Understanding workflow in telehealth video visits: Observations from the IDEATel project

AbstractHome telemedicine is an emerging healthcare paradigm that has the potential to transform the treatment of chronic illness. The purpose of this paper is to: (1) develop a theoretical and methodological framework for studying workflow in telemediated clinician–patient encounters drawing on a distributed cognition approach and (2) employ the framework in an in-depth analysis of workflow in the IDEATel project, a telemedicine program for older adults with diabetes. The methods employed in this research included (a) videotaped observations of 27 nurse–patient encounters and (b) semi-structured interviews with participants. The analyses were used to provide a descriptive analysis of video visits, understand the mediating role of different technologies and to characterize the ways in which artifacts and representations are used to understand the state of the patient. The study revealed barriers to productive use of telehealth technology as well as adaptations that circumvented such limitations. This research has design implications for: (a) improving the coordination of communication and (b) developing tools that better integrate and display information. Although home telemedicine programs will differ in important respects, there are invariant properties across such systems. Explicating these properties can serve as a needs requirement analysis to develop more effective systems and implementation plans

Functional evolution of IGF2:IGF2R domain 11 binding generates novel structural interactions and a specific IGF2 antagonist

Among the 15 extracellular domains of the mannose 6-phosphate/insulin-like growth factor-2 receptor (M6P/IGF2R), domain 11 has evolved a binding site for IGF2 to negatively regulate ligand bioavailability and mammalian growth. Despite the highly evolved structural loops of the IGF2:domain 11 binding site, affinity-enhancing AB loop mutations suggest that binding is modifiable. Here we examine the extent to which IGF2:domain 11 affinity, and its specificity over IGF1, can be enhanced, and we examine the structural basis of the mechanistic and functional consequences. Domain 11 binding loop mutants were selected by yeast surface display combined with high-resolution structure-based predictions, and validated by surface plasmon resonance. We discovered previously unidentified mutations in the ligand-interacting surface binding loops (AB, CD, FG, and HI). Five combined mutations increased rigidity of the AB loop, as confirmed by NMR. When added to three independently identified CD and FG loop mutations that reduced the koff value by twofold, these mutations resulted in an overall selective 100-fold improvement in affinity. The structural basis of the evolved affinity was improved shape complementarity established by interloop (AB-CD) and intraloop (FG-FG) side chain interactions. The high affinity of the combinatorial domain 11 Fc fusion proteins functioned as ligand-soluble antagonists or traps that depleted pathological IGF2 isoforms from serum and abrogated IGF2-dependent signaling in vivo. An evolved and reengineered high-specificity M6P/IGF2R domain 11 binding site for IGF2 may improve therapeutic targeting of the frequent IGF2 gain of function observed in human cancer

Schlafstörungen und deren Auswirkungen auf Betroffene - Die Integration von schlaffördernden Interventionen in die pflegerische Praxis

