The acceptability and impact of the Xploro digital therapeutic platform to inform and prepare children for planned procedures in a hospital: Before and after evaluation study

Background: There is increasing interest in finding novel approaches to improve the preparation of children for hospital procedures such as surgery, X-rays, and blood tests. Well-prepared and informed children have better outcomes (less procedural anxiety and higher satisfaction). A digital therapeutic (DTx) platform (Xploro) was developed with children to provide health information through gamification, serious games, a chatbot, and an augmented reality avatar. Objective: This before and after evaluation study aims to assess the acceptability of the Xploro DTx and examine its impact on children and their parent's procedural knowledge, procedural anxiety, and reported experiences when attending a hospital for a planned procedure. Methods: We used a mixed methods design with quantitative measures and qualitative data collected sequentially from a group of children who received standard hospital information (before group) and a group of children who received the DTx intervention (after group). Participants were children aged between 8 and 14 years and their parents who attended a hospital for a planned clinical procedure at a children's hospital in North West England. Children and their parents completed self-report measures (perceived knowledge, procedural anxiety, procedural satisfaction, and procedural involvement) at baseline, preprocedure, and postprocedure. Results: A total of 80 children (n=40 standard care group and n=40 intervention group) and their parents participated in the study; the children were aged between 8 and 14 years (average 10.4, SD 2.27 years) and were attending a hospital for a range of procedures. The children in the intervention group reported significantly lower levels of procedural anxiety before the procedure than those in the standard group (two-tailed t63.64=2.740; P=.008). The children in the intervention group also felt more involved in their procedure than those in the standard group (t75=-2.238; P=.03). The children in the intervention group also reported significantly higher levels of perceived procedural knowledge preprocedure (t59.98=-4.892; P=.001) than those in the standard group. As for parents, those with access to the Xploro intervention reported significantly lower levels of procedural anxiety preprocedure than those who did not (t68.51=1.985; P=.05). During the semistructured write and tell interviews, children stated that they enjoyed using the intervention, it was fun and easy to use, and they felt that it had positively influenced their experiences of coming to the hospital for a procedure. Conclusions: This study has shown that the DTx platform, Xploro, has a positive impact on children attending a hospital for a procedure by reducing levels of procedural anxiety. The children and parents in the intervention group described Xploro as improving their experiences and being easy and fun to use

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Background Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs). Objective We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. Methods In UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed. Results Among 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of ‘primary non-adherence’ (stopping after first prescription), ‘non-adherent non-persistence’ and ‘persistent adherence’ were 3.5%, 26.5% and 40.2%, differing across OACs. Conclusions Adherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations

Hot and cold knees: exploring differences in patella skin temperature in patients with patellofemoral pain

Objectives: to investigate the distribution of patella skin temperature (Tsk) measurements and to explore the presence of temperature subgroups in patellofemoral pain (PFP) patients. Design: cross-sectional observational study design Participants: One dataset of 58 healthy participants and 232 PFP patients from three different datasets. Main outcome measures: Patella skin temperature, measured by physiotherapists using a low cost hand held digital thermometer. The distribution of patella skin temperature was assessed and compared across datasets. To objectively determine the clinically meaningful number of subgroups, we used the average silhouette method. Finite mixture models were then used to examine the presence of PFP temperature subgroups. Receiver operating characteristic curves were used to estimate optimal patella Tsk thresholds for allocation of participants into the identified subgroups. Results: In contrast to healthy participants, the patella skin temperature had an obvious bimodal distribution with wide dispersion present across all three PFP datasets. The fitted finite mixture model suggested three temperature subgroups (cold, normal and hot) that had been recommended by the average silhouette method with discrimination cut-off thresholds for subgroup membership based on receiver operating curve analysis of Cold=<30.0oC; Normal 30.0-35.2oC; Hot ≥35.2oC. Conclusion: A low cost hand held digital thermometer appears to be a useful clinical tool to identify three PFP temperature subgroups. Further research is recommended to deepen understanding of these clinical findings and to explore the implications to different treatments

Developing robust statistical scoring methods for use in child assessment tools

Timely and accurate diagnosis of developmental disability reduces its detrimental effect on children. Most of the current scoring methods do not appropriately remove the effect of age on development scores. This frustrates both disability status classification and comparison of scores across different child populations because their age dependent development profiles are usually quite different. Hence, the key objective of this research is to develop robust statistical scoring methods that appropriately correct for age using a) item by item age estimation methods that provide the expected age of achieving specific developmental milestones and b) overall score norms independent of the age effect using all the responses of a child to give one score across the entire domain for each child. Using data from 1,446 healthy and normally developing children (standard group) from the 2007 Malawi Development Assessment Tool (MDAT) study, a review of classical methods including generalised linear models, simple sum, Z-score, Log Age Ratio and Item Response Theory scoring methods in this child development context using binary responses only was carried out. While evaluating the pros and cons of each method, extensions to the current scoring methods using more flexible and robust methods including smoothing to reduce score variability are suggested. The results show that; a) the suggested generalized additive model extensions used for age estimation were more suited to deal with skewed item pass rate response distributions, b) smoothing of Z-scores was especially beneficial when variability in certain age groups is high due to low sample sizes, c) the more complex methods accounting for item response correlation or increase in item difficulty resulted in reliable and generalisable normative scores d) the extended overall scoring approaches were able to effectively correct for age achieving correlation coefficients of less than +0.25 between age and scores. The suggested overall scoring extensions improved the accuracy of detecting delayed development both in the disabled and even in the harder to classify malnourished children achieving sensitivity values of up to 98% and 85% respectively

Additional file 2: of A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

Recruitment. (DOCX 14 kb

Additional file 1: of A mixed methods study to evaluate the feasibility of using the Adolescent Diabetes Needs Assessment Tool App in paediatric diabetes care in preparation for a longitudinal cohort study

Ethics. (PDF 169 kb