The Role of Wearable Sensors in the Future Primary Healthcare - Preferences of the Adult Swiss Population: A Mixed Methods Approach.

Wearable sensors have the potential to increase continuity of care and reduce healthcare expenditure. The user concerns and preferences regarding wearable sensors are the least addressed topic in related literature. Therefore, this study aimed first, to examine the preferences of the adult Swiss population regarding the use of wearable sensors in primary healthcare. Second, the study aimed to explain and learn more about these preferences and why such wearable sensors would or would not be used. An explanatory sequential design was used to reach the two aims. In the initial quantitative phase preferences of a nationwide survey were analyzed descriptively and a multivariable ordered logistic regression was used to identify key characteristics, that influence the preferences. In the second phase, eight semi-structured interviews were conducted. The cleaned study sample of the survey included 687 participants, 46% of whom gave a positive rating regarding the use of wearable sensors. In contrast, 44% gave a negative rating and 10% were neutral. The interviews showed that sensors should be small, not flashy and be compatible with everyday activities. Individuals without a current health risk or existing chronic disease showed lower preferences for using wearable sensors, particularly because they fear losing control over their own body. In contrast, individuals with increased risk or with an existing chronic disease were more likely to use wearable sensors as they can increase the personal safety and provide real-time health information to physicians. Therefore, an important deciding factor for and against the use of wearable sensors seems to be the perceived personal susceptibility for potential health problems

Simulation and evaluation of a body energy harvesting device for arm and leg swing motions

Body energy harvesting (BEH), especially for wearable devices, is an emerging and promising technology to improve the battery capacity and to avoid regular maintenance in terms of energy supply. A broad application of BEH increases sustainability and thus offers an advantage from an environmental point of view. We present a light weight BEH device for non-resonant arm and leg swing motions. The design was kept as simple and robust as possible and is based on an electrical generator. The generator is moved by an oscillating mass, which was previously simulated in a model, so that in this generator model, the kinetic energy is optimally transformed into electrical energy. Additionally, an ultra-low voltage power conditioning circuit, based on a step-up converter, was adapted to the BEH generator. The BEH generator and the power conditioning circuit were evaluated in a real test setup for arm and leg movements during walking and jogging with the BEH device worn on the wrist or ankle. An effective power of ∼11.3 mW was generated. This provides a constant voltage to charge a battery or supercapacitor

Transition bei chronischen Erkrankungen der Kindheit und Jugend

Gesundheitspersonen kommt eine wichtige Aufgabe in der Betreuung von Jugendlichen mit einer chronischen Erkrankung zu. Adoleszenz ist per se keine einfache Zeit, so sind Jugendliche mit einer chronischen Erkrankung zusätzlich damit konfrontiert, Verantwortung für sich und ihre Erkrankung zu übernehmen. Gerade der Transfer von der Kinder- in die Erwachsenenmedizin kann dazu führen, dass Jugendliche die Behandlung abbrechen und es vermehrt zu Notfallsituationen kommt. Somit gehört es zur Verantwortung der betreuenden Kindermediziner, frühzeitig sicherzustellen, dass die Selbstmanagementkompetenzen dieser Jugendlichen gefördert werden und eine adäquate Weiterbetreuung organisiert ist. Dem übernehmenden Erwachsenenteam obliegt es, die Familie willkommen zu heißen und jugendspezifische Themen gemeinsam weiter anzugehen. Diese Themen regelmäßig anzusprechen, sich genügend Zeit für den Jugendlichen zu nehmen und Gespräche unter vier Augen anzubieten, hat sich für eine erfolgreiche Transition als hilfreich erwiesen

Communicating "cure" to pediatric oncology patients: A mixed-methods study

Abstract Background Uncertainty about cure puts childhood cancer survivors at risk of mental distress. We asked survivors if they had been told they had been cured and investigated associated factors. Procedure We used nationwide registry data and a questionnaire survey for ≥five-year survivors of childhood cancer (n = 301), followed by online focus groups with a purposive sample of Swiss pediatric oncologists (n = 17). Discussions were coded by investigators using thematic analysis. Results Overall, 235 among 301 survivors (78%; 95% confidence interval, 73%?83%) reported having been told they were cured. The proportion was 89% (81%?97%) among lymphoma and 84% (77%?91%) among leukemia survivors, but only 49% (33%?65%) among central nervous system tumor survivors. Pediatric oncologists acknowledged that telling survivors they are cured may reassure them that their cancer lies behind them. However, many refrained from telling all patients. Reasons included the possibility of late effects (cure disrupted by a continued need for follow-up care) or late relapse (uncertainty of biological cure), case-by-case strategies (use of ?cure? according to individual factors), and reluctance (substitution of noncommittal terms for ?cure?; waiting for the patient to raise the topic). Conclusions Not all physicians tell survivors they have been cured; their choices depend on the cancer type and risk of late effects

Health-Related Quality of Life in Long-Term Survivors of Relapsed Childhood Acute Lymphoblastic Leukemia

