2,199 research outputs found

    How will the Internet of Things enable Augmented Personalized Health?

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    Internet-of-Things (IoT) is profoundly redefining the way we create, consume, and share information. Health aficionados and citizens are increasingly using IoT technologies to track their sleep, food intake, activity, vital body signals, and other physiological observations. This is complemented by IoT systems that continuously collect health-related data from the environment and inside the living quarters. Together, these have created an opportunity for a new generation of healthcare solutions. However, interpreting data to understand an individual's health is challenging. It is usually necessary to look at that individual's clinical record and behavioral information, as well as social and environmental information affecting that individual. Interpreting how well a patient is doing also requires looking at his adherence to respective health objectives, application of relevant clinical knowledge and the desired outcomes. We resort to the vision of Augmented Personalized Healthcare (APH) to exploit the extensive variety of relevant data and medical knowledge using Artificial Intelligence (AI) techniques to extend and enhance human health to presents various stages of augmented health management strategies: self-monitoring, self-appraisal, self-management, intervention, and disease progress tracking and prediction. kHealth technology, a specific incarnation of APH, and its application to Asthma and other diseases are used to provide illustrations and discuss alternatives for technology-assisted health management. Several prominent efforts involving IoT and patient-generated health data (PGHD) with respect converting multimodal data into actionable information (big data to smart data) are also identified. Roles of three components in an evidence-based semantic perception approach- Contextualization, Abstraction, and Personalization are discussed

    Adherence to therapy enhanced by a pharmaceutical service: dose administration aids

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    The average life expectancy has been increasing due to aspects such as the advances in medicine and technology. An older population leads to the appearance of several chronic pathologies regarding polymedication, and the outcomes highly depend on patients’ adherence to treatment. This is one of the most determining factors in cure, stabilization, or regression of the disease. The purpose of this project is to highlight the principal failures in the patient journey, from medical appointment to the treatment itself, and to analyze the pharmacist’s role as an adherence promoter. In order to understand the gaps, interviews were made to the three main actors in the patient journey (physician, pharmacist, and patient). This study supports the implementation of a new service in a local community pharmacy of Abrantes. Throughout the interviews it was possible to infer the main adherence to therapy failures, such as the lack of cooperation between healthcare professionals, a non-existent patient-oriented follow-up, and a communication gap between the three main groups. This project also aimed to overcome the obstacles in the patient journey and to increase adherence to therapy by launching a medication management service for patients – Dose Administration Aids (DAA). Thus, to understand the service's feasibility, it was observed the implementation of DAA in a community pharmacy in Abrantes. Despite claiming some requirements, it was possible to conclude the service benefits both customers and pharmacy.A esperança média de vida da população tem vindo a aumentar devido a aspetos como o desenvolvimento tecnológico na medicina. Este envelhecimento da população conduziu ao aparecimento de diversas patologias crónicas às quais estão associadas a polimedicação. O tratamento só é eficaz se houver adesão à terapêutica, considerada um fator-chave para a cura, estabilização ou regressão de uma doença. O propósito deste projeto é destacar as principais falhas que ocorrem na jornada do doente, desde a consulta até à toma da medicação, avaliando também o papel do farmacêutico na promoção à adesão terapêutica. Para identificar as lacunas neste processo, foram realizadas entrevistas aos três principais grupos, com intervenção direta ou indireta na adesão à terapêutica por parte do doente. Este estudo serve de base à criação de um novo serviço numa farmácia de Abrantes. Ao longo das entrevistas aos três grupos já referidos, foi possível inferir as principais falhas na adesão à terapêutica, das quais se destacam a falta de cooperação entre os profissionais de saúde, a não existência de um acompanhamento personalizado ao doente e uma lacuna na comunicação entre os intervenientes. Não obstante, este projeto ambiciona colmatar estas falhas e aumentar a adesão à terapêutica, propondo um serviço farmacêutico que garante a gestão da medicação aos doentes – Preparação Individualizada da Medicação (PIM). De modo a perceber a sua viabilidade, foi observada a implementação do PIM numa farmácia comunitária em Abrantes, que permitiu concluir que apesar de reivindicar alguns requisitos, o serviço é vantajoso tanto para o cliente como para a farmácia

