Development of a telehealth monitoring service after colorectal surgery: a feasibility study

AIM: To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery, within an enhanced recovery protocol. METHODS: Florence (FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions, such as hypertension, using text-messaging. New algorithms were designed to monitor the well-being, basic physiological observations and any patient-reported symptoms, and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge. All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback. RESULTS: Over a four-week period, 16 out of 17 patients used the FLO telehealth service at home. These patients did not receive telephone follow-up at three days, as per our standard protocol, unless they reported being unwell or did not make use of the technology. Three patients were readmitted within 30 d, and two of these were identified as being unwell by FLO prior to readmission. No adverse events attributable to the use of the technology were encountered. CONCLUSION:The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible. The use of this technology may assist in the early recognition and management of complications after discharge

รูปแบบโมบายแอพพลิเคชั่นสำหรับผู้ป่วยสูงอายุโรคความดันโลหิตสูง เพื่อจัดการเกี่ยวกับการดูแลตนเอง Descriptive Model of a Self-care Mobile Application for Elderly Patients with Hypertension

วัตถุประสงค์: เพื่ออธิบายรูปแบบโมบายแอพพลิเคชั่นที่เหมาะสมสำหรับผู้ป่วยสูงอายุโรคความดันโลหิตสูงในการดูแลตนเองตามปัญหาด้านความรู้และพฤติกรรม จากมุมมองของผู้ป่วย บุคลากรทางการแพทย์ และผู้พัฒนาโมบายแอพพลิเคชั่น วิธีการศึกษา: การวิจัยเชิงคุณภาพใช้การสัมภาษณ์เชิงลึกแบบเห็นหน้ากันกับผู้ให้ข้อมูล 3 กลุ่มซึ่งเก็บข้อมูลในช่วง 1 เมษายน  – 31 ธันวาคม 2563 ผลการศึกษา: ผู้ให้ข้อมูลทั้งสิ้น 25 คน เป็นผู้ป่วยสูงอายุโรคความดันโลหิตสูง 14 คน บุคลากรทางการแพทย์ 7 คนและผู้พัฒนาโมบายแอพพลิเคชั่น 4 คน จากปัญหาด้านความรู้และพฤติกรรมที่พบ สามารถจัดตามมองค์ประกอบหลักดังนี้ 1) ด้านโครงสร้างหลักของเมนู ได้แก่ ความรู้เรื่องโรค การแปลผลค่าความดัน ความรู้เรื่องยา และการจัดการเกี่ยวกับยาที่ผู้ป่วยได้รับ การเตือนกินยา การเตือนวันนัด ช่องทางติดต่อโรงพยาบาล ข้อมูลผู้ป่วย พิกัดสถานพยาบาล ปุ่มกดเรียกรถพยาบาล และการวัดความเค็มของอาหาร 2) ด้านการออกแบบสื่อสาร สีที่สบายตา ตัวหนังสือขนาดใหญ่ ข้อความสั้นกระชับ มีเสียงหรือวีดิโอ และ 3) ด้านแรงจูงใจในการใช้งาน เน้นถึงประโยชน์ที่ผู้ป่วยจะได้รับ มีคำแนะนำของแพทย์ และไม่มีค่าใช้จ่าย สรุป: พบองค์ประกอบของรูปแบบโมบายแอพพลิเคชั่นที่จะช่วยให้การออกแบบเฉพาะเพื่อแก้ปัญหาที่ตรงกับความต้องการเกี่ยวกับความรู้และพฤติกรรมการดูแลตนเองของผู้ป่วย ตามเป้าหมายการดูแลผู้ป่วยตามแนวทางการรักษาโรคความดันโลหิตสูงในปัจจุบัน คำสำคัญ: การดูแลตนเอง, ผู้สูงอายุ, โรคความดันโลหิตสูง, โมบายแอพส์, ความต้องการของผู้ป่วย, การผสานมุมมอง, การออกแบบเฉพาะObjective: To create a descriptive model for a mobile phone application that addresses the knowledge problems and behavioral needs of elderly patients in self-care with hypertension with emerging viewpoints of patients, medical personnel and mobile application developers. Methods: This qualitative study used semi-structured, face-to-face, in-depth interviews with three groups of key informants. Data collection was conducted between 1 April and 31 December 2020. Results: A total of 25 key informants were 14 elderly patients, 7 medical personnel, and 4 mobile application developers. Three core components emerged from the informants. First, Main Menu Structures included knowledge about hypertension, blood pressure interpretation, medication management and daily reminder, doctor’s appointment reminder, hospital contact channels, patient information, hospital location, emergency call button, and measurement of sodium in food. Second, Design of Mobile Application included eye comfort colors, large text size, short and concise messages including voice or video. Third, Motivation to Use Mobile Application included benefits for the use, doctors’ suggestions, and free-of-charge use. Conclusion: Important components for designing application that addresses hypertensive patients’ knowledge and behavior on self-care based on the present hypertension management guideline were found. Keywords: self-care, mobile applications,elderly, hypertension, patient’s needs, merging viewpoints, custom-designe