BACKGROUND: Relapses occur in about 20% of children with acute lymphoblastic leukemia (ALL). Approximately one-third of these children can be cured. Their risk for late effects is high because of intensified treatment, but their health-related quality of life (HRQOL) was largely unmeasured. Our aim was to compare HRQOL of ALL survivors with the general population, and of relapsed with non-relapsed ALL survivors. METHODOLOGY/PRINCIPAL FINDINGS: As part of the Swiss Childhood Cancer Survivor Study (SCCSS) we sent a questionnaire to all ALL survivors in Switzerland who had been diagnosed between 1976-2003 at age <16 years, survived ≥5 years, and were currently aged ≥16 years. HRQOL was assessed with the Short Form-36 (SF-36), which measures four aspects of physical health and four aspects of mental health. A score of 50 corresponded to the mean of a healthy reference population. We analyzed data from 457 ALL survivors (response: 79%). Sixty-one survivors had suffered a relapse. Compared to the general population, ALL survivors reported similar or higher HRQOL scores on all scales. Survivors with a relapse scored lower in general health perceptions (51.6) compared to those without (55.8;p=0.005), but after adjusting for self-reported late effects, this difference disappeared. CONCLUSION/SIGNIFICANCE: Compared to population norms, ALL survivors reported good HRQOL, even after a relapse. However, relapsed ALL survivors reported poorer general health than non-relapsed. Therefore, we encourage specialists to screen for poor general health in survivors after a relapse and, when appropriate, specifically seek and treat underlying late effects. This will help to improve patients' HRQOL

Effect of a patient-centred deprescribing procedure in older multimorbid patients in Swiss primary care - A cluster-randomised clinical trial

Background Management of patients with polypharmacy is challenging, and evidence for beneficial effects of deprescribing interventions is mixed. This study aimed to investigate whether a patient-centred deprescribing intervention of PCPs results in a reduction of polypharmacy, without increasing the number of adverse disease events and reducing the quality of life, among their older multimorbid patients. Methods This is a cluster-randomised clinical study among 46 primary care physicians (PCPs) with a 12 months follow-up. We randomised PCPs into an intervention and a control group. They recruited 128 and 206 patients if ≥60 years and taking ≥five drugs for ≥6 months. The intervention consisted of a 2-h training of PCPs, encouraging the use of a validated deprescribing-algorithm including shared-decision-making, in comparison to usual care. The primary outcome was the mean difference in the number of drugs per patient (dpp) between baseline and after 12 months. Additional outcomes focused on patient safety and quality of life (QoL) measures. Results Three hundred thirty-four patients, mean [SD] age of 76.2 [8.5] years participated. The mean difference in the number of dpp between baseline and after 12 months was 0.379 in the intervention group (8.02 and 7.64; p = 0.059) and 0.374 in the control group (8.05 and 7.68; p = 0.065). The between-group comparison showed no significant difference at all time points, except for immediately after the intervention (p = 0.002). There were no significant differences concerning patient safety nor QoL measures. Conclusion Our straight-forward and patient-centred deprescribing procedure is effective immediately after the intervention, but not after 6 and 12 months. Further research needs to determine the optimal interval of repeated deprescribing interventions for a sustainable effect on polypharmacy at mid- and long-term. Integrating SDM in the deprescribing process is a key factor for success. Trial registration Current Controlled Trials, prospectively registered ISRCTN16560559 Date assigned 31/10/2014

Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

Background: Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in Swiss primary care. Methods: This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results: Data from 5210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70-4.36), multimorbid (OR 1.37; 95%-CI 1.24-1.51; p < 0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15-1.42; p < 0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72-3.42; p < 0.001) and anthropometric data (OR 1.33; 95%-CI 1.09-1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04-1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30-0.41; p < 0.001) were prescribed or changed less frequently in NP consultations. Conclusions: Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care

Frequency of home visits where general practitioners are exposed to a problem different from that foreseen - a Swiss cross-sectional study.

BACKGROUND When a home visit is considered, patients' suspected health problems are important for correct triage, the decision for or against the visit and allocation of the visit to a general practitioner (GP) or a nurse practitioner. Misjudgment might lead to suboptimal patient outcomes. OBJECTIVE We aimed to evaluate the accuracy of suspected health problems (based on pre-visit assessments) by comparing them with the actual health problems (post-visit assessments) and investigating associated factors. METHODS GPs of the Swiss Sentinel Surveillance Network (Sentinella) reported pre-visit and post-visit assessments and patient characteristics for up to 20 consecutive home visits, which they conducted in 2019. Using multivariable logistic regressions, we investigated associations between patient and clinical factors and unconfirmed suspected health problems from pre-visit assessments and unforeseen actual health problems from post-visit assessments. RESULTS Overall, 114 GP practices participated. The GPs reported 1496 patient visits with a total of 1789 and 1762 health problems from pre-visit and post-visit assessments, respectively, that were included in the analysis. Musculoskeletal and circulatory problems were the most common in patients receiving home visits. The health problems from pre-visit and post-visit assessments were unconfirmed and unforeseen in15% and 13% of the cases, respectively. Older age (odds ratio [OR] 1.1 in 10-year steps; 95% confidence interval [95% CI] 1.0-1.3) and urgent visits (OR 1.7 compared with regular visits; 95% CI 1.1-2.6) showed a trend for more unforeseen health problems. CONCLUSION When home visits were conducted, about one out of seven health problems from pre-visit and post-visit assessments were unconfirmed and unforeseen. Particularly when patients were older or visits were urgent, there were higher odds of unconfirmed and unforeseen health problems.These results should be considered when triaging patients