    Improving Clinicians’ Access to Patient Education and VA Resource Information

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    Abstract Problem: In a western US Veterans Administration (VA) hospital system, patient education materials are provider-specific, not standardized, and not located in a central, readily available location. Context: How does a patient education tool affect the clinicians\u27 delivery of health education in increasing health literacy compared to written information alone in the US veteran population? An integrated literature review was performed using Cochrane, Joanna Briggs Institute (JBI), Scopus, CINAHL, and PubMed databases to address the PICOT question above and determine the impact of patient education tools on health literacy and patient engagement. The literature recommended improving patient education for better health outcomes. Individualizing care is one of the most commonly used approaches. The patient education delivery should be standardized but still individualized, per the patient\u27s needs. The analysis of the integrated review of evidence uncovered promising results. Patients have the right to safe healthcare, but with this right comes the responsibility to educate themselves about their medical information. The change in providing health education in structured format could improve the patient’s understanding of the care they had in the hospital and their knowledge of the information they need to recover fully at home. Clinicians must have the proper training and knowledge to emphasize patient involvement throughout each step of patient education. Interventions: Clinicians frequently used electronic charting Computerized Patient Record System (CPRS) for entering patient-related orders and documentation. A linkage in CPRS to a web-based collaboration site, Microsoft SharePoint, was created to directly connect clinicians to the patient\u27s education and VA resource information. These collected patient education materials came from VA-approved patient education sites and expert clinicians. Due to the COVID 19 pandemic, some VA resources were halted and the resource information in SharePoint underwent several modifications with the corresponding program managers. Measures: The pre-and post-implementation surveys compared the timeliness and the degree of difficulty in aggregating the health-related information. Results: The creation of a SharePoint site improved clinicians\u27 timely and easy access to evidence-based, systemwide, and clinician-driven patient education and resource information across the care continuum. The level of difficulty in aggregating patient education decreased with the use of the SharePoint site. Clinicians say it is easier to find information on diagnoses, medication, and resources on the SharePoint site. Conclusions: The nursing implication in future research is warranted to determine the tangible impact of clinicians\u27 roles in providing patient education and resource information—which, as this project showed, often evolved into the ever-changing healthcare system. Future research should include defining the quality of how clinicians provide this health-related information and how patients benefit from the information

    The steps to therapeutic drug monitoring: A structured approach illustrated with imatinib

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    Pharmacometric methods have hugely benefited from progress in analytical and computer sciences during the past decades, and play nowadays a central role in the clinical development of new medicinal drugs. It is time that these methods translate into patient care through therapeutic drug monitoring (TDM), due to become a mainstay of precision medicine no less than genomic approaches to control variability in drug response and improve the efficacy and safety of treatments. In this review, we make the case for structuring TDM development along five generic questions: 1) Is the concerned drug a candidate to TDM? 2) What is the normal range for the drug's concentration? 3) What is the therapeutic target for the drug's concentration? 4) How to adjust the dosage of the drug to drive concentrations close to target? 5) Does evidence support the usefulness of TDM for this drug? We exemplify this approach through an overview of our development of the TDM of imatinib, the very first targeted anticancer agent. We express our position that a similar story shall apply to other drugs in this class, as well as to a wide range of treatments critical for the control of various life-threatening conditions. Despite hurdles that still jeopardize progress in TDM, there is no doubt that upcoming technological advances will shape and foster many innovative therapeutic monitoring methods

    Application of Mobile Health Services to Support Patient Self-Management of Chronic Conditions

