Factors affecting engagement in web-based health care patient information: narrative review of the literature

BACKGROUND: Web-based content is rapidly becoming the primary source of health care information. There is a pressing need for web-based health care content to not only be accurate but also be engaging. Improved engagement of people with web-based health care content has the potential to inform as well as influence behavioral change to enable people to make better health care choices. The factors associated with better engagement with web-based health care content have previously not been considered. OBJECTIVE: The aims of this study are to identify the factors that affect engagement with web-based health care content and develop a framework to be considered when creating such content. METHODS: A comprehensive search of the PubMed and MEDLINE database was performed from January 1, 1946, to January 5, 2020. The reference lists of all included studies were also searched. The Medical Subject Headings database was used to derive the following keywords: "patient information," "online," "internet," "web," and "content." All studies in English pertaining to the factors affecting engagement in web-based health care patient information were included. No restrictions were set on the study type. Analysis of the themes arising from the results was performed using inductive content analysis. RESULTS: The search yielded 814 articles, of which 56 (6.9%) met our inclusion criteria. The studies ranged from observational and noncontrolled studies to quasi-experimental studies. Overall, there was significant heterogeneity in the types of interventions and outcome assessments, which made quantitative assessment difficult. Consensus among all authors of this study resulted in six categories that formed the basis of a framework to assess the factors affecting engagement in web-based health care content: easy to understand, support, adaptability, accessibility, visuals and content, and credibility and completeness. CONCLUSIONS: There is a paucity of high-quality data relating to the factors that improve the quality of engagement with web-based health care content. Our framework summarizes the reported studies, which may be useful to health care content creators. An evaluation of the utility of web-based content to engage users is of significant importance and may be accessible through tools such as the Net Promoter score. Web 3.0 technology and development of the field of psychographics for health care offer further potential for development. Future work may also involve improvement of the framework through a co-design process

Healthcare interventions to aid patient self-management of lower limb wounds: A systematic scoping review

Chronic lower limb wounds can be described as having the inability to progress through stages of wound healing. Although 80% of lower limb wounds develop as a result of venous insufficiency, other causes include arterial disease and diabetes. In addition to the sustained impact on quality of life, the chronicity of lower limb wounds presents a significant financial burden to healthcare systems. Self-management is a fundamental aspect of the long-term management of chronic illness and its relevance has intensified since the start of the global pandemic. The objective of this systematic scoping review was to define what the self-management of a lower limb wound entails and explore the interventions available to support patients to self-manage. A total of seven articles were evaluated. There was limited consensus regarding the definition and components of self-management in this area. Interventions involved patients participating in additional exercise, wound care, and lifestyle behaviours such as limb elevation and skin care. Only two studies applied theory and only one evaluated participant acceptability of interventions, making it difficult to assess the feasibility of implementation. Although the evidence reviewed provides some insight into the self-management of a lower limb wound, theoretically-guided research is needed in this area

Appropriate use criteria for transesophageal echocardiography in Greece: A single center experience

Introduction The American College of Cardiology Foundation (ACCF) along with the American Society of Echocardiography (ASE) have enabled an accurate and clinically oriented evaluation of echocardiography indications by introducing Appropriate Use Criteria (AUC). Aim This study was designed to evaluate the degree of implementation of AUC for transesophageal echocardiography (TEE) during daily clinical practice in a tertiary university hospital in Greece during the era of economic recession. Materials and Methods From November 2014 to May 2014, we prospectively enrolled 300 patients who were examined in the Echocardiography Laboratory of the First University Cardiology. We recorded the participants' demographic and clinical characteristics using questionnaires and followed a scoring process according to ACCF guidelines to classify patients into an appropriate, inappropriate or uncertain category. The primary endpoint was to assess the association between the class of appropriateness and abnormal TEE results. Results In 89.4% of patients labelled appropriate, TEE was abnormal and significantly higher compared to patients of uncertain eligibility (50%) and to patients for whom TEE was considered to be inappropriate (35%) (p < 0.001). Subgroup analysis revealed a positive association between AUC and an increased possibility for abnormal TEE in female subjects (p = 0.001) as well as in patients who were younger than 50 years old (p < 0.001). A significant association was finally established between AUC and abnormal findings in TEE in patients with no risk factors (p = 0.028) and in patients with more than 3 risk factors (p = 0.013). Conclusion TEE constitutes a medical practice with an optimal cost/effectiveness ratio and should be further encouraged in our country in accordance with the austerity policy as long as the AUC are generally applied

Electrocardiographic predictors of successful resynchronization of left bundle branch block by his bundle pacing

Background His bundle pacing (HBP) is an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy (CRT) in patients with heart failure and left bundle branch block (LBBB). It is not known whether ventricular activation times and patterns achieved by HBP are equivalent to intact conduction systems and not all patients with LBBB are resynchronized by HBP. Objective To compare activation times and patterns of His-CRT with BVP-CRT, LBBB and intact conduction systems. Methods In patients with LBBB, noninvasive epicardial mapping (ECG imaging) was performed during BVP and temporary HBP. Intrinsic activation was mapped in all subjects. Left ventricular activation times (LVAT) were measured and epicardial propagation mapping (EPM) was performed, to visualize epicardial wavefronts. Normal activation pattern and a normal LVAT range were determined from normal subjects. Results Forty-five patients were included, 24 with LBBB and LV impairment, and 21 with normal 12-lead ECG and LV function. In 87.5% of patients with LBBB, His-CRT successfully shortened LVAT by ≥10 ms. In 33.3%, His-CRT resulted in complete ventricular resynchronization, with activation times and patterns indistinguishable from normal subjects. EPM identified propagation discontinuity artifacts in 83% of patients with LBBB. This was the best predictor of whether successful resynchronization was achieved by HBP (logarithmic odds ratio, 2.19; 95% confidence interval, 0.07–4.31; p = .04). Conclusion Noninvasive electrocardiographic mapping appears to identify patients whose LBBB can be resynchronized by HBP. In contrast to BVP, His-CRT may deliver the maximum potential ventricular resynchronization, returning activation times, and patterns to those seen in normal hearts

Appropriate use criteria for transesophageal echocardiography in Greece: A single center experience

Introduction: The American College of Cardiology Foundation (ACCF) along with the American Society of Echocardiography (ASE) have enabled an accurate and clinically oriented evaluation of echocardiography indications by introducing Appropriate Use Criteria (AUC). Aim: This study was designed to evaluate the degree of implementation of AUC for transesophageal echocardiography (TEE) during daily clinical practice in a tertiary university hospital in Greece during the era of economic recession. Materials and Methods: From November 2014 to May 2014, we prospectively enrolled 300 patients who were examined in the Echocardiography Laboratory of the First University Cardiology. We recorded the participants’ demographic and clinical characteristics using questionnaires and followed a scoring process according to ACCF guidelines to classify patients into an appropriate, inappropriate or uncertain category. The primary endpoint was to assess the association between the class of appropriateness and abnormal TEE results. Results: In 89.4% of patients labelled appropriate, TEE was abnormal and significantly higher compared to patients of uncertain eligibility (50%) and to patients for whom TEE was considered to be inappropriate (35%) (p &lt; 0.001). Subgroup analysis revealed a positive association between AUC and an increased possibility for abnormal TEE in female subjects (p = 0.001) as well as in patients who were younger than 50 years old (p &lt; 0.001). A significant association was finally established between AUC and abnormal findings in TEE in patients with no risk factors (p = 0.028) and in patients with more than 3 risk factors (p = 0.013). Conclusion: TEE constitutes a medical practice with an optimal cost/effectiveness ratio and should be further encouraged in our country in accordance with the austerity policy as long as the AUC are generally applied. (C) 2017 Hellenic Society of Cardiology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

A Risk Score for Predicting the Incidence of Hemorrhage in Critically Ill Neonates: Development and Validation Study

