Mobile app to support cancer patients:caregivers’ view

Abstract. Mobile healthcare systems that support patients’ treatments have become more common in recent years. The purpose of this study was to find out how health care professionals experience the use of the AforCP mobile application when monitoring the breast cancer patients’ wellbeing, the assessment of the symptoms, the side effects of the treatments, and how the implementation of the application was experienced. The AforCP is a mobile application that allows cancer patients to determine their own health status and independently monitor their symptoms. In addition, cancer clinics can monitor the well-being of their patients and evaluate how the symptoms of the patients are developing in real-time. The study was carried out at a Finnish university hospital, where the AforCP information system had been in pilot use for about nine months. The study was conducted as a qualitative case study and the research material was collected from the theme interviews made to five health professionals including doctors and nurses. The content analysis was used to analyse the content of the interviews. Earlier studies have, among other things, demonstrated that patient-reported outcome systems may help communication between the patients and healthcare professionals and they may even prolong the survival time of cancer patients. Additional research was needed to gain insight into how the healthcare professionals perceived the AforCP system when following the patients’ healthcare. Healthcare professionals experienced that the AforCP reduced phone calls from the patients and the side effects of the treatments were received earlier. The patients were able to record information about their wellbeing at a time appropriate for them. They did not have to remember all important things when visiting a doctor and using a completely new drug. The healthcare professionals believed that the system could give a better picture of possible side effects than if it had been run without this system. The implementation of the AforCP system turned out to be a challenge. The interviewed healthcare professionals felt that the pilot project did not go as it was originally planned. Due to the small number of patients as users of the application the staff did not reach sufficient routine in using it. Some of them would have needed more training in the introduction phase. The integration into the main patient information system however would have reduced double recordings and saved working time from them. It is important to pay attention to the planning and implementation of the pilot project in which patient’s well-being is monitored so that users’ attitudes towards the use of the system could be as positive as possible. Health care professionals are especially looking for systems that could offer them savings in work time and give them a clear picture of how their patients are doing.Tiivistelmä. Terveydenhuollon mobiilijärjestelmät ovat yleistyneet viimeisten vuosien aikana potilaiden hoidon tukena. Tämän tutkimuksen tarkoituksena oli selvittää, miten terveydenhuollon ammattilaiset kokivat AforCP mobiilisovelluksen käytön potilaiden hoidon tukena heidän voinnin ja hoidon haittavaikutusten seurannassa. AforCP on mobiilijärjestelmä, jonka avulla syöpäpotilaat voivat itse määrittää terveydentilansa ja monitoroida itsenäisesti oireitaan. Lisäksi syöpäpotilaita hoitavat klinikat voivat seurata potilaidensa hyvinvointia ja arvioida potilaiden oireiden kehittymistä reaaliaikaisesti. Tutkimus toteutettiin suomalaisessa yliopistosairaalassa, jossa AforCP tietojärjestelmä oli ollut pilottikäytössä noin yhdeksän kuukauden ajan. Tutkimus tehtiin laadullisena tapaustutkimuksena ja tutkimusmateriaali kerättiin teemahaastatteluilla terveydenhuollon ammattilaisilta, lääkäreiltä ja sairaanhoitajilta. Haastateltavia terveydenhuollon ammattilaisia oli viisi. Haastattelujen sisällön analyysimenetelmänä käytettiin sisällönanalyysiä. Aikaisemmat tutkimukset ovat mm. osoittaneet itseraportointijärjestelmien parantavan potilaiden ja lääkärin kommunikaatiota ja jopa pidentävän syöpäpotilaiden elossaoloaikaa. Lisätutkimusta tarvittiin, jotta saatiin tietoa siitä, miten terveydenhuollon ammattilaiset kokivat AforCP-järjestelmän käytön potilaiden voinnin ja haittavaikutusten seurannassa. Lisäksi tavoitteena oli saada tietoa järjestelmän käyttöönotosta. Terveydenhuollon ammattilaiset kokivat, että AforCP vähensi puheluita potilailta. He saivat hoitojen sivuvaikutukset tietoonsa aikaisemmin. Potilaat pystyivät kirjaamaan vointinsa seurantaan liittyviä tietoja heille sopivana ajankohtana. Potilaiden ei tarvinnut muistaa asioita lääkärikäynnillä ja käyttäessään täysin uutta lääkettä, terveydenhuollon ammattilaiset olettivat, että järjestelmä voisi antaa paremmin kuvan mahdollisista sivuvaikutuksista, kuin jos olisi toimittu ilman järjestelmää. AfoCP-järjestelmän käyttöönotossa koettiin olleen kohtuullisen paljon haasteita. Haastatellut terveydenhuollon ammattilaiset kokivat, ettei pilottiprojekti sujunut alkuperäisten suunnitelmien mukaan. Koska potilasmäärä oli pieni, henkilökunnalle ei syntynyt riittävää rutiinia järjestelmän käyttöön. Osa heistä olisi toivonut saavansa enemmän koulutusta käyttöönottovaiheessa. Integraatio potilastietojärjestelmään olisi vähentänyt moninkertaista kirjaamista ja säästänyt työaikaa. Potilaiden voinnin seurantaan käytettävien mobiilijärjestelmien käyttöönottoprojektin suunnitteluun, resursointiin ja toteutukseen on tärkeää kiinnittää huomiota, jotta käyttäjien asenteet järjestelmän käyttöä kohtaan voisivat olla mahdollisimman positiiviset Terveydenhuollon ammattilaiset hakevat järjestelmiltä erityisesti työajansäästöä ja selkeää kuvaa potilaan voinnista

