage treatment using frangipani aromatherapy oil on the childbirth pain intensity ( < .001).
CONCLUSION
In this study, massage treatment using frangipani oil aromatherapy decreased the childbirth pain intensity.
PubMed: 31191785
DOI: No ID Found -
BMC Public Health May 2019Thermal fogging of Insecticides is a vector control strategy used by the Medellin Secretary of Health to combat dengue. This method is employed during outbreaks to curb... (Observational Study)
Observational Study
BACKGROUND
Thermal fogging of Insecticides is a vector control strategy used by the Medellin Secretary of Health to combat dengue. This method is employed during outbreaks to curb populations of potentially infectious adult mosquitoes and interrupt transmission cycles. While this strategy has been used in Medellin since 2007, in some years it has not reduced dengue cases as expected. Difficulties in the implementation of fumigation strategies, such as lack of opportunity for treatment and public perception may be factors that limit its utility. The objective of this study was to identify barriers that hinder the implementation of thermal fogging, as well as attitudes and beliefs that prevent its acceptance.
METHODS
We used a cross-sectional observational study of mixed methods carried out in neighborhoods prioritized for fumigation treatment in Medellin, Colombia. First, we assessed the timeliness of treatment by determining the latency period between reported dengue cases and the implementation of fumigation in response to those cases. Next, we administered structured questionnaires to residents in the area of fumigation treatments (n = 4455 homes) to quantify acceptance and rejection, as well as factors associated with rejection.
RESULTS
The median time between notification and treatment was 25 days (IQR 20.0-36.5). Fumigators were only able to treat 53.7% of total households scheduled for treatment; 9.6% rejected treatment, and treatment teams were unable to fumigate the remaining 36.7% of homes due to absent residents, no adults being present, and other reasons. The most frequent causes for rejection were residents being busy at the time of treatment (33.1%) and no interest in the treatment (24.5%). Other reasons for rejection include the perceptions that fumigation does not control pests other than mosquitoes (4.3%), that no mosquitoes were present in the home (3.3%), and that fumigation affects human health (3.1%).
CONCLUSIONS
The high percentage of houses where it was not possible to perform fumigation limits control of the vector. Future strategies should consider more flexible treatment schedules and incorporate informational messages to educate residents about the safety and importance of treatment.
Topics: Adult; Colombia; Cross-Sectional Studies; Dengue; Family Characteristics; Female; Fumigation; Health Knowledge, Attitudes, Practice; Humans; Insecticides; Male; Middle Aged; Mosquito Control; Mosquito Vectors; Residence Characteristics; Surveys and Questionnaires
PubMed: 31146722
DOI: 10.1186/s12889-019-7029-1 -
JAMA Cardiology Jul 2019Physician behavior in response to knowledge of a patient's CYP2C19 clopidogrel metabolizer status is unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Physician behavior in response to knowledge of a patient's CYP2C19 clopidogrel metabolizer status is unknown.
OBJECTIVE
To investigate the association of mandatory reporting of CYP2C19 pharmacogenomic testing, provided to investigators with no direct recommendations on how to use these results, with changes in P2Y12 inhibitor use, particularly clopidogrel, in the Randomized Trial to Compare the Safety of Rivaroxaban vs Aspirin in Addition to Either Clopidogrel or Ticagrelor in Acute Coronary Syndrome (GEMINI-ACS-1) clinical trial.
DESIGN, SETTING, AND PARTICIPANTS
The GEMINI-ACS-1 trial compared rivaroxaban, 2.5 mg twice daily, with aspirin, 100 mg daily, plus open-label clopidogrel or ticagrelor (provided), in patients with recent acute coronary syndromes (ACS). The trial included 371 clinical centers in 21 countries and 3037 patients with ACS. Data were analyzed between May 2017 and February 2019.
INTERVENTIONS
Investigators were required to prestipulate their planned response to CYP2C19 metabolizer status. In response to a regulatory mandate, results for all patients were reported to investigators approximately 1 week after randomization.
MAIN OUTCOMES AND MEASURES
Reasons for switching P2Y12 inhibitors and occurrence of bleeding and ischemic events were collected.
RESULTS
Of 3037 patients enrolled (mean [SD] age, 62.8 [9.0] years; 2275 men [74.9%], and 2824 white race/ethnicity [93.0%]), investigators initially treated 1704 (56.1%) with ticagrelor and 1333 (43.9%) with clopidogrel. Investigators prestipulated that they would use CYP2C19 metabolizer status to change P2Y12 inhibitor in 48.5% of genotyped clopidogrel-treated patients (n = 642 of 1324) and 5.5% of genotyped ticagrelor-treated patients (n = 93 of 1692). P2Y12 inhibitor switching for any reason occurred in 197 patients and was more common in patients treated with ticagrelor (146 of 1704 [8.6%]) compared with clopidogrel (51 of 1333 [3.8%]). Of patients initially treated with ticagrelor, only 1 (0.1% overall; 0.7% of all who switched) was switched based on CYP2C19 status. Of patients initially treated with clopidogrel, 23 (1.7% overall,;45.1% of all who switched) were switched owing to metabolizer status. Of 48 patients (3.6%) with reduced metabolizer status treated initially with clopidogrel, 15 (31.3%) were switched based on metabolizer status, including 48.1% (13 of 27) in which switching was prestipulated.
CONCLUSIONS AND RELEVANCE
Physicians were evenly split on how to respond to knowledge of CYP2C19 metabolizer status in clopidogrel-treated patients. Mandatory provision of this information rarely prompted P2Y12 inhibitor switching overall, including a minority of patients with reduced metabolizer status. These findings highlight the clinical equipoise among physicians regarding use of this information and the reluctance to use information from routine genotyping in the absence of definitive clinical trial data demonstrating the efficacy of this approach.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02293395.
Topics: Acute Coronary Syndrome; Aspirin; Clopidogrel; Cytochrome P-450 CYP2C19; Drug Administration Schedule; Drug Substitution; Drug Therapy, Combination; Hemorrhage; Humans; Ischemia; Platelet Aggregation Inhibitors; Purinergic P2Y Receptor Antagonists; Rivaroxaban; Ticagrelor
PubMed: 31141104
DOI: 10.1001/jamacardio.2019.1510