Healthy lottery. A design theory for a mobile system to increase compliance of individuals with diabetes

This article shows the preliminary results of an ongoing study to develop a system that financially rewards individuals with diabetes. Previous studies have already shown that monetary incentives appear to be the strongest motivator for older individuals with type II diabetes. Nonetheless, design criteria for a mobile service are not well established and there is no study available to assess the viability of a system that financially rewards individuals for self-management. Therefore, in this paper we explore a design theory that describes a new mobile service that integrates data from existing mobile application, and includes a self-supported lottery in a business model, which allows patients with effective self-management to be rewarded without any deficit. Our prototype is based on a social business model, which aims at improving patients’ health and that can be described as ”healthy” for them

Data, Data Everywhere, and Still Too Hard to Link: Insights from User Interactions with Diabetes Apps

For those with chronic conditions, such as Type 1 diabetes, smartphone apps offer the promise of an affordable, convenient, and personalized disease management tool. How- ever, despite significant academic research and commercial development in this area, diabetes apps still show low adoption rates and underwhelming clinical outcomes. Through user-interaction sessions with 16 people with Type 1 diabetes, we provide evidence that commonly used interfaces for diabetes self-management apps, while providing certain benefits, can fail to explicitly address the cognitive and emotional requirements of users. From analysis of these sessions with eight such user interface designs, we report on user requirements, as well as interface benefits, limitations, and then discuss the implications of these findings. Finally, with the goal of improving these apps, we identify 3 questions for designers, and review for each in turn: current shortcomings, relevant approaches, exposed challenges, and potential solutions

Effects of Blindfold on Leadership in Pediatric Resuscitation Simulation: A Randomized Trial

Background: Pediatric resuscitations are rare events. Simulation-based training improves clinical and non-clinical skills, as well as survival rate. We assessed the effectiveness of using blindfolds to further improve leadership skills in pediatric simulation-based training.Methods: Twelve teams, each composed of 1 pediatric emergency fellow, 1 pediatric resident, and 2 pediatric emergency nurses, were randomly assigned to the blindfold group (BG) or to the control group (CG). All groups participated in one session of five simulation-based resuscitation scenarios. The intervention was using a blindfold for the BG leader for the scenarios B, C, and D. Three evaluators, who were blinded to the allocation, assessed leadership skills on the first and last video-recorded scenarios (A and E). Questionnaires assessed self-reported changes in stress and satisfaction about skills after the first and the last scenarios.Results: Improvement in leadership skills doubled in the BG compared with the CG (11.4 vs. 5.4%, p = 0.04), whereas there was no increase in stress or decrease in satisfaction.Conclusion: Blindfold could be an efficient method for leadership training during pediatric resuscitation simulated scenarios. Future studies should further assess its effect at a follow-up and on clinical outcomes after pediatric resuscitation

Brief report: Beyond clinical experience: Features of data collection and interpretation that contribute to diagnostic accuracy

BACKGROUND: Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN: Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS: Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS: Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION: Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic succes

Designing for Diabetes Decision Support Systems with Fluid Contextual Reasoning

Type 1 diabetes is a potentially life-threatening chronic condition that requires frequent interactions with diverse data to inform treatment decisions. While mobile technolo- gies such as blood glucose meters have long been an essen- tial part of this process, designing interfaces that explicitly support decision-making remains challenging. Dual-process models are a common approach to understanding such cog- nitive tasks. However, evidence from the first of two stud- ies we present suggests that in demanding and complex situations, some individuals approach disease management in distinctive ways that do not seem to fit well within existing models. This finding motivated, and helped frame our second study, a survey (n=192) to investigate these behaviors in more detail. On the basis of the resulting analysis, we posit Fluid Contextual Reasoning to explain how some people with diabetes respond to particular situations, and discuss how an extended framework might help inform the design of user interfaces for diabetes management

Résolution de cas cliniques prototypiques : analyse de l'approche de cliniciens experts comparée avec celle de modèles conceptuels dérivés de la littérature