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    Background: Chronic conditions are the leading cause of ill-health, disability and premature death, adding huge health and socioeconomic burden to the healthcare system. Although mobile health (mHealth) services have the potential to provide patients with a timely, ubiquitous, and cost-effective means to access healthcare services, to date, much remains to be revealed for their application in chronic condition management. Aim: This doctoral project aims to comprehensively understand the application of mHealth services to support patient self-management of chronic conditions. This aim is achieved through four objectives: (1) to synthesise research evidence about health outcomes of applying mHealth services to support patient self-management of chronic conditions and the essential components to achieve these outcomes, (2) to determine the mechanism for applying mHealth services to support patient self-management of chronic conditions, (3) to explore critical factors and how these factors influence patients\u27 intention to continuously use mHealth services, and (4) to apply the above findings to guide the design of a prototype mHealth service. Methods: To increase the generalisability of the findings, three chronic conditions that could benefit from mHealth services were purposively studied to address the research objectives within the feasibility of available study sites and resources at different stages of the project. First, two literature review studies were conducted to achieve Objective 1. One was a systematic review to investigate health outcomes of mHealth services to support patient self-management of one chronic condition, unhealthy alcohol use, and the essential components to achieve these outcomes. The other was a rapid review on using behavioural theory to guide the design of mHealth services that support patient self-management of another chronic condition, hypertension. Second, two field studies were conducted to achieve Objectives 2 and 3, respectively. One was an interview study that explored patients\u27 perceptions of a mHealth service to support their self-management of hypertension in China. The other was a questionnaire survey study conducted on the same site that explored critical factors influencing patients\u27 intention to continuously use the mHealth service. Third, a clinician-led, experience-based co-design approach was implemented to apply the above-mentioned learning experience to the development practice of a mHealth service that supports patient self-management of obesity before elective surgery in Australia, achieving Objective 4. Results: Literature reviews identify five structural components - context, theory, content, delivery mode, and implementation procedure - which are essential for mHealth services to achieve three health outcomes - behavioural, physiological, and cognitive outcomes. Inductive synthesis of the interview findings lead to a 6A framework that summarises the mechanisms for mHealth services: access, assessment, assistance, awareness, ability, and activation. Mobile health services provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. Questionnaire survey study finds that patients\u27 intention to continuously use mHealth services can be influenced by the information quality, system quality and service quality by influencing their perceived usefulness and satisfaction with the mHealth services. Guided by Social Cognitive Theory, the developed prototype mHealth service provide patients with functions of automatic push notifications, online resources, goal setting and monitoring, and interactive health-related exchanges that encourage their physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. The patients\u27 requirements in two focus group discussions enabled the research team to improve the mHealth service design. Conclusion: Mobile health services guided by behavioural theories can provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. The effort for designing mHealth services needs to be placed on crafting content (to improve information quality), developing useful functions and selecting a proper delivery mode (to improve system quality), and establishing effective implementation procedures (to improve service quality). These will ensure patients\u27 perceived usefulness and satisfaction with mHealth services, increase their intention to continuously use such services, thus supporting long-term patient self-management of chronic conditions. As demonstrated by the design case, the findings of this PhD project can be generalised to guide the design of other mHealth services that aim to support patient self-management of chronic conditions

    Improving Provider Knowledge on Surgical Site Infection Prevention Using a Surgical Surveillance Education Program

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    Background: Surgical site infections are a serious adverse outcome following any surgery. Despite the presence of international and standardized hospital guidelines, the prevention of surgical site infections remains a challenge for private practices and ambulatory centers. Currently, most ambulatory centers rely solely on provider reporting for their infection control reports and the education on prevention in these practices is minimal. It is critical that healthcare professionals have appropriate knowledge on surgical site infections, prevention methods and on their role in implementing evidence-based prevention strategies such as a surgical surveillance program. Purpose: The purpose of this quality improvement project (QIP) was to improve healthcare professionals’ knowledge on surgical surveillance and its potential impact on infection prevention in private and ambulatory settings. Methods/practice: The findings from the literature helped guide this QIP. A test was created to be used in the pre- and post-intervention phases. The test consisted of 4 demographic questions and 10 knowledge questions on current surgical infection prevention practices, surgical surveillance guidelines including telehealth follow ups, and 4 ungraded self-knowledge level questions. Ten participants completed the pre-test, and ten participants completed the educational session and post-test. A 30-minute evidenced-based educational session was conducted at a primary care clinic on indirect surgical surveillance and how it can be utilized in private practice to improve patient outcomes. Conclusion: The findings indicated that the participants lacked the appropriate education and information on what surgical surveillance entails and how it can be utilized in private settings. Findings from the post-test indicated that the educational session did increase the knowledge of the participants on surgical surveilling and how it can directly impact patient outcomes. Post-test scores improved 29% over pre-testing scores following the educational session. Implications for Practice: There is a lack of education and implementation of surgical surveillance guidelines in private practices across the country. Both educational leadership and management should implement the continuous and important education on how to properly utilize surgical surveillance to ensure the best and safest care is being provided to patients