Time-course of left ventricle function during mild therapeutic hypothermia in out-of-hospital cardiac arrest patients

Peer reviewe

Effect of Inhaled Xenon on Cerebral White Matter Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

IMPORTANCE: Evidence from preclinical models indicates that xenon gas can prevent the development of cerebral damage after acute global hypoxic-ischemic brain injury but, thus far, these putative neuroprotective properties have not been reported in human studies. OBJECTIVE: To determine the effect of inhaled xenon on ischemic white matter damage assessed with magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS: A randomized single-blind phase 2 clinical drug trial conducted between August 2009 and March 2015 at 2 multipurpose intensive care units in Finland. One hundred ten comatose patients (aged 24-76 years) who had experienced out-of-hospital cardiac arrest were randomized. INTERVENTIONS: Patients were randomly assigned to receive either inhaled xenon combined with hypothermia (33°C) for 24 hours (n = 55 in the xenon group) or hypothermia treatment alone (n = 55 in the control group). MAIN OUTCOMES AND MEASURES: The primary end point was cerebral white matter damage as evaluated by fractional anisotropy from diffusion tensor MRI scheduled to be performed between 36 and 52 hours after cardiac arrest. Secondary end points included neurological outcome assessed using the modified Rankin Scale (score 0 [no symptoms] through 6 [death]) and mortality at 6 months. RESULTS: Among the 110 randomized patients (mean age, 61.5 years; 80 men [72.7%]), all completed the study. There were MRI data from 97 patients (88.2%) a median of 53 hours (interquartile range [IQR], 47-64 hours) after cardiac arrest. The mean global fractional anisotropy values were 0.433 (SD, 0.028) in the xenon group and 0.419 (SD, 0.033) in the control group. The age-, sex-, and site-adjusted mean global fractional anisotropy value was 3.8% higher (95% CI, 1.1%-6.4%) in the xenon group (adjusted mean difference, 0.016 [95% CI, 0.005-0.027], P = .006). At 6 months, 75 patients (68.2%) were alive. Secondary end points at 6 months did not reveal statistically significant differences between the groups. In ordinal analysis of the modified Rankin Scale, the median (IQR) value was 1 (1-6) in the xenon group and 1 (0-6) in the control group (median difference, 0 [95% CI, 0-0]; P = .68). The 6-month mortality rate was 27.3% (15/55) in the xenon group and 34.5% (19/55) in the control group (adjusted hazard ratio, 0.49 [95% CI, 0.23-1.01]; P = .053). CONCLUSIONS AND RELEVANCE: Among comatose survivors of out-of-hospital cardiac arrest, inhaled xenon combined with hypothermia compared with hypothermia alone resulted in less white matter damage as measured by fractional anisotropy of diffusion tensor MRI. However, there was no statistically significant difference in neurological outcomes or mortality at 6 months. These preliminary findings require further evaluation in an adequately powered clinical trial designed to assess clinical outcomes associated with inhaled xenon among survivors of out-of-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00879892

Posttraumatic epilepsy in intensive care unit-treated pediatric traumatic brain injury patients

publishedVersionPeer reviewe

Spoken words are processed during dexmedetomidine-induced unresponsiveness

Background: Studying the effects of anaesthetic drugs on the processing of semantic stimuli could yield insights into how brain functions change in the transition from wakefulness to unresponsiveness. Here, we explored the N400 event-related potential during dexmedetomidine- and propofol-induced unresponsiveness. Methods: Forty-seven healthy subjects were randomised to receive either dexmedetomidine (n = 23) or propofol (n = 24) in this open-label parallel-group study. Loss of responsiveness was achieved by stepwise increments of pseudo-steady-state plasma concentrations, and presumed loss of consciousness was induced using 1.5 times the concentration required for loss of responsiveness. Pre-recorded spoken sentences ending either with an expected (congruous) or an unexpected (incongruous) word were presented during unresponsiveness. The resulting electroencephalogram data were analysed for the presence of the N400 component, and for the N400 effect defined as the difference between the N400 components elicited by congruous and incongruous stimuli, in the time window 300-600 ms post-stimulus. Recognition of the presented stimuli was tested after recovery of responsiveness. Results: The N400 effect was not observed during dexmedetomidine- or propofol-induced unresponsiveness. The N400 component, however, persisted during dexmedetomidine administration. The N400 component elicited by congruous stimuli during unresponsiveness in the dexmedetomidine group resembled the large component evoked by incongruous stimuli at the awake baseline. After recovery, no recognition of the stimuli heard during unresponsiveness occurred. Conclusions: Dexmedetomidine and propofol disrupt the discrimination of congruous and incongruous spoken sentences, and recognition memory at loss of responsiveness. However, the processing of words is partially preserved during dexmedetomidine-induced unresponsiveness.</p

Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest : an analysis of the TTH48 trial

BackgroundThe aim of this study was to explore the performance and outcomes for intravascular (IC) versus surface cooling devices (SFC) for targeted temperature management (TTM) after out-of-hospital cardiac arrest.MethodsA retrospective analysis of data from the Time-differentiated Therapeutic Hypothermia (TTH48) trial (NCT01689077), which compared whether TTM at 33 degrees C for 48h results in better neurologic outcomes compared with standard 24-h duration. Devices were assessed for the speed of cooling and rewarming rates. Precision was assessed by measuring temperature variability (TV), i.e., the standard deviation (SD) of all temperature measurements in the cooling phase. Main outcomes were overall mortality and poor neurological outcome, including death, severe disability, or vegetative status.ResultsA total of 352 patients had available data and were included in the analysis; of those, 218 (62%) were managed with IC. A total of 114/218 (53%) patients with IC and 61/134 (43%) with SFC were cooled for 48h (p=0.22). Time to target temperature (34 degrees C) was significantly shorter for patients treated with endovascular devices (2.2 [1.1-4.0] vs. 4.2 [2.7-6.0] h, pPeer reviewe

Electrolyte profiles with induced hypothermia : A sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest

Background Electrolyte disturbances can result from targeted temperature treatment (TTM) in out-of-hospital cardiac arrest (OHCA) patients. This study explores electrolyte changes in blood and urine in OHCA patients treated with TTM. Methods This is a sub-study of the TTH48 trial, with the inclusion of 310 unconscious OHCA patients treated with TTM at 33 degrees C for 24 or 48 h. Over a three-day period, serum concentrations were obtained on sodium potassium, chloride, ionized calcium, magnesium and phosphate, as were results from a 24-h diuresis and urine electrolyte concentration and excretion. Changes over time were analysed with a mixed-model multivariate analysis of variance with repeated measurements. Results On admission, mean +/- SD sodium concentration was 138 +/- 3.5 mmol/l, which increased slightly but significantly (p < .05) during the first 24 h. Magnesium concentration stayed within the reference interval. Median ionized calcium concentration increased from 1.11 (IQR 1.1-1.2) mmol/l during the first 24 h (p < .05), whereas median phosphate concentration dropped to 1.02 (IQR 0.8-1.2) mmol/l (p < .05) and stayed low. During rewarming, potassium concentrations increased, and magnesium and ionizes calcium concentration decreased (p < .05). Median 24-h diuresis results on days one and two were 2198 and 2048 ml respectively, and the electrolyte excretion mostly stayed low in the reference interval. Conclusions Electrolytes mostly remained within the reference interval. A temporal change occurred in potassium, magnesium and calcium concentrations with TTM's different phases. No hypothermia effect on diuresis was detected, and urine excretion of electrolytes mostly stayed low.Peer reviewe

Comparison of the prognostic value of early-phase proton magnetic resonance spectroscopy and diffusion tensor imaging with serum neuron-specific enolase at 72 h in comatose survivors of out-of-hospital cardiac arrest-a substudy of the XeHypotheca trial

Purpose: We compared the predictive accuracy of early-phase brain diffusion tensor imaging (DTI), proton magnetic resonance spectroscopy (1H-MRS), and serum neuron-specific enolase (NSE) against the motor score and epileptic seizures (ES) for poor neurological outcome after out-of-hospital cardiac arrest (OHCA).Methods: The predictive accuracy of DTI, 1H-MRS, and NSE along with motor score at 72 h and ES for the poor neurological outcome (modified Rankin Scale, mRS, 3 - 6) in 92 comatose OHCA patients at 6 months was assessed by area under the receiver operating characteristic curve (AUROC). Combined models of the variables were included as exploratory.Results: The predictive accuracy of fractional anisotropy (FA) of DTI (AUROC 0.73, 95% CI 0.62-0.84), total N-acetyl aspartate/total creatine (tNAA/tCr) of 1H-MRS (0.78 (0.68 - 0.88)), or NSE at 72 h (0.85 (0.76 - 0.93)) was not significantly better than motor score at 72 h (0.88 (95% CI 0.80-0.96)). The addition of FA and tNAA/tCr to a combination of NSE, motor score, and ES provided a small but statistically significant improvement in predictive accuracy (AUROC 0.92 (0.85-0.98) vs 0.98 (0.96-1.00), p = 0.037).Conclusion: None of the variables (FA, tNAA/tCr, ES, NSE at 72 h, and motor score at 72 h) differed significantly in predicting poor outcomes in this patient group. Early-phase quantitative neuroimaging provided a statistically significant improvement for the predictive value when combined with ES and motor score with or without NSE. However, in clinical practice, the additional value is small, and considering the costs and challenges of imaging in this patient group, early-phase DTI/MRS cannot be recommended for routine use.</p