L'évaluation de la démarche diagnostique des étudiants en médecine se base souvent sur des listes d'éléments discriminants recueillis durant une consultation médicale, déterminées par consensus d'experts ou par des modèles conceptuels (MC) tirés de la littérature. Pour comparer ces sources, nous avons étudié l'approche clinique de six cliniciens expérimentés face à une plainte principale lors de trois entretiens avec patients standardisés. Parallèlement, une recherche de littérature a permis d'établir des MC de recueil d'informations pour ces plaintes. La comparaison entre les deux approches révèle que les données sollicitées par les experts sont majoritairement discriminantes selon le MC, alors que moins de la moitié des éléments discriminants du MC sont utilisés. Les experts parviennent toutefois aux diagnostics corrects. En conclusion, les cliniciens ne suivent pas forcément l‘approche des modèles conceptuels ; la préparation de listes de critères d'évaluation des étudiants doit en tenir compte et se baser sur ces deux sources

Patient attitudes about financial incentives for diabetes self-management: A survey

Aim: To study the acceptability of incentives for behavior changes in individuals with diabetes, comparing financial incentives to self-rewards and non-financial incentives.Methods: A national online survey of United States adults with diabetes was conducted in March 2013 (n = 153). This survey was designed for this study, with iterative testing and modifications in a pilot population. We measured the demographics of individuals, their interest in incentives, as well as the perceived challenge of diabetes self-management tasks, and expectations of incentives to improve diabetes self-management (financial, non-financial and self-rewards). Using an ordered logistic regression model, we assessed the association between a 32-point score of the perceived challenge of the self-management tasks and the three types of rewards.Results: Ninety-six percent of individuals were interested in financial incentives, 60% in non-financial incentives and 72% in self-rewards. Patients were less likely to use financial incentives when they perceived the behavior to be more challenging (odds ratio of using financial incentives of 0.82 (95%CI: 0.72-0.93) for each point of the behavior score). While the effectiveness of incentives may vary according to the perceived level of challenge of each behavior, participants did not expect to need large amounts to motivate them to modify their behavior. The expected average amounts needed to motivate a 5 lb weight loss in our population and to maintain this weight change for a year was $258 (interquartile range of$10-100) and $713 (interquartile range of$25-250) for a 15 lb weight loss. The difference in mean amount estimates for 5 lb and 15 lb weight loss was significant (P Conclusion: Individuals with diabetes are willing to consider financial incentives to improve diabetes self-management. Future studies are needed to explore incentive programs and their effectiveness for diabetes.</p

Ensuring the continuity of care: approaches to improve handoffs and subsequent patient management

Healthcare is a collaborative practice, which relies on team skills such as communication, mutual support and leadership. Teams maintain continuity of care through handoffs, which are the transfer of patient information and accountability between clinicians. In hospital settings, handoffs occur at the beginning and end of every shift between day and night teams to provide 24h/24 care. Handoffs and other defaults in communication are involved in the large majority of preventable adverse events. After receiving a handoff, physicians need to retrieve and integrate additional information in their mental models of the patients to manage their patients. Although much focus has been placed on the verbal handoff, it is important to consider the whole process. This thesis aims to better understand the various processes that help ensure the continuity of care, through handoffs and subsequent patient management and to discuss approaches for improvement. Focusing on day and night team transitions in internal medicine wards, I present four studies that span the process: from the preparation of handoffs, the concept of collaborative reasoning, the search for additional information in the electronic health record (EHR) during chart biopsies, to the errors that can occur during the handoff process. Approaches for improvement involve concepts in medical education and in medical informatics. Medical education can help train students for verbal handoffs, during clinical reasoning sessions or simulations for example. Medical informatics can improve the support tools for handoffs, as well as the information retrieval process in the EHR through the use of a dashboard. Future perspectives also include the use of mobile devices throughout the process