Effectiveness and Feasibility of In-office versus Smartphone Text-delivered Nutrition Education in the College Setting: A Mixed-methods Pilot Study

Often, being away from home for the first time, coupled with limited knowledge regarding healthy eating behaviors, leads to poor food choices and an increased risk of obesity among college-aged young adults. These college students are prone to high-calorie diets and limited physical activity, putting them at risk for obesity, a physiologically, psychologically, and financially costly epidemic in the United States. College students use their cellular phones over eight and a half hours a day and cell phones are their primary means of information consumption outside of the classroom, suggesting that the phones would be a useful tool to provide nutrition education to this at-risk population. This mixed-methods randomized-controlled trial took place over eight weeks, between 9/15/15 and 12/2/15. The primary aims of this study were to assess the effectiveness and feasibility between an educational nutrition intervention delivered via smartphone texts and a traditional in-office setting for 18-22-year-old, overweight college students at the Sonoma State University Student Health Center. Using simple randomization, participants were assigned to one of two groups: text, or in-office. Participants in the in-office group received one-on-one nutrition counseling framed within the social cognitive theory by a registered nurse at the study onset, week two, and week four. Participants in the text group received the same information, broken up into weekly text messages with links to websites, YouTube, and explanations of content. Participant characteristics, including weight, height, and health behaviors (hours of sleep a night, number of fruits and vegetables per day), were assessed at the study onset (T1) and again at week two (T2), week four (T3), and week eight (T4). All participants were invited to take part in an in-depth, qualitative, face-to-face interview at the end of the study (T4). Nine participants completed both the trial and interviews. Two-thirds (66.7%, n=6) were in the text group, 66.7% (n=6) were female, 33.3% (n=3) were minorities, 66.7% lived on- campus, and 44.4% (n=4) took part in the university’s on-campus meal plan. No statistically significant differences were noted in participant characteristics, or health behaviors between the two groups throughout the study. Although no statistical significance was noted between the two groups with regard to weight change, the text group’s mean weight decreased from 188.25(sd=25.03) pounds to 184.58(sd=24.67) pounds while the in-office group’s mean weight increased from 254.00(sd=90.15) to 257.00(sd=94.14) pounds. Weight loss in the text group should be further evaluated as it may hold clinical significance for effectiveness of the intervention. Through qualitative interviews exploring participants’ experiences, four major themes emerged. All participants in the text group (n=6) stated that they felt there was a need for their method of education, they felt their method was effective, they would recommend their method, and their health behaviors changed positively. For the in-office group, all participants (n=3) said there was a need for their method of education, 67% (n=2) said it was effective, all would recommend it, and 67% stated that they changed their behaviors. Both the quantitative and qualitative findings of this study hold clinical significance as to the effectiveness and feasibility of text messages as a means of providing nutrition education in the college setting. Future research with larger sample sizes and a longer-term study are recommended for more statistical power and to determine the long-term benefits of these methods of nutrition education