The aim of the study was to develop and validate a prediction model for hemorrhage in critically ill neonates which combines rotational thromboelastometry (ROTEM) parameters and clinical variables. This cohort study included 332 consecutive full-Term and preterm critically ill neonates. We performed ROTEM and used the neonatal bleeding assessment tool (NeoBAT) to record bleeding events. We fitted double selection least absolute shrinkage and selection operator logit regression to build our prediction model. Bleeding within 24 hours of the ROTEM testing was the outcome variable, while patient characteristics, biochemical, hematological, and thromboelastometry parameters were the candidate predictors of bleeding. We used both cross-validation and bootstrap as internal validation techniques. Then, we built a prognostic index of bleeding by converting the coefficients from the final multivariable model of relevant prognostic variables into a risk score. A receiver operating characteristic analysis was used to calculate the area under curve (AUC) of our prediction index. EXTEM A10 and LI60, platelet counts, and creatinine levels were identified as the most robust predictors of bleeding and included them into a Neonatal Bleeding Risk (NeoBRis) index. The NeoBRis index demonstrated excellent model performance with an AUC of 0.908 (95% confidence interval [CI]: 0.870-0.946). Calibration plot displayed optimal calibration and discrimination of the index, while bootstrap resampling ensured internal validity by showing an AUC of 0.907 (95% CI: 0.868-0.947). We developed and internally validated an easy-To-Apply prediction model of hemorrhage in critically ill neonates. After external validation, this model will enable clinicians to quantify the 24-hour bleeding risk. © 2021 Georg Thieme Verlag. All rights reserved

ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis

Background: Hypofibrinolysis has been demonstrated in several studies in adult sepsis. Although fibrinolysis is an important and integral part of the hemostatic system, few data are available regarding its role in neonatal sepsis. Our purpose was to define fibrinolytic profiles across neonatal sepsis spectrum using rotational thromboelastometry (ROTEM). Material and methods: This study was performed in a Greek tertiary General Hospital during an 18 month-period and included 44 neonates with confirmed sepsis and 22 with suspected sepsis; 110 healthy neonates served as controls. Whenever sepsis was suspected, EXTEM and APTEM assays were performed, clinical findings and laboratory data were recorded. Results: Although most EXTEM parameters were significantly different among the 3 groups, Maximal Lysis (ML) and Lysis Index at 60 min (LI60) levels were similar (p = 0.11 and p = 0.20, respectively). Hyperfibrinolysis, as defined by ROTEM parameters, did not significantly differ among the study populations (p = 0.41). On the contrary, fibrinolysis shutdown, defined as an EXTEM LI60 ≥98%, was more common in septic neonates than in healthy (p &lt; 0.001) and neonates with suspected sepsis (p = 0.042). A weak to moderate correlation of LI60 and ML with mortality (Spearman rho = 0.43 and − 0.40, p = 0.005 and 0.007, respectively) and SNAPE score (Spearman rho = 0.35 and − 0.33, p = 0.02 and 0.03, respectively) was noticed in sepsis group. Conclusions: ROTEM, based on fibrinolytic parameters, showed a more frequent fibrinolysis shutdown in neonatal sepsis, but it could neither effectively discriminate septic neonates, nor predict their clinical outcome. The considerable overlap among numerical ROTEM values probably compromises their diagnostic clinical utility in neonatal sepsis. © 2020 Elsevier Lt

The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates

Background: Our aim was to investigate the role of thromboelastometry (ROTEM) parameters, including maximum clot elasticity (MCE) and platelet component (PLTEM MCE and PLTEM MCF), in early prediction of bleeding events in thrombocytopenic critically ill neonates. Material and methods: This single-center, prospective cohort study included 110 consecutive thrombocytopenic neonates with sepsis, suspected sepsis, or hypoxia. On the first day of disease onset, ROTEM EXTEM and FIBTEM assays were performed and the neonatal bleeding assessment tool was used for the evaluation of bleeding events. Results: Most EXTEM and FIBTEM ROTEM parameters significantly differed between neonates with (n = 77) and without bleeding events (n = 33). Neonates with bleeding events had significantly lower PLTEM MCE and PLTEM MCF values compared to those without bleeding events (P &lt;.001). Platelet count was found to be strongly positively correlated with EXTEM A5 (Spearman&apos;s rho = 0.61, P &lt;.001) and A10 (rho = 0.64, P &lt;.001). EXTEM A10 demonstrated the best prognostic performance (AUC = 0.853) with an optimal cutoff value (≤37 mm) (sensitivity = 91%, specificity = 76%) for prediction of bleeding events in thrombocytopenic neonates. Conclusions: EXTEM A5 and EXTEM A10 were found to be strong predictors of hemorrhage, compared to most ROTEM variables quantifying clot elasticity and platelet component in thrombocytopenic critically ill neonates. © 2020 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Lt