Using Task Technology Fit Theory to Guide the Codesign of Mobile Clinical Decision Support Systems

A clinical decision support system (CDSS) is designed to assist health professionals in perioperative patient management. Robust CDSSs are vital to deliver enhanced healthcare services. Incorporating the latest advancements in digital technologies, mobile device based CDSSs are being introduced to healthcare settings at a considerable pace. However, given the nascency of this tech-health synergy, well-defined systematic approaches to be followed to design and develop mobile CDSSs to ensure developed technological solutions are of best fit-for-purpose, are lacking. To address this void, this study proposes an approach combining Task Technology Fit theory and Design Science Research Methodology, to guide the design and development of mobile CDSSs. The proposed approach is applied to a case study to design a mobile CDSS to assist perioperative optimization of surgery patients. The learnings from the case study are reported

The MDM2 antagonist idasanutlin in patients with polycythemia vera:results from a single-arm phase 2 study

Idasanutlin, an MDM2 antagonist, showed clinical activity and a rapid reduction in JAK2 V617F allele burden in patients with polycythemia vera (PV) in a phase 1 study. This open-label phase 2 study evaluated idasanutlin in patients with hydroxyurea (HU)-resistant/-intolerant PV, per the European LeukemiaNet criteria, and phlebotomy dependence; prior ruxolitinib exposure was permitted. Idasanutlin was administered once daily on days 1 through 5 of each 28-day cycle. The primary end point was composite response (hematocrit control and spleen volume reduction > 35%) in patients with splenomegaly and hematocrit control in patients without splenomegaly at week 32. Key secondary end points included safety, complete hematologic response (CHR), patient-reported outcomes, and molecular responses. All patients (n = 27) received idasanutlin; 16 had response assessment (week 32). Among responders with baseline splenomegaly (n = 13), 9 (69%) attained any spleen volume reduction, and 1 achieved composite response. Nine patients (56%) achieved hematocrit control, and 8 patients (50%) achieved CHR. Overall, 43% of evaluable patients (6/14) showed a ≥50% reduction in the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (week 32). Nausea (93%), diarrhea (78%), and vomiting (41%) were the most common adverse events, with grade ≥ 3 nausea or vomiting experienced by 3 patients (11%) and 1 patient (4%), respectively. Reduced JAK2 V617F allele burden occurred early (after 3 cycles), with a median reduction of 76%, and was associated with achieving CHR and hematocrit control. Overall, the idasanutlin dosing regimen showed clinical activity and rapidly reduced JAK2 allele burden in patients with HU-resistant/- intolerant PV but was associated with low-grade gastrointestinal toxicity, leading to poor long-term tolerability. This trial was registered at www.clinincaltrials.gov as #NCT03287245

Success Factors of a Perioperative Medication Mobile CDSS

Up to 20% of patients undergoing major surgery suffer complications (Chahal, et. al., 2020). Optimal perioperative management of patients are crucial to mitigate this risk. The following presents current progress of an exemplary case study, where a mobile Clinical Decision Support System (CDSS) for perioperative patient management in a leading Australian cancer hospital is codesigned (Peffers, et. al., 2007) through Academic and Industry collaboration. An existing mobile CDSS that was developed in 2013 has been utilized real-time in the clinic at a dedicated cancer hospital. The clinical impact since the implementation of this CDSS was assessed between 2013 and 2018 (Chahal, et. Al., 2020). The purpose of the redesign is to update the content and decision-making algorithms; integrate into existing electronic workflows; advance the CDSS to gain the approval of the Therapeutics Goods Administration (TGA) of Australia and commercialization. Between October 2020 and October 2021, multiple codesign cycles were carried out with the participation from health informatics and computer science specialists from an Australian university, and the clinical leads and end users of the current CDSS in the selected leading cancer hospital in the southern hemisphere. The codesign study is governed by the principles from Design Science Research Methodology (DSRM) (Peffers, et. al., 2007). The critical success factors of a mobile CDSS for perioperative management are discussed under the following themes: Perspectives of the clinician leads; perspectives of the end-user clinicians; and IoT and analytics capabilities desired by clinician leads. In addition, user satisfaction, fidelity and ease of use were gathered. This was mapped using a task technology fit perspective where fit was connected with ability to support decision making around blood clotting/bleeding in surgery. A brief demonstration of the mobile CDSS (i.e., the CLOTS App) is provided in the video (CLOTS App, 2022)

Prehabilitation prior to major cancer surgery: Training for surgery to optimize physiologic reserve to reduce postoperative complications

Purpose of Review The aging, sedentary global population and associated increasing incidence of cancer calls for increasingly complex surgery. These patients are at particular risk of postoperative complications. This review will explore the redesign of the perioperative care pathway, with emphasis on preoperative risk stratification to identify modifiable risk, to implement risk mitigation strategies (e.g., prehabilitation), and to partner with patients to enhance recovery after surgery. Recent Findings In the last decade, there has been a growing body of literature surrounding prehabilitation. A number of these studies report a staggering halving of postoperative complications. This body of literature requires perioperative medicine clinicians to appraise and build on the robustness of the data and to consider pragmatic strategies toward implementation of what appears to be a cost-effective intervention. Summary A redesign of perioperative care pathways with early risk stratification and implementing risk mitigation strategies is essential to delivering on the value proposition of healthcare. Challenges include a redesign of funding models to deliver such services, engaging patients with relatively remote access to such services, and the cultural trends of sedentary lifestyles and perceived urgency to have immediate surgery at all costs

Investigation of Intervention Solutions to Enhance Adherence to Oral Anticancer Medicines in Adults: Overview of Reviews

BackgroundAdherence to anticancer medicines is critical for the success of cancer treatments; however, nonadherence remains challenging, and there is limited evidence of interventions to improve adherence to medicines in patients with cancer. ObjectiveThis overview of reviews aimed to identify and summarize available reviews of interventions to improve adherence to oral anticancer medicines in adult cancer survivors. MethodsA comprehensive search of 7 electronic databases was conducted by 2 reviewers who independently conducted the study selection, quality assessment using the A Measurement Tool to Assess Systematic Reviews 2, and data extraction. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was adapted to report the results. ResultsA total of 29 reviews were included in the narrative synthesis. The overall quality of the systematic reviews was low. The 4 main strategies to promote adherence were focused on education, reminders, behavior and monitoring, and multicomponent approaches. Digital technology–based interventions were reported in most reviews (27/29, 93%). A few interventions applied theories (10/29, 34%), design frameworks (2/29, 7%), or engaged stakeholders (1/29, 3%) in the development processes. The effectiveness of interventions was inconsistent between and within reviews. However, interventions using multiple strategies to promote adherence were more likely to be effective than single-strategy interventions (12/29, 41% reviews). Unidirectional communication (7/29, 24% reviews) and technology alone (11/29, 38% reviews) were not sufficient to demonstrate improvement in adherence outcomes. Nurses and pharmacists played a critical role in promoting patient adherence to oral cancer therapies, especially with the support of digital technologies (7/29, 24% reviews). ConclusionsMulticomponent interventions are potentially effective in promoting patient adherence to oral anticancer medicines. The seamless integration of digital solutions with direct clinical contacts is likely to be effective in promoting adherence. Future research for developing comprehensive digital adherence interventions should be evidence-based, theory-based, and rigorously evaluated