MS

thesisThe objective of the study was to develop a computerized reminder system to ensure that preoperative deep vein thrombosis (DVT) prophylaxis (anticoagulation or compression devices) was provided for eligible patients. The study design was a prospective trial with historic controls. The setting was LDS Hospital in Salt Lake City, Utah, a tertiary care teaching center. The alternate hypothesis stated that a computerized reminder system would increase the rate of DVT prophylaxis in surgical patients. A local consensus was developed among surgeons as to which procedures should receive DVT prophylaxis. The historic rate of DVT prophylaxis was measured for these procedures at 83.8% (794 of 948 eligible cases). A computerized reminder system was implemented on the hospital's computer system, which flagged patients scheduled for a procedure for which DVT prophylaxis was indicated. The rate of DVT prophylaxis was then remeasured. For the 3 months after the introduction of the reminder, compliance with DVT prophylaxis rose to 99.3% (1118 out of 1126 eligible cases). Fourteen of 54 types of procedures showed statistically significant improvement in the rate of DVT prophylaxis between the study group and the historic controls. The procedures which did not show improvement had a small number of cases (n90%). When individual procedures were combined into groups of similar surgeries, 7 of 10 groups showed statistically significant improvement. Similarly, 3 of 4 surgical divisions showed statistically significant improvement. For all cases combined, the rate of DVT prophylaxis showed highly significant improvement (p<.001) between the historic controls (83.8%) and the study group (99.3%). The conclusion of the study was that a computerized reminder appeared to be an effective method of increasing the rate of DVT prophylaxis in surgical patient

An exploration of the strengths and weaknesses of using text messaging as a tool for self-report data collection in psychological research

Short Message Service (SMS) has immense potential for self-report data collection because it makes use of mobile phones that people already own, and allows researchers to communicate with participants regardless of physical location. Though interest in the possibilities of SMS as a tool for psychological research is slowly growing, to date, there has been no structured investigation of how this potential may be applied in psychological research. The research within this thesis examined the feasibility of using SMS as a tool for self-report psychological research, focussing on its strengths and weaknesses as a research mode. Across fifteen studies, this was investigated using a mixture of literature review, meta-analysis, surveys, and interviews. Participant samples varied from the broad (general population, university students) to specific (the elderly, the deaf). Strengths of SMS as a tool for self-report psychological research included growing interest in research community; positive perceptions of SMS as a research tool amongst potential sample; prompt responses and high response rate; suitability for frequent repeated sampling; and usefulness as a reminder prompt to support other modes of data collection. Weaknesses included a disconnect between stated willingness to participate and actual participation; response incompleteness; unsuitability for infrequent sampling; and some problems with psychometric equivalence in relation to other research modes like online or paper surveys. This was the first structured evaluation of SMS as a tool for self-report data collection in psychological research. Conclusions are limited by somewhat arbitrary design choices (such as the psychological topic within surveys) made in the absence of guiding background literature. Future research can refine these choices and use the logic presented here to guide further investigation into how SMS performs with more varied samples, different psychological topics, and as part of different research designs. This research has shown that while SMS has great potential as a tool for psychological self-report research, it has a number of weaknesses. Identifying these strengths and weaknesses, and some design choices which may mitigate the weaknesses, will open up possibilities for a wide range of future psychological research

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

BACKGROUND: Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child’s complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. METHODS: A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. RESULTS: 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. DISCUSSION: Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI

Managerial Intervention Strategies to Reduce Patient No-Show Rates

High patient no-show rates increase health care costs, decrease healthcare access, and reduce the clinical efficiency and productivity of health care facilities. The purpose of this exploratory qualitative single case study was to explore and analyze the managerial intervention strategies healthcare administrators use to reduce patient no-show rates. The targeted research population was active American College of Healthcare Executives (ACHE), Hawaii-Pacific Chapter healthcare administrative members with operational and supervisory experience addressing administrative patient no-show interventions. The conceptual framework was the theory of planned behavior. Semistructured interviews were conducted with 4 healthcare administrators, and appointment cancellation policy documents were reviewed. Interpretations of the data were subjected to member checking to ensure the trustworthiness of the findings. Based on the methodological triangulation of the data collected, 5 common themes emerged after the data analysis: reform appointment cancellation policies, use text message appointment reminders, improve patient accessibility, fill patient no-show slots immediately, and create organizational and administrative efficiencies. Sharing the findings of this study may help healthcare administrators to improve patient health care accessibility, organizational performance and the social well-being of their communities