Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic

BackgroundThe uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic.MethodsWe conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases—containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model.ResultsThe mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21–40 years: (2.98 [1.04–8.55])}, no prior clinical consultation (2.10 [1.13–3.89]), adherence to employer's health policy (3.70 [1.79–7.67]), perceived non-severity of illness (2.50 [1.39–4.55]), being worried about contracting COVID-19 (2.29 [1.11–4.69]), and during the transition phase of the pandemic (2.29 [1.15–4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26–11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21–40 years: (3.61 [1.26–10.38]); 41–60 years: (4.49 [1.43–14.13])}, adherence to employer's health policy (2.94 [1.41–6.14]), being worried about contracting COVID-19 (2.95 [1.45– 5.99]), and during the transition (2.03 [1.02–4.06]) and mitigation (2.02 [1.03–3.97]) phases of the pandemic.ConclusionPatients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19

Smartphone apps for type 2 diabetes self-management and medication adherence : a multi-method study

Type 2 diabetes (T2D) is a growing public health problem for many countries. Smartphone apps are increasingly used to assist in T2D self-management due to their convenience, ubiquity, and emerging positive evidence. Currently, the rate of diabetes apps production far outpaces their adoption. There is a lack of evidence on the quality, utility, and clinical relevance of health apps and whether these apps meet the users’ needs. This dissertation investigated the quality and clinical relevance of apps for diabetes mellitus (DM) management through three sub-studies: (1) An assessment of the clinical relevance of DM self-management apps in ten languages of countries with the highest prevalence of diabetes; (2) a systematic assessment of the medication management features of apps for people with T2D against its (i) congruence with international diabetes and medication management guidelines, and (ii) the quality of health information disseminated; and (3) a pilot assessing the feasibility and impact of a smartphone app in improving medication adherence in people with T2D in Singapore. The global assessment of DM self-management apps showed that apps in English and Mandarin dominated the app market. Although highly downloaded apps had more clinically relevant app features, they still lacked important features for DM self-management, such as information provision, physical activity tracking, diet modification, medication management, and risk reduction strategies. Next, the systematic assessment of the medication management features of apps for people with T2D identified essential gaps in (i) app features for enhancing medication adherence and safety, such as the ability to enter medication-taking instructions, and (ii) variable adherence to the transparency and reliability of health information disseminated via these apps. Finally, the feasibility pilot showed that a smartphone app intervention for (self-reported) medication non-adherent T2D patients was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence. Access to high-quality diabetes apps is unequal across populations. Apart from English and Mandarin DM apps, those in other major languages lacked comprehensive features for self-management. Of concern is the paucity of medication management features in T2D apps elicited via the in-depth assessment. The assessment criteria from this research could be used as a checklist for app development and selection for usage to raise the standard of future DM apps. A good app should possess essential evidence-based features, safeguard data privacy and security, disseminate accurate and high-quality content, and be easy to use.Doctor of Philosoph

Cell behaviour under externally applied mechanical load

The cytoskeleton plays a very important role in upholding the mechanical integrity and controlling the movement of the cell. One technique to probe into the mechanical properties of the cell, which is influenced by the cytoskeleton, is to use micropipette aspiration as it allows us to measure the elasticity and observe the behaviour of the cell when it is subjected to external stimuli. In our study, micropipette aspiration was used to compare the mechanical properties between two types of inherently different breast cancer cell lines, MCF-7 and BT-474. BT-474 cells are perceived to be more aggressive than MCF-7 cells, as they tend to metastasize extensively to the other parts of the body and proliferate rapidly due to the over expression of HER-2 protein on the surface of its membrane. The rupture strength test showed that BT-474 cell membrane has more than twice the tendency to rupture as compared to MCF-7, which suggests that they (BT-474 cell membranes) are more rigid and vulnerable to shear stresses. This is linked to the over expression of HER-2 protein on the membrane surface and approximately half the strength that is needed to rupture MCF-7 cell membrane is required to rupture the BT-474 cell membrane. Data from the micropipette aspiration also showed a lower Young’s modulus for BT-474 cells, which implies that it has a softer and more elastic cell body as compared to MCF-7 cells. This might provide us with a clue to the higher metastasis rate of BT-474.Bachelor of Engineering (Chemical and Biomolecular Engineering

Medication management apps for diabetes: Systematic assessment of the transparency and reliability of health information dissemination

Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. Objective: This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. Methods: English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: Authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ≥100,000 downloads and <100,000 downloads). Results: A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer's email listed on the app store (Android: 75/81, 98%; and iOS: 52/62, 84%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88%; and low downloads: 33/64, 52%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82%; and low downloads: 32/64, 50%; P=.03) compared with apps with a low number of downloads. Conclusions: Gaps in the disclosure of the developer's qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps.</p

Determinants of the acceptance and adoption of a digital contact tracing tool during the COVID-19 pandemic in Singapore

