Promotors and barriers to the implementation and adoption of assistive technology and telecare for people with dementia and their caregivers: a systematic review of the literature

Background One of the most pressing issues in our society is the provision of proper care and treatment for the growing global health challenge of ageing. Assistive Technology and Telecare (ATT) is a key component in facilitation of safer, longer, and independent living for persons with Dementia (PwD) and has the potential to extend valuable care and support for caregivers (formal and informal) globally. Results of this systematic review are of key importance because well-executed ATT implementation, leading to habitual usage and adoption, can assist and strengthen current healthcare services, improve access to healthcare and decrease societal and caregiver burden. Objective The objective of this study is to identify promotors and barriers to implementation and adoption of ATT for PwD and their informal (family and friends) and formal (healthcare professionals) caregivers. In addition, we aim to provide valuable insight for municipalities and healthcare organizations for improved implementation strategies. Methods The study was registered in PROSPERO 25th of February, 2021: CRD42021239448. NVivo was utilized for synthesis and analysis of article content. As the results were from diverse disciplines using varied methods of analysis, a semi-systematic approach with narrative synthesis was used for the review. PICO criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been used to guide all processes and results. Rayyan and NVivo were utilized for selection of articles and analysis of found themes. In addition, the Critical Appraisal Skills Programme (CASP) has been used to visualize meta-synthesis and meta-analysis results and overall quality of included literature. Results This review encompasses relevant information regarding the implementation and adoption of ATT for PwD and their caregivers from five continents and sixty-five countries. It is a true global representation of the growing challenge of ageing. In total, 32 publications were included for review. Identified primary promotors for the implementation and adoption of ATT were as follows: personalized (tailored) training and co-designed solutions, safety for the PwD, involvement of all relevant stakeholders (multi-faceted approach including PwD), ease of use and support (design and follow up), and cultural relevance. Main barriers for the implementation and adoption of ATT included: unintended adverse consequences, timing and disease progress, technology anxiety, system failures (connectivity, errors, etc.), digital divide and lack of access to or knowledge of available ATT. Conclusions The most crucial elements for the adoption of ATT in the future will be a focus on co-design, improved involvement of both the PwD and their caregivers, and the adaptability (tailoring related to context) of ATT solutions over time (disease process). 94% of the literature presented in the review comes from high income countries. There is a significant need for more quality research to be conducted in the regions of the world where population growth and prevalence of dementia is expected to grow most rapidly over the next 30 years.M.Phil. in Global Health - ThesisINTH395AMAMD-GLO

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Promotors and barriers to the implementation and adoption of assistive technology and telecare for people with dementia and their caregivers: a systematic review of the literature

Background One of the most pressing issues in our society is the provision of proper care and treatment for the growing global health challenge of ageing. Assistive Technology and Telecare (ATT) is a key component in facilitation of safer, longer, and independent living for persons with Dementia (PwD) and has the potential to extend valuable care and support for caregivers (formal and informal) globally. Results of this systematic review are of key importance because well-executed ATT implementation, leading to habitual usage and adoption, can assist and strengthen current healthcare services, improve access to healthcare and decrease societal and caregiver burden. Objective The objective of this study is to identify promotors and barriers to implementation and adoption of ATT for PwD and their informal (family and friends) and formal (healthcare professionals) caregivers. In addition, we aim to provide valuable insight for municipalities and healthcare organizations for improved implementation strategies. Methods The study was registered in PROSPERO 25th of February, 2021: CRD42021239448. NVivo was utilized for synthesis and analysis of article content. As the results were from diverse disciplines using varied methods of analysis, a semi-systematic approach with narrative synthesis was used for the review. PICO criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been used to guide all processes and results. Rayyan and NVivo were utilized for selection of articles and analysis of found themes. In addition, the Critical Appraisal Skills Programme (CASP) has been used to visualize meta-synthesis and meta-analysis results and overall quality of included literature. Results This review encompasses relevant information regarding the implementation and adoption of ATT for PwD and their caregivers from five continents and sixty-five countries. It is a true global representation of the growing challenge of ageing. In total, 32 publications were included for review. Identified primary promotors for the implementation and adoption of ATT were as follows: personalized (tailored) training and co-designed solutions, safety for the PwD, involvement of all relevant stakeholders (multi-faceted approach including PwD), ease of use and support (design and follow up), and cultural relevance. Main barriers for the implementation and adoption of ATT included: unintended adverse consequences, timing and disease progress, technology anxiety, system failures (connectivity, errors, etc.), digital divide and lack of access to or knowledge of available ATT. Conclusions The most crucial elements for the adoption of ATT in the future will be a focus on co-design, improved involvement of both the PwD and their caregivers, and the adaptability (tailoring related to context) of ATT solutions over time (disease process). 94% of the literature presented in the review comes from high income countries. There is a significant need for more quality research to be conducted in the regions of the world where population growth and prevalence of dementia is expected to grow most rapidly over the next 30 years