Motivational Interviewing Impact on Cardiovascular Disease

abstract: Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014). If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems

A Jini-Based Solution for Electronic Prescriptions

In most countries today, handwritten, paper-based medical prescriptions are the norm.While efforts have been made in the past and are being made at present to migrate toward electronic dispensation of prescriptions, these have generally omitted to incorporate ubiquitous computing technology in their proposed solutions. In this paper, we focus on this issue and describe a Jini-based prototypical solution for electronic prescriptions, which allows for their wireless transmission to in-range pharmacies and the augmentation of the service levels rendered to the user, with, for instance, information about queue lengths and estimated waiting times being provided to the patients. Clinical and user evaluation revealed that there were high levels of agreement as regards the prototype’s effectiveness, ease of use, and usefulness

A Framework for the Design of a Mobile-Based Alert System for Outpatient Adherence in Nigeria

Nigeria ranks among the countries with the highest child and maternal mortality rate. Chronic diseases are the most common contributors to the diseases burden in Nigeria most especially Malaria, Tuberculosis (TB) and HIV/AIDS. Adherence to long-term therapy in out-patient condition is required to reduce and curb the prevalence of these diseases. Poor adherence to long-term therapies severely compromises the effectiveness of treatment; making this a critical issue in population health both from the perspective of quality of life and of health economics. This work introduces a m-technology based system that will provide an easy way of complying with drug regimen. It will make use of the Short Messaging Service (SMS) of mobile phones to provide reminders at dosing times. It will design architecture for mobile health interventions and develop a prototype SMS-based system to improve out-patient adherence. This system will be deployed over a period of time at selected hospitals and chronic disease management centers in selected states in Nigeria, and the adherence rates measured via health outcomes and evaluated. This would provide a significant positive return on investment through primary prevention (of risk factors) and secondary prevention of adverse health outcomes. It will also inform predictions of future population health outcomes predicted by treatment efficacy data. Keywords: out-patient, m-technology, adherence, chronic diseases, Nigeria, SM

Reducing Unlawful Prescription Drug Promotion: Is the Public Health Being Served by an Enforcement Approach that Focuses on Punishment?

Despite the imposition of increasingly substantial fines and recently successful efforts to impose individual liability on corporate executives under the Park doctrine, punishing pharmaceutical companies and their executives for unlawful promotional activities has not been as successful in achieving compliance with the Federal Food, Drug, and Cosmetic Act (FD&C Act) as the protection of the public health demands. Over the past decade, the Food and Drug Administration (FDA) and the Department of Justice (DOJ) have shifted their focus from correction and compliance to a more punitive model when it comes to allegedly unlawful promotion of pharmaceuticals. The shift initially focused on imposing monetary penalties and was arguably justified by the expectation that financial punishment would achieve a level of compliance that would reduce the need for correction. By exacting enormous fines from companies, the agencies presumably hoped that the costs associated with unlawful promotion would be too high to justify the monetary benefits of non-compliance. Unfortunately, however, that approach has not been entirely successful. Despite the growth in settlements and penalties, and the recent efforts to hold individual executives liable for corporate misbehavior, the intended impact of substantially increased compliance has only partially materialized. The upward spiraling of settlement amounts and the trend toward prosecuting repeat offenders indicate that a change in approach is necessary. This article argues that FDA and DOJ cannot justify a continued emphasis on punishment without more demonstrable improvement in compliance and corporate accountability. The article goes on to describe several proposals to refocus the agencies’ efforts to effectively address the impact of unlawful promotion on public health by returning to an approach that emphasizes the more traditional goals of correction and compliance. It also argues that any meaningful protection of the public health ultimately requires a broader public understanding of the issues surrounding unlawful promotion of pharmaceutical products and greater participation by patients; physicians; health care professionals; and others with an interest in, and the opportunity to, impact this area. Increasing the public’s ability and interest in monitoring companies’ promotional activities at every level will reinforce the benefits of compliance, which will better serve the public health goals of the FD&C Act

Discontinuously supervised aerobic training vs. physical activity promotion in the self-management of type 2 diabetes in older Italian patients: design and methods of the 'TRIPL-A' randomized controlled trial

