eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Medication-related cognitive artifacts used by older adults with heart failure

OBJECTIVE: To use a human factors perspective to examine how older adult patients with heart failure use cognitive artifacts for medication management. METHODS: We performed a secondary analysis of data collected from 30 patients and 14 informal caregivers enrolled in a larger study of heart failure self-care. Data included photographs, observation notes, interviews, video recordings, medical record data, and surveys. These data were analyzed using an iterative content analysis. RESULTS: Findings revealed that medication management was complex, inseparable from other patient activities, distributed across people, time, and place, and complicated by knowledge gaps. We identified fifteen types of cognitive artifacts including medical devices, pillboxes, medication lists, and electronic personal health records used for: 1) measurement/evaluation; 2) tracking/communication; 3) organization/administration; and 4) information/sensemaking. These artifacts were characterized by fit and misfit with the patient's sociotechnical system and demonstrated both advantages and disadvantages. We found that patients often modified or "finished the design" of existing artifacts and relied on "assemblages" of artifacts, routines, and actors to accomplish their self-care goals. CONCLUSIONS: Cognitive artifacts are useful but sometimes are poorly designed or are not used optimally. If appropriately designed for usability and acceptance, paper-based and computer-based information technologies can improve medication management for individuals living with chronic illness. These technologies can be designed for use by patients, caregivers, and clinicians; should support collaboration and communication between these individuals; can be coupled with home-based and wearable sensor technology; and must fit their users' needs, limitations, abilities, tasks, routines, and contexts of use

Collaboration between Librarians and Learning Technologists to enhance the learning of health sciences students.

Collaboration between Librarians and Learning Technologists at Bournemouth University (BU) has been stimulated and cemented by Pathfinder funding from the Higher Education Academy. This paper will consider four case studies collected as part of the eRes Project that describe the use of Web 2.0 technologies in the School of Health and Social Care at BU. The project aimed to enhance the student learning experience in an increasingly electronic environment. This was achieved by developing and disseminating innovative pedagogical frameworks, bringing together learning activities and academically led quality e-resources within the unit of study. An e-reading strategy which encompasses models for resource discovery and e-literacy was developed, drawing on the experiences and findings of the case studies. Issues considered in this paper will include accessing academic electronic reading materials and using a social bookmarking tool integrated within BU’s virtual learning environment with students studying away from the main campus. Additionally the paper will consider how technology can be used to motivate students, especially in large groups and how it can be used to engage students with a subject perceived as “dry” or “difficult”. The rich possibilities of health science materials can be exploited more fully using new technologies embedded within the curriculum

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Bringing Anglo-governmentality into public management scholarship : the case of evidence-based medicine in UK health care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science–based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely “Anglo-governmentality.” Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of “post hierarchical” UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power–knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the “subjectification” of local governing agents, herein analyzed using Foucauldian concepts of the “technology of the self” and “pastoral power”; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid “grey sciences,” which include clinical elements and energetic self-directed clinical–managerial hybrids as local governing agents. These findings suggest that the State and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations

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Activity Theory Analysis of Heart Failure Self-Care

The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems

The Effectiveness of Tablet-based Application for Older Adults with Diabetes Mellitus Type II: A Pilot Study

Introduction: Advances in technological applications such as tablet-based computers is growing dramatically in the field of healthcare, as there is a considerable eagerness for mobile health interventions. Tablet-based interventions can have positive effects on both health and health service delivery processes (Free et al, 2013). Technological applications have been developed for a wide range of healthcare needs, including patient registration, data management, and self- management applications. Background: The usefulness of technology and the powerful capabilities of technological applications have led to a significantly increased interest in finding novel approaches to support older adults’ self-management.Self-management technological applications have been used in various contexts, and usability is key in sustainability and adoption of such technologies. Theoretical Framework: The study will be guided by the self-management model of Maintaining the Balance (Jacelon, 2010). Design: Quasi-experimental design. Methods: Quantitative standardized measures will be used in this study. A purposive sample of 24 elderly patients with DMII will be recruited for the study. The descriptive and inferential analysis will be used to analyze the quantitative data. Results: This is an ongoing project, and the study is currently in the recruitment and data collection phase.The final patient is expected to be enrolled by the end of March 2017. We hope to recruit approximately 24 patients to the study. Analyses will focus on usability attributes (effectiveness, efficacy, errors/simplicity, and overall satisfaction), perceived diabetes self-management and blood glucose level are the main outcomes. Conclusion: A well-designed application with new features has the ability to provide more promising results regarding improving the quality of life, supporting informed decision making, improving communication with care providers, promoting active collaboration with care teams, encouraging self-care behaviors, problem-solving, improving health status, and improving clinical outcomes