Participatory eHealth development to support nurses in antimicrobial stewardship

Background Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses’ can be supported in ASPs by means of an eHealth intervention that targets their information needs. Methods We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital. Results To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application’s functionality, content, and structure to nurse work practice and tasks. Conclusions By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses’) and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspective

Structure model index does not measure rods and plates in trabecular bone

Structure model index (SMI) is widely used to measure rods and plates in trabecular bone. It exploits the change in surface curvature that occurs as a structure varies from spherical (SMI = 4), to cylindrical (SMI = 3) to planar (SMI = 0). The most important assumption underlying SMI is that the entire bone surface is convex and that the curvature differential is positive at all points on the surface. The intricate connections within the trabecular continuum suggest that a high proportion of the surface could be concave, violating the assumption of convexity and producing regions of negative differential. We implemented SMI in the BoneJ plugin and included the ability to measure the amounts of surface that increased or decreased in area after surface mesh dilation, and the ability to visualize concave and convex regions. We measured SMI and its positive (SMI+) and negative (SMI-) components, bone volume fraction (BV/TV), the fraction of the surface that is concave (CF), and mean ellipsoid factor (EF) in trabecular bone using 38 X-ray microtomography (XMT) images from a rat ovariectomy model of sex steroid rescue of bone loss, and 169 XMT images from a broad selection of 87 species' femora (mammals, birds, and a crocodile). We simulated bone resorption by eroding an image of elephant trabeculae and recording SMI and BV/TV at each erosion step. Up to 70%, and rarely less than 20%, of the trabecular surface is concave (CF 0.155 – 0.700). SMI is unavoidably influenced by aberrations from SMI-, which is strongly correlated with BV/TV and CF. The plate-to-rod transition in bone loss is an erroneous observation resulting from SMI's close and artefactual relationship with BV/TV. SMI cannot discern between the distinctive trabecular geometries typical of mammalian and avian bone, whereas EF clearly detects birds' more plate-like trabeculae. EF is free from confounding relationships with BV/TV and CF. SMI results reported in the literature should be treated with suspicion. We propose that EF should be used instead of SMI for measurements of rods and plates in trabecular bone

The prevalence rates of refractive errors among children, adolescents, and adults in Germany

Sandra Jobke1, Erich Kasten2, Christian Vorwerk31Institute of Medical Psychology, 3Department of Ophthalmology, Otto-von Guericke-University of Magdeburg, Magdeburg, Germany; 2Institute of Medical Psychology, University Hospital Schleswig-Holstein, Luebeck, GermanyPurpose: The prevalence rates of myopia vary between 5% in Australian Aborigines to 84% in Hong Kong and Taiwan, 30% in Norwegian adults, and 49.5% in Swedish schoolchildren. The aim of this study was to determine the prevalence of refractive errors in German children, adolescents, and adults.Methods: The parents (aged 24–65 years) and their children (516 subjects aged 2–35 years) were asked to fill out a questionnaire about their refractive error and spectacle use. Emmetropia was defined as refractive status between +0.25D and –0.25D. Myopia was characterized as ≤−0.5D and hyperopia as ≥+0.5D. All information concerning refractive error were controlled by asking their opticians.Results: The prevalence rates of myopia differed significantly between all investigated age groups: it was 0% in children aged 2–6 years, 5.5% in children aged 7–11 years, 21.0% in adolescents (aged 12–17 years) and 41.3% in adults aged 18–35 years (Pearson’s Chi-square, p = 0.000). Furthermore, 9.8% of children aged 2–6 years were hyperopic, 6.4% of children aged 7–11 years, 3.7% of adolescents, and 2.9% of adults (p = 0.380). The prevalence of myopia in females (23.6%) was significantly higher than in males (14.6%, p = 0.018). The difference between the self-reported and the refractive error reported by their opticians was very small and was not significant (p = 0.850).Conclusion: In Germany, the prevalence of myopia seems to be somewhat lower than in Asia and Europe. There are few comparable studies concerning the prevalence rates of hyperopia.Keywords: Germany, hyperopia, incidence, myopia, prevalenc

Tailoring eHealth design to support the self-care needs of patients with cardiovascular diseases:a vignette survey experiment

Self-care support is a key cornerstone of treatment for patients with a cardiovascular disease. The success of any supportive intervention requires adaptation to the distinct needs of individuals. This requirement also applies to eHealth interventions. This study investigates how experts from multiple fields of science assess the potential success of different eHealth design strategies when matched to key self-care needs. An online vignette survey experiment was conducted. Nine vignettes representing different combinations of self-care needs (maintenance, monitoring, management) and eHealth persuasive design strategies (primary task support, dialogue support, social support) were evaluated. In total, 118 experts from 18 different countries participated in the survey. Their evaluations show primary task support as a promising design strategy across all self-care needs. In contrast, dialogue support and social support showed more promise for specific self-care needs. Above all, according to experts, the success of design strategies could be enhanced by (i) personalising the pacing of the intervention and (ii) tailoring the information to the literacy and culture of the person. Adding to that, self-care support should distinctly (iii) support the three self-care needs, be (iv) patient-centered, (v) support the collaboration with caregivers, and (vi) be aligned to the life goals and values of individuals