Physical activity (PA) has health benefits for people with type 2 diabetes (T2D). Indeed, regular PA is considered an important part of any T2D management plan, yet most patients adopt a sedentary lifestyle. Exercise referral schemes (ERS) have the potential to effectively promote physical activity among T2D patients, and their effectiveness may be enhanced when they are supported by computer-based technologies. The 'TRIPL-A' study (i.e., a TRIal to promote PhysicaL Activity among patients in the young-old age affected by T2D) aims to assess if realizing an innovative ERS, based on a strong partnership among general practitioners, specialist physicians, exercise specialists, and patients, and supported by a web-based application (WBA), can effectively lead sedentary older T2D patients to adopt an active lifestyle

IT-based Patient Interventions for Opioid Abuse: Evaluation using Analytical Model

The number of people in the US with opioid abuse exceeds 2 million and the total cost is approximately $100B per year. In this study, we focus on patient-level interventions and present three IT-based interventions: (a) mobile reminders, (b) electronic monitoring, and (c) composite intervention. We have developed an analytical model for evaluating interventions using Return-on-Investment (ROI). The interventions are cost-effective for higher values of intervention effectiveness, hospital, and emergency room cost. However, with QoL improvement, cost-effectiveness improves significantly. We also explored the use of financial incentives for increasing the adoption of interventions. These results will help patients, healthcare professionals, decision-makers, and family members to choose the most suitable intervention to address opioid abuse

Recording of time-varying back-pain data: A wireless solution

Chronic back pain is a debilitating experience for a considerable proportion of the adult population, with a significant impact on countries’ economies and health systems. While there has been increasing anecdotal evidence to support the fact that for certain categories of patients (such as wheelchair users), the back pain experienced is dynamically varying with time, there is a relative scarcity of data to support and document this observation, with consequential impact upon such patients’ treatment and care. Part of the reason behind this state of affairs is the relative difficulty in gathering pain measurements at precisely defined moments in time. In this paper,we describe a wireless-enabled solution that collects both questionnaire and diagrammatic, visual-based data, via a pain drawing, which overcomes such limitations, enabling seamless data collection and its upload to a hospital server using existing wireless fidelity technology. Results show that it is generally perceived to be an easy-to-use and convenient solution to the challenges of anywhere/anytime data collection

Inhalation therapy in the next decade : Determinants of adherence to treatment in asthma and COPD

Peer reviewedPublisher PD

Effective Assessment of Power Standing Device to Adults with Permanent Lower Limb Paralysis

Introduction: Standing routine is a known beneficial daily activity for both healthy and disabled persons, especially those with permanent lower limb paralysis. However, the prescription of standing device for adults with permanent paralysis was inadequate and non-standard in existing local practice because of lack of good design and evidence based funding support. Objective: In view of the availability of new advances in power standing device, we aim to perform an effective health technology assessment (HTA) from professional and users perspectives to develop the decision pathway in prescription for long term home use. Methodology: A functional test and social cost analysis was performed on one high cost new standing mobile devices in recent market. A practical workshop and surveys were performed to collect feedback from 24 healthcare professionals and 8 expert users on a spectrum of new standing mobile device. Results: From the survey results, there was consensus among all participants that ‘Standing’ as daily routine at home is essential and beneficial. 62.5% of healthcare professionals would provide training to users and their cares to facilitate users to perform standing at home. Eight factors were identified from factor analysis in affecting the choice of standing devices for home use by healthcare professionals and users. Users scored high (mean=9.25/10) in “compliance with the new power standing mobile device”. The cost analysis showed considerable savings in social costs in using even the high-cost power standing mobile device. Discussion: The group welcomed power standing device with or without mobile function to support their standing activity at home. A possible clinical decision for prescribing different standing devices with identified factors was summarized. Conclusion: More recent researches have reported the negative health issues associated with prolonged sitting. With more innovative product designs, the power standing devices with or without mobile function is a new concept welcomed by both healthcare professionals and users in promotion of their health, preventing complications as well as independent living in home environment. A larger scale of HTA with structured cost-effectiveness analysis is essential to inform the healthcare resources planners