A Multilevel Investigation of Participation Within Virtual Health Communities

Virtual health communities are a major channel through which health consumers share health-related knowledge and/or exchange social support with their peers. These virtual environments can be a form of, or a potential component of, integrated Patient-centered e-Health (PCEH) applications, which represent emerging healthcare information systems that emphasize the role of patients and revolve around providing patient-focus, patient-activity, and patient-empowerment services. Because of the collaborative nature of virtual health communities, user participation is a critical factor for community growth and prosperity. In this study, we examine user participation at the individual and group (thread) levels. At the individual level, we investigate the impact of reciprocity and homophily (similarity of user characteristics such as age, gender, and tenure) on user participation within virtual health communities. At the thread level, we study the role of highly active users (power users) as thread initiators as well as the role of thread initiators’ participation on the overall thread vibrancy. To do so, we analyzed 2,176 threads initiated by 130 users and 1,947 messages exchanged between these users and their peers. Our results support short-term reciprocity, but refute the positive relationship associated with long-term reciprocity. Among homophily hypotheses, our results support gender homophily, but not age or tenure homophily. At the thread level our findings suggest that a discussion thread is vibrant if the thread initiator is a power user or participates actively within the thread. These findings have important implications for future research and practice in PCEH applications

Physiolytics at the workplace : Affordances and constraints of wearables use from an employee’s perspective

Wearables paired with data analytics and machine learning algorithms which measure physiological (and other) parameters are slowly finding their way into our workplace. Several studies have reported positive effects from using such “physiolytics” devices and purported the notion that it may lead to significant workplace safety improvements or to increased awareness among employees concerning unhealthy work practices and other job-related health and well-being issues. At the same time, physiolytics may cause an over-dependency on technology and create new constraints on privacy, individuality, and personal freedom. While it is easy to understand why organizations are implementing physiolytics, it remains unclear what employees think about using wearables at their workplace. Using an affordance theory lens, we, therefore, explore the mental models of employees who are faced with the introduction of physiolytics as part of corporate wellness or security programs. We identify five distinct user types each of which characterizes a specific viewpoint on physiolytics at the workplace: the freedom-loving, the individualist, the cynical, the tech-independent, and the balancer. Our findings allow for better understanding the wider implications and possible user responses to the introduction of wearable technologies in occupational settings and address the need for opening up the “user black box” in IS use research

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19: JACC State-of-the-Art Review

Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs. © 2021 American College of Cardiology Foundatio