Einleitung: Schlaf stellt einen überlebensnotwendigen Vorgang im Körper dar, jedoch kann die Schlafqualität im Krankenhaus durch unterschiedliche Faktoren abnehmen. Der Einsatz von Hypnotika ist oft mit Nebenwirkungen verbunden, dadurch ist die nicht-medikamentöse Therapie im Krankenhaus sehr entscheidend. Ziel der Untersuchung: Ziel dieser Bachelorarbeit ist es, die Auswirkungen von Schlafstörungen bei geriatrischen Patienten/innen aufzuzeigen und die Unterstützungsmöglichkeiten durch Gesundheits- und Krankenpfleger/innen, in Hinblick einer guten Schlafqualität, darzustellen. Methodik: Die systematische Literaturrecherche, fand im Zeitraum von Dezember 2018 bis Juni 2019, in den Datenbanken Cinhal, PubMed und Livivo statt. Daraus wurden sechs relevante Studien verwendet und um die Aktualität dieser Arbeit zu gewährleisten, wurden nur Studien miteingeschlossen, die nach dem Jahr 2013 veröffentlicht wurden. Ergebnisse: Es zeigt sich eine Verbindung zwischen Schlafstörungen und depressiven Symptomen und dass Schlafstörungen, bei Personen mit der Diagnose Demenz, vermehrt auftreten. Des Weiteren wurden, bei Personen die an einer Schlafstörung leiden, eine subjektive Verschlechterung der Gedächtnisleistung und ein häufigeres Auftreten von Angststörungen sichtbar. Sicherheit und Vertrauen, durch ausführliche Gespräche mit den Patienten/innen gelten als erfolgreiche Maßnahmen, zur Förderung einer guten Schlafqualität im Krankenhaus. Der Einsatz von Hausmittel und die Musiktherapie in Kombination mit Sport, werden als wirksame Interventionen und als Ergänzung zur medikamentösen Therapie bestätigt. Schlussfolgerungen mit Implikationen für die Praxis: Die Interventionen führen zu einer verbesserten Schlafqualität bei Patienten/innen und stellen ergänzende Maßnahmen zur medikamentösen Therapie dar. Die Motivation von Gesundheits- und Krankenpflegern/innen, bei der Anwendung von diesen Maßnahmen in der Praxis ist, jedoch sehr niedrig.Introduction: Sleep is very important for ones well-being but also for many biological and psychological processes.The quality of sleep at hospital may decrease in order of different factors. The usage of hypnotics is often associated with a varied field of side effects.Therefore, alternative therapy is essential to promote satisfying quality. Aim of the study: Aim of this thesis is to show consequences of sleep disturbance of elderly people and possible nursing interventions to support good sleep at hospital. Methods: The systematic literacy research was executed in the period from December 2018 to June 2019. Data bases like Cinhal, PubMed and Livivo were consulted. To guarantee the currentness of data, only literature, not older than six years was included. For this thesis six current studies have been used. Results: People suffering of sleep disturbance often have depressive symptoms. Patients diagnosed dementia frequently show symptoms of sleeping disorders. Furthermore, people who are suffering from a sleep disorder have a subjective deterioration in memory and are more often affected by anxiety disorders. To promote a good quality of sleep it is important to create mutual trust, detailed conversations, patient education and a certain feeling of safety. The uses of proven house medicine and music therapy in combination with sports are also effective interventions to promote a good sleep. Conclusion: The interventions improve the quality of sleep during hospitalization and are alternative method to medical treatment. The motivation of nurses to use this intervention in practice is low

Postoperatives Delir - Präventivmaßnahmen durch Pflegepersonen

Einleitung: Eine Erhöhung des durchschnittlichen Alters der Weltbevölkerung ist zu erwarten. Ältere Patienten*innen haben ein erhöhtes Risiko ein Delir zu entwickeln, diese Komplikation gilt als die am häufigsten auftretende Komplikation bei Patienten*innen ab 70 Jahren, während eines Krankenhausaufenthaltes. Methodik: Die vorliegende Bachelorarbeit verfolgt das Ziel, die möglichen Auswirkungen von pflegerischen Präventivmaßnahmen bei geriatrischen Patienten*innen im Akutkrankenhaus mit einem postoperativen Delir darzustellen. Mittels einer systematischen Literaturrecherche, durchgeführt im Zeitraum Dezember 2019 bis März 2020 auf den ausgewählten Datenbanken PubMed, Cinhal und Livivo, fanden zwölf Studien für dieses Forschungswerk Relevanz. Der Publikationszeitraum der inkludierten Studien reichte von 2013 bis 2020. Ergebnisse: Es zeigt sich, dass eine präoperative Aufklärungseinheit zu keinem nachweisbaren Effekt, bezüglich der Entstehung eines postoperativen Delirs führt. Die Implementierung von speziellen Screening Instrumenten hilft, erfolgreich Patienten*innen mit einem erhöhten Risiko eines Delirs zu identifiziert. Als wirksame Interventionen zur Vorbeugung eines postoperativen Delirs, gelten die Frühmobilisation, sensorische Stimulation, nicht-medikamentöse Schlafförderung, sowie eine vermehrte Flüssigkeits- und Nahrungsaufnahme. Schlussfolgerung: Durch eine strategische Integrierung von nicht-medikamentösen Interventionen in den Pflegealltag, kann eine Reduktion von Patienten*innen mit einem Delir bis zu 50% erfolgen. Da es im deutschsprachigen Raum derzeit nur wenige Studien zu dieser Thematik gibt, besteht die Notwendigkeit für weitere pflegewissenschaftliche Untersuchungen.Introduction: An increase of average age within the world population is expected. Elderly patients have an increased risk of developing a delirium. This complication is considered to be the most common complication of patients over the age of 70 years during a stay at hospital. Methodology: Aim of this thesis is to present possible effects regarding nursing preventive measures of geriatric patients with a postoperative delirium in an acute care. The systematic literacy research was accomplished in the period from December 2019 to March 2020. Data bases like Cinhal, PubMed and Livivo were consulted. To guarantee the currentness of data literature, not older than seven years, was included. For this thesis twelve current studies have been consulted. Results: It turns out that a preoperative reconnaissance unit does not have any demonstrable effect with regards to the development of a postoperative delirium. The implementation of special screening tools helps to successfully identify patients with an increased risk of delirium. Effective interventions to prevent a postoperative delirium include early mobilization, sensory stimulation, non-drug sleep promotion and increased fluid and food intake. Conclusion: An integration of non-drug interventions into a nursing care can reduce the rate of patients with delirium up to 50%. There are currently only a few studies existing regarding this topic in German-speaking countries. There is a need for further nursing science examinations

