The Role of Wearable Technologies and Telemonitoring in Managing Vascular Disease

Wearable devices and telemonitoring are becoming increasingly widespread in the clinical environment and have many applications in the tracking and maintenance of patient wellbeing. Interventions incorporating these technologies have been used with some success in patients with vascular disorders. Wearable fitness monitors and telemonitoring have been used in the community to mobilise patients with peripheral vascular disease with good results. Additionally, wearable monitors and telemonitoring have been studied for blood pressure monitoring in patients with hypertension. Telemonitoring interventions incorporating electronic medication trays and ingestible sensors have also been found to increase drug adherence in hypertensive patients and ultimately improve health outcomes. However, wearable and telemonitoring interventions often face problems with patient adherence, digital literacy and infrastructure. Further work needs to address these challenges and validate the technology before widespread implementation can occur

Sitting at the edge: How biomolecules use hydrophobicity to tune their interactions and function

Water near hydrophobic surfaces is like that at a liquid-vapor interface, where fluctuations in water density are substantially enhanced compared to that in bulk water. Here we use molecular simulations with specialized sampling techniques to show that water density fluctuations are similarly enhanced, even near hydrophobic surfaces of complex biomolecules, situating them at the edge of a dewetting transition. Consequently, water near these surfaces is sensitive to subtle changes in surface conformation, topology, and chemistry, any of which can tip the balance towards or away from the wet state, and thus significantly alter biomolecular interactions and function. Our work also resolves the long-standing puzzle of why some biological surfaces dewet and other seemingly similar surfaces do not.Comment: 12 pages, 4 figure

Evaluating the Impact of the National Health Service Digital Academy on Participants’ Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study

BackgroundThe key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership. ObjectiveThis study aims to examine the impact of the NHSDA program on participants’ perceptions of themselves as digital health leaders. MethodsWe recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals’ perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework. ResultsOf the 41 participants, 42% (17/41) were in clinical roles, 34% (14/41) were in program delivery or management roles, 20% (8/41) were in data science roles, and 5% (2/41) were in “other” roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants’ values and direction within the wider digital health community. According to the questionnaire, after graduation, 59% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46% (11/24) reporting that the course was a strong determinant of this change. ConclusionsA digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development

Perceptions and priorities of perioperative staff and the public for sustainable surgery: a validated questionnaire study

This project looked to examine the opinions of key stakeholders with respect the introduction sustainability initiatives into peri-operative care. It develope and validated a questionnaire which was sent out to peri-operative care staff and the publi

Investigating the national implementation of SMS and mobile messaging in population screening (The SIPS study)Research in context

Summary: Background: The increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake. Methods: Initial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed ‘core’ recommendations. Those reaching this threshold on importance only, were labelled ‘desirable’. All items were subsequently discussed at an expert meeting to confirm suitability. Findings: Of the initial 101 items, 23 reached consensus regarding importance and feasibility. These ‘core’ items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. ‘Core’ items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 ‘desirable’ items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification. Interpretation: These findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow. Funding: NIHR Imperial Patient Safety Translational Research Centre

Impact of the covid-19 pandemic on emergency adult surgical patients and surgical services : an international multi-center cohort study and department survey

Objectives: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. Background: High mortality rates were reported for surgical patients with COVID- 19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. Methods: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020. conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. Results: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3.6%, compared to 15.5% for those with COVID-19. However, only 14.1% received a COVID-19 test on admission in March, increasing to 76.5% by July. Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87). ASA grade above 2 (aOR 4.29), and COVID-19 infection (aOR 5.12) were independently associated with significantly increased IHM. The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4.34; April aOR 4.25; May aOR 3.97), compared to non-peak months. During the study, UK operating theatre capacity decreased by a mean of 63.6% with a concomitant 27.3% reduction in surgical staffing. Conclusion: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status. Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis