Patient Perspectives on Post-Discharge Surgical Site Infections: Towards a Patient-Centered Mobile Health Solution

<div><p>Background</p><p>Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring “app” as a novel solution to address this problem.</p><p>Methods</p><p>Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center.</p><p>Results</p><p>From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges.</p><p>Conclusions</p><p>Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.</p></div

Perceived benefits and limitations of mHealth approach.

<p>Based on two survey questions about benefits and limitations, respectively. N denotes number of participants mentioning the particular benefit/limitation.</p><p>Perceived benefits and limitations of mHealth approach.</p

Participant demographics.

<p>Participant demographics.</p

Barriers to post-discharge care addressable by mHealth application.

<p>Barriers to post-discharge care addressable by mHealth application.</p

Barriers and facilitators to coping with wound complications.

<p>Ten sub-themes identified from patient interviews related to coping with post-discharge wound complications, organized into 3 major themes. The color distribution of each bar represents the number of participants who considered each sub-theme to be a barrier (red) or a facilitator (green). Grey indicates that the participant did not mention the sub-theme.</p

Comfort with mHealth application.

<p>Participants' comfort with 4 key elements of a wound-tracking mHealth application. Based on 4 survey questions, participants were either “Very comfortable” (dark green), “Somewhat comfortable” (light green), “Neither comfortable nor uncomfortable (grey), or “Somewhat uncomfortable” (light red). No participants selected “Very uncomfortable”.</p

The Discovery of Potent, Selective, and Reversible Inhibitors of the House Dust Mite Peptidase Allergen Der p 1: An Innovative Approach to the Treatment of Allergic Asthma

Blocking the bioactivity of allergens is conceptually attractive as a small-molecule therapy for allergic diseases but has not been attempted previously. Group 1 allergens of house dust mites (HDM) are meaningful targets in this quest because they are globally prevalent and clinically important triggers of allergic asthma. Group 1 HDM allergens are cysteine peptidases whose proteolytic activity triggers essential steps in the allergy cascade. Using the HDM allergen Der p 1 as an archetype for structure-based drug discovery, we have identified a series of novel, reversible inhibitors. Potency and selectivity were manipulated by optimizing drug interactions with enzyme binding pockets, while variation of terminal groups conferred the physicochemical and pharmacokinetic attributes required for inhaled delivery. Studies in animals challenged with the gamut of HDM allergens showed an attenuation of allergic responses by targeting just a single component, namely, Der p 1. Our findings suggest that these inhibitors may be used as novel therapies for allergic asthma