International practice patterns and factors associated with non-conventional hemodialysis utilization

<p>Abstract</p> <p>Background</p> <p>The purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use.</p> <p>Methods</p> <p>An international cohort of subscribers of a nephrology education website <url>http://www.nephrologynow.com</url> was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence.</p> <p>Results</p> <p>544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes.</p> <p>Conclusion</p> <p>Physician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.</p

How effective is a hospital at home service for people with acute mental illness?

Objective: Hospital at home (HAH) services have been developed to replace traditional inpatient care but there is little recent published data about their efficacy. This study evaluates HAH treatment for people with an acute episode of psychiatric illness who would otherwise have been admitted to hospital. Method: The staffing and operation of the service is described, along with admission criteria. Patients could be visited by the HAH team up to three times a day, 7 days a week. Data were collected for 1 year. Demographic data, diagnoses, referral, discharge pathways, and outcomes are presented. Results: One hundred and eleven people were admitted to HAH. The most common diagnoses were mood disorders and non-affective psychoses. The mean length of stay was 17 days with an average of 22 home visits to each patient. Twenty percent of patients were transferred to inpatient services. For those who completed their treatment with HAH, symptom improvement and length of stay were comparable to inpatient services. There was only one adverse event, an episode of self harm. Conclusions: HAH services can provide a safe, effective alternative to inpatient care for suitable patients. Home treatment has the potential to reduce costs, reduce the pressure on inpatient services and provide care that is acceptable to patients and their families.Rajan Singh, Jacky Rowan, Cassandra Burton and Cherrie Galletl

The world of micro-surgery

Hundreds of diabetes self-management apps are available for smart phones, typically using a diary or logging methodology. This paper investigates how well such approaches help participants to make sense of collected data. We found that, while such systems typically support data and trend review, they are ill suited to helping users understand complex correlations in the data. The cognitively demanding user interfaces (UI’s) of these apps are poorly adapted both to the restricted real estate of smartphone displays and to the daily needs of users. Many participants expressed the desire for intelligent, personalized and contextually aware near-term advice. By contrast, users did not see tools for reflection on prior data and behavior, seen as indispensable by many researchers, as a priority. We argue that while designers of future mobile health (mHealth) systems need to take advantage of automation through connected sensors, and the increasing subtlety of intelligent processing, it is also necessary to evolve current graphs and dashboards UI paradigms to assist users in long-term self-management health practices

Gamification in Crowdsourcing Applications

In recent years, new forms of game and game technologies have emerged in the fields of industry and academia research. In particular, it is evident the growth of seri- ous and pervasive games. In this context, a new trend, called \u201cgamification\u201d has reached and won many sectors, including the business and the marketing domains (Seaborn and Fels, 2015). Such a new trend essentially uses game design and elements with the aim of improving users\u2019 experience and increasing users\u2019 involvement in services and applications which are not games (Deterding et al. 2011). Its goal is explicitly different from the merely users\u2019 entertainment. It is worth noting that gamification is not a new issue, but it can go back to market- ing activities and techniques (i.e. points cards and rewards memberships), usually ex- ploited to engage clients, by creating or enforcing loyalty in a product or in a brand (Zichermann and Linder, 2010). Current technologies, together with the widespread and massive use of social media and mobile devices can be identified as joining causes which are facilitating the diffusion and adoption of gamification techniques in so many and different contexts (Seaborn and Fels, 2015). The first successful example of gamified service has been Foursquare. Starting from such an experience, other several gamified applications were born, exploiting game elements together with interactive design and digital marketing issues (Zichermann and Linder, 2010). At the same time, gamification has been recognized as a key issue to support and incentive massive collaboration from and among users (McGonigal, 2011). The goal of this work is to define Gamification, by summarizing game design ele- ments which characterize it, and by describing how such elements can be exploited in crowdsourcing systems, improving crowd\u2019s experience and involvement. The remainder of the work is organized as follows. The \u201cGamification\u201d section de- scribes the introduction of the term, the game elements which characterize it and pla y- ers\u2019 motivations. The section entitled \u201cGamification in crowdsourcing systems and social media\u201d presents some examples of crowdsourcing applications which benefit from the use of gamification. Finally \u201cConclusion\u201d closes the paper