The motivations that govern the adoption of digital contact tracing (DCT) tools are complex and not well understood. Hence, we assessed the factors influencing the acceptance and adoption of Singapore's national DCT tool - TraceTogether - during the COVID-19 pandemic. We surveyed 3943 visitors of Tan Tock Seng Hospital from July 2020 to February 2021 and stratified the analyses into three cohorts. Each cohort was stratified based on the time when significant policy interventions were introduced to increase the adoption of TraceTogether. Binary logistic regression was preceded by principal components analysis to reduce the Likert items. Respondents who 'perceived TraceTogether as useful and necessary' had higher likelihood of accepting it but those with 'Concerns about personal data collected by TraceTogether' had lower likelihood of accepting and adopting the tool. The injunctive and descriptive social norms were also positively associated with both the acceptance and adoption of the tool. Liberal individualism was mixed in the population and negatively associated with the acceptance and adoption of TraceTogether. Policy measures to increase the uptake of a national DCT bridged the digital divide and accelerated its adoption. However, good public communications are crucial to address the barriers of acceptance to improve voluntary uptake widespread adoption.Nanyang Technological UniversityPublished versionThis project is supported by the NISTH Seed Grant from the NTU Institute of Science and Technology for Humanity, Nanyang Technological University

Probe Sensor Using Nanostructured Multi-Walled Carbon Nanotube Yarn for Selective and Sensitive Detection of Dopamine

The demands for electrochemical sensor materials with high strength and durability in physiological conditions continue to grow and novel approaches are being enabled by the advent of new electromaterials and novel fabrication technologies. Herein, we demonstrate a probe-style electrochemical sensor using highly flexible and conductive multi-walled carbon nanotubes (MWNT) yarns. The MWNT yarn-based sensors can be fabricated onto micro Pt-wire with a controlled diameter varying from 100 to 300 µm, and then further modified with Nafion via a dip-coating approach. The fabricated micro-sized sensors were characterized by electron microscopy, Raman, FTIR, electrical, and electrochemical measurements. For the first time, the MWNT/Nafion yarn-based probe sensors have been assembled and assessed for high-performance dopamine sensing, showing a significant improvement in both sensitivity and selectivity in dopamine detection in presence of ascorbic acid and uric acid. It offers the potential to be further developed as implantable probe sensors

Psychosocial determinants of healthcare personnel's willingness to carry real-time locating system tags during daily inpatient care in hospital managing COVID-19 patients: insights from a mixed-methods analysis

Objective: Real-Time locating systems (RTLS) enable contact tracing and hand hygiene reminders, to improve hospital safety. Successful implementation requires healthcare personnel (HCP) to carry RTLS tags continuously. We assessed for determinants of HCP's willingness to use RTLS tags during routine inpatient care, and evaluated concerns using mixed-methods analysis. Materials and Methods: We conducted a cross-sectional study in the 330-bed purpose-built National Centre for Infectious Diseases in Singapore, from January 15 through February 4, 2020. The anonymous survey comprised 24 questions based on constructs from behavioral models and an open-ended question. Principal component analysis was performed to derive the latent factor structure applied in the multivariable logistic regression analysis. Concerns were analyzed using thematic analysis. Results: Of 260 HCP (nurses [40.8%], ancillary and administrative staff [23.1%], allied health professionals [18.5%], and physicians [17.7%]), 75% were willing to use the RTLS tag. After adjusting for age, gender, healthcare professional group, and duration of practice, the acceptance of the use of the RTLS tag (adjusted OR 11.28 [95% CI 4.39-29.00], P <. 001) was highly associated with the willingness to use the RTLS tag. HCP who perceived the tag to be easy to use (adjusted OR 2.80 [95% CI 1.37-5.72], P =. 005), were also more willing to use the tag. HCP were willing to carry the RTLS tag for the purpose of contact tracing despite privacy concerns. Conclusion: More communications on the intentions and data protection standards of the RTLS, and accessory enhancements for HCP's convenient and sustained use of the RTLS tag are crucial, to optimize RTLS's usefulness during the COVID-19 pandemic.Published versio

Reminders for medication adherence in Type 2 diabetes management apps

Medication adherence is important for glycaemic control. However, less than half of those with Type 2 diabetes take medications as prescribed. One of the known barriers to medication adherence is forgetfulness. Given the current ubiquity of smartphones, diabetes self-management apps represent a valuable avenue for providing medication reminders to help users adhere to their medication treatments and improve health outcomes. We assessed 181 diabetes management apps for the presence of medication reminder features and compared their characteristics with the evidence provided in studies showing the effectiveness of SMS reminders. We found that only 55.8% of the apps had a basic medication reminder function, although those that had them conformed to the characteristics of SMS reminders shown to be effective. This is an important missed opportunity for diabetes management apps to contribute not only to improving medication adherence, but also in having a positive effect on the health outcomes of this population.</p