Examining Older Adults\u27 Perceptions of Usability and Acceptability of Remote Monitoring Systems to Manage Chronic Heart Failure

Objective: This study was conducted to evaluate the feasibility, usability, and acceptability of using remote monitoring systems (RMS) in monitoring health status (e.g., vital signs, symptom distress) in older adults (≥ 55) with chronic heart failure (HF). Method: Twenty-one patients (52.4% women, mean age 73.1 ± 9.3) were trained to measure and transmit health data with an RMS. Data transmissions were tracked for 12 weeks. Results: All participants initiated use of RMS within 1 week; 71%, 14%, and 14% of patients transmitted daily health data 100%, ≥ 75%, and \u3c 75% of the time, respectively, for 12 weeks. Overall usability and acceptability of the RMS were 4.08 ± 0.634 and 4.10 ± 0.563, respectively (when scored on a range of 1-5, where 1 = strongly disagree and 5 = strongly agree). Discussion: Findings show that an RMS-based intervention can be successfully implemented in a group of older patients with chronic HF

Computerized assessment of competence‐related abilities in living liver donors: the Adult‐to‐Adult Living Donor Liver Transplantation Cohort Study

Background Despite its importance, determination of competence to consent to organ donation varies widely based on local standards. We piloted a new tool to aid transplant centers in donor assessment. Methods We assessed competence‐related abilities among potential living liver donors ( LD s) in the nine‐center A2ALL study. Prospective LD s viewed an educational video and were queried to assess Understanding, Appreciation, Reasoning, and ability to express a Final Choice using the MacArthur Competence Assessment Tool for Clinical Research, adapted for computerized administration in LDs (“MacLiver”). Videotaped responses were scored by a clinical neuropsychologist ( JF ). Results Ninety‐three LD s were assessed. Mean (standard deviation; domain maximum) scores were as follows: Understanding: 18.1 (2.6; max = 22), Appreciation: 5.1 (1.0; max = 6), Reasoning: 3.1 (0.8; max = 4), and Final Choice: 3.8 (0.5; max = 4). Scores did not differ by demographics, relationship to the recipient, eligibility to donate, or eventual donation (p > 0.4). Higher education was associated with greater Understanding (p = 0.004) and Reasoning (p = 0.03). Conclusion Standardized, computerized education with independent ratings of responses may (1) alert the clinical staff to potential donors who may not be competent to donate and (2) highlight areas needing further assessment and education, leading to better informed decision making.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99637/1/ctr12184.pd

J Am Geriatr Soc

Background:Disparities in healthcare access and delivery caused by transportation and health workforce difficulties negatively impact individuals living in rural areas. These challenges are especially prominent in older adults.Design:We systematically evaluated the feasibility, acceptability and effectiveness in providing telemedicine searching the English-language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO).Participants:Older adults (mean age 6565 and none were less than 60 years)Interventions:Interventions consisted of live, synchronous, two-way video-conferencing communication in non-hospital settings. All medical interventions were included.Measurements:Quality assessment using the Cochrane Collaboration\u2019s Risk of Bias Tool was applied on all included articles, including a qualitative summary of all articles.Results:Of 6,616 citations, we reviewed the full text of 1,173 articles, excluding 1,047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]) with cohort sizes ranging from 3\u2013844 (median 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that telemedicine can improve health outcomes in older adults and that it could be used in this population.Conclusions:Telemedicine is feasible and acceptable in delivering care to older adults. Research should focus on well-designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using telemedicine in routine practice to overcome barriers of distance and access to care.NCATS UL1TR001086/AG/NIA NIH HHS/United StatesP30 CA023108/CA/NCI NIH HHS/United StatesUL1 TR001086/TR/NCATS NIH HHS/United StatesP30 DA029926/DA/NIDA NIH HHS/United StatesCDC U48DP005018/AG/NIA NIH HHS/United StatesU48DP005018/ACL/ACL HHS/United StatesK23AG051681/AG/NIA NIH HHS/United StatesK23 AG051681/AG/NIA NIH HHS/United StatesNCI P30CA023108-37/AG/NIA NIH HHS/United StatesNIDA P30DA029926/AG/NIA NIH HHS/United States2020-08-01T00:00:00Z31066916PMC66844098081vault:3367

Form And Function Glucometer Evaluation For Specialized Populations

Patient self-management technologies (glucometer, blood pressure monitor, etc.) are a critical component of chronic disease care. Although these technologies are intended to support patient activities, low device usability can produce design imped-iments that may negatively impact patient adherence and hence treatment outcomes. In particular, patients with disabilities, who are the majority of the chronic disease population, are typically excluded from medical device usability studies required for FDA approval. This study aims to develop a usability method to: 1) evaluate patient self-management technology and 2) inform design decision making for disabled pa-tients. The study will focus on handheld device use (glucometers) for diabetic patients with mobility and vision impairment. An initial expert usability analysis was per-formed for 13 glucometers to determine the design features that are most problematic for disabled users. The usability analysis informed the design of an experiment to test disabled user performance and satisfaction for several meter interaction tasks. Com-mon diabetes disabilities were simulated in healthy subjects through the use of glasses (retinopathy, glaucoma) and gloves (arthritis, neuropathy) to evaluate the experimental protocol prior to future testing in the actual disease population. Results suggested a preference of participants for large text, large protruding buttons, and contrast color between case and buttons to facilitate locating buttons. Future studies will integrate the disabled diabetic population in the data collection and integration of these results in the design of a new glucometer. This work can inform regulatory guidelines for usability testing with disabled patients and the patient-centric design practices of medical device manufacturers

The Empirical Evidence for the Telemedicine Intervention in Diabetes Management

Objective: The research presented here assesses the scientific evidence for the telemedicine intervention in the management of diabetes (telediabetes), gestational diabetes, and diabetic retinopathy. The impetus derives from the confluence of high prevalence of these diseases, increasing incidence, and rising costs, while telemedicine promises to ameliorate, if not prevent, type 2 diabetes and its complications. Materials and Methods: A purposeful review of the literature identified relevant publications from January 2005 to December 2013. These were culled to retain only credible research articles for detailed review and analysis. The search yielded approximately 17,000 articles with no date constraints. Of these, 770 appeared to be research articles within our time frame. A review of the abstracts yielded 73 articles that met the criteria for inclusion in the final analysis. Evidence is organized by research findings regarding feasibility/acceptance, intermediate outcomes (e.g., use of service, and screening compliance), and health outcomes (control of glycemic level, lipids, body weight, and physical activity.) Results: Definitions of telediabetes varied from study to study vis-à-vis diabetes subtype, setting, technology, staffing, duration, frequency, and target population. Outcome measures also varied. Despite these vagaries, sufficient evidence was obtained from a wide variety of research studies, consistently pointing to positive effects of telemonitoring and telescreening in terms of glycemic control, reduced body weight, and increased physical exercise. The major contributions point to telemedicine's potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated. Conclusions: Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140288/1/tmj.2015.0029.pd