Recombinant human thyrotropin stimulates thyroid function and radioactive iodine uptake in the rhesus monkey

The administration of bovine TSH to stimulate thyroid radioactive iodine uptake to detect functioning thyroid tissue in man after surgery for thyroid cancer is rarely, if ever, used, due to allergic reactions and/or the development of TSH antibodies. Human (h) TSH would be far less likely to induce allergic reactions or TSH antibodies. Recombinant hTSH (rec-hTSH) was produced by a line of Chinese hamster ovary cells that had been transfected with cDNA for the two subunit proteins that comprise hTSH. The present study was carried out to determine the half-life of rec-hTSH in the monkey and its ability to stimulate thyroid function. The half-life of rec-hTSH after iv administration was approximately 63 min for the rapid phase and 326 min for the slow phase. After three daily im injections of 2 U rec-hTSH to two monkeys, serum T4 concentrations increased several-fold, and serum T3 increased 2-3 times above basal values. The 6 and 20 h thyroid 123I uptakes doubled after rec-hTSH administration. These results demonstrate the biological efficacy of rec-hTSH administered to the monkey and strongly suggest that rec-hTSH will be effective in stimulating thyroid function in man

Performance characteristics of five immunoassays for SARS-CoV-2: a head-to-head benchmark comparison

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic in 2020. Testing is crucial for mitigating public health and economic effects. Serology is considered key to population-level surveillance and potentially individual-level risk assessment. However, immunoassay performance has not been compared on large, identical sample sets. We aimed to investigate the performance of four high-throughput commercial SARS-CoV-2 antibody immunoassays and a novel 384-well ELISA.We did a head-to-head assessment of SARS-CoV-2 IgG assay (Abbott, Chicago, IL, USA), LIAISON SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Saluggia, Italy), Elecsys Anti-SARS-CoV-2 assay (Roche, Basel, Switzerland), SARS-CoV-2 Total assay (Siemens, Munich, Germany), and a novel 384-well ELISA (the Oxford immunoassay). We derived sensitivity and specificity from 976 pre-pandemic blood samples (collected between Sept 4, 2014, and Oct 4, 2016) and 536 blood samples from patients with laboratory-confirmed SARS-CoV-2 infection, collected at least 20 days post symptom onset (collected between Feb 1, 2020, and May 31, 2020). Receiver operating characteristic (ROC) curves were used to assess assay thresholds.At the manufacturers' thresholds, for the Abbott assay sensitivity was 92·7% (95% CI 90·2–94·8) and specificity was 99·9% (99·4–100%); for the DiaSorin assay sensitivity was 96·2% (94·2–97·7) and specificity was 98·9% (98·0–99·4); for the Oxford immunoassay sensitivity was 99·1% (97·8–99·7) and specificity was 99·0% (98·1–99·5); for the Roche assay sensitivity was 97·2% (95·4–98·4) and specificity was 99·8% (99·3–100); and for the Siemens assay sensitivity was 98·1% (96·6–99·1) and specificity was 99·9% (99·4–100%). All assays achieved a sensitivity of at least 98% with thresholds optimised to achieve a specificity of at least 98% on samples taken 30 days or more post symptom onset.Four commercial, widely available assays and a scalable 384-well ELISA can be used for SARS-CoV-2 serological testing to achieve sensitivity and specificity of at least 98%. The Siemens assay and Oxford immunoassay achieved these metrics without further optimisation. This benchmark study in immunoassay assessment should enable refinements of testing strategies and the best use of serological testing resource to benefit individuals and population health.Public Health England and UK National Institute for Health Research