    Implement exercise in the oncological setting

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    Over the past 20 years, the understanding of the role of physical activity in cancer has been increased. Traditionally, patients were advised to rest, recovery, and save energy during and after anticancer treatments. Nevertheless, it is now clear that physical activity may help alleviate some side effects caused by therapies and a sedentary lifestyle; consequently, cancer patients should be encouraged to perform exercise. Epidemiological evidence shows that post-diagnosis physical activity is associated with enhancing patients \u2018survival, especially in breast, colon, and prostate cancer. In cancer patients, exercise acts by improving health-related skills, particularly cardiorespiratory fitness, strength, and body composition. Moreover, several trials demonstrated that a regular exercise program effectively relieves some cancer and treatments \u2018side effects, such as fatigue, nausea, and vomiting, thereby improving patients\u2019 quality of life. The last update of the American College of Sports Medicine\u2019 guidelines recommends that patients perform 90 minutes per week of aerobic exercise at moderate intensity, with strength activities twice a week. Despite these important benefits, in Italy, the spread of exercise-oncology programs and the research in the exercise oncology field are still poor, negatively impacting patients and producing a gap in the literature. The purpose of this thesis is trying to fill this gap, increasing the available literature, and proposing an exercise program based on patients\u2019 needs and the current guidelines. Chapter one is dedicated to a brief introduction about physical activity in cancer. In chapters two, three, four, and five, the experimental studies that led to the development of patient-centred exercise program are presented. Chapters six and seven report two other studies investigating exercise as part of the multimodal approach in counteracting cancer cachexia. The last chapter is dedicated to a summary of the main thesis results

    Advancing Chronic Respiratory Disease Care with Real-Time Vital Sign Prediction

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    Cardiovascular and chronic respiratory diseases, being pervasive in nature, pose formidable challenges to the overall well-being of the global populace. With an alarming annual mortality rate of approximately 19 million individuals across the globe, these diseases have emerged as significant public health concerns warranting immediate attention and comprehensive understanding. The mitigation of this elevated mortality rate can be achieved through the application of cutting-edge technological innovations within the realm of medical science, which possess the capacity to enable the perpetual surveillance of various physiological indicators, including but not limited to blood pressure, cholesterol levels, and blood glucose concentrations. The forward-thinking implications of these pivotal physiological or vital sign parameters not only facilitate prompt intervention from medical professionals and carers, but also empower patients to effectively navigate their health status through the receipt of pertinent periodic notifications and guidance from healthcare practitioners. In this research endeavour, we present a novel framework that leverages the power of machine learning algorithms to forecast and categorise forthcoming values of pertinent physiological indicators in the context of cardiovascular and chronic respiratory ailments. Drawing upon prognostications of prospective values, the envisaged framework possesses the capacity to effectively categorise the health condition of individuals, thereby alerting both caretakers and medical professionals. In the present study, a machine-learning-driven prediction and classification framework has been employed, wherein a genuine dataset comprising vital signs has been utilised. In order to anticipate the forthcoming 1-3 minutes of vital sign values, a series of regression techniques, namely linear regression and polynomial regression of degrees 2, 3, and 4, have been subjected to rigorous examination and evaluation. In the realm of caregiving, a concise 60-second prognostication is employed to enable the expeditious provision of emergency medical aid. Additionally, a more comprehensive 3-minute prognostication of vital signs is utilised for the same purpose. The patient's overall health is evaluated based on the anticipated vital signs values through the utilisation of three machine learning classifiers, namely Support Vector Machine (SVM), Decision Tree and Random Forest. The findings of our study indicate that the implementation of a Decision Tree algorithm exhibits a high level of accuracy in accurately categorising a patient's health status by leveraging anomalous values of vital signs. This approach demonstrates its potential in facilitating prompt and effective medical interventions, thereby enhancing the overall quality of care provided to patients
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