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Please summerize the given abstract to a title | instruction | 0 | 77,235 | 74 | 231,295 |
Assessing the effect of Independent Prescribing for community optometrists and referral rates to Hospital Eye Services in Scotland | output | 1 | 77,235 | 74 | 231,296 |
INTRODUCTION: Since 2010, General Ophthalmic Services (GOS) legislation and Independent Prescribing (IP) enable community optometrists to manage primary eye conditions. No studies have assessed the effect of IP. We wished to determine the distribution of IP optometrists and associated hospital referral rates across Scotland. METHODS: In 2019, FOI requests (General Optical Council and NHS Education Scotland) identified all registered IP optometrists in Scotland and their registered postcodes. Data regarding community eye examinations and referrals to HES since 2010 were gathered via Information Services Division of NHS Scotland. RESULTS: As of March 2019, there were 278 IP optometrists in Scotland (278/1189; 23.4%). Two hundred eighteen IP optometrists work in 293 practices across 11 of Scotland's 14 health boards. There was a strong correlation (r = +0.96) between population density and number of IP optometrists. Fifty-six percent of IP optometrists work in the two most deprived quintiles. Since IP's introduction, there has been a marked increase in anterior segment supplementary visits (+290%). Optometry referrals to GPs have reduced by 10.5%, but referrals to HES have increased by 118% (to 96,315). There was no correlation between quantity of IP optometrists and referral rates to HES (r = -0.06, 95% CI -0.64 to 0.56, p = 0.86). CONCLUSIONS: This is the first analysis of IP optometrists and associated referral rates in Scotland. Despite good geographical distribution and increased supplementary attendances, optometric referrals to HES have doubled and continue to rise. We propose a ratio of primary, supplementary, non-referral and referral rates to discern the true impact of IP versus non-IP community optometric behaviour. | input | 2 | 77,235 | 74 | 231,297 |
Please summerize the given abstract to a title | instruction | 0 | 77,268 | 74 | 231,394 |
A Review of Web-Based Tools for Value-of-Information Analysis. | output | 1 | 77,268 | 74 | 231,395 |
Value-of-information analysis (VOI) is a decision-theoretic approach that is used to inform reimbursement decisions, optimise trial design and set research priorities. The application of VOI analysis for informing policy decisions in practice has been limited due, in part, to the perceived complexity associated with the calculation of VOI measures. Recent efforts have resulted in the development of efficient methods to estimate VOI measures and the development of user-friendly web-based tools to facilitate VOI calculations. We review the existing web-based tools including Sheffield Accelerated Value of Information (SAVI), the web interface to the BCEA (Bayesian Cost-Effectiveness Analysis) R package (BCEAweb), Rapid Assessment of Need for Evidence (RANE), and Value of Information for Cardiovascular Trials and Other Comparative Research (VICTOR). We describe what each tool is designed to do, the inputs they require, and the outputs they produce. Finally, we discuss how tools for VOI calculations might be improved in the future to facilitate the use of VOI analysis in practice. | input | 2 | 77,268 | 74 | 231,396 |
Please summerize the given abstract to a title | instruction | 0 | 77,279 | 74 | 231,427 |
Public opinion on sharing data from health services for clinical and research purposes without explicit consent: an anonymous online survey in the UK | output | 1 | 77,279 | 74 | 231,428 |
OBJECTIVES: UK National Health Service/Health and Social Care (NHS/HSC) data are variably shared between healthcare organisations for direct care, and increasingly de-identified for research. Few large-scale studies have examined public opinion on sharing, including of mental health (MH) versus physical health (PH) data. We measured data sharing preferences. DESIGN/SETTING/INTERVENTIONS/OUTCOMES: Pre-registered anonymous online survey, measuring expressed preferences, recruiting February to September 2020. Participants were randomised to one of three framing statements regarding MH versus PH data. PARTICIPANTS: Open to all UK residents. Participants numbered 29 275; 40% had experienced an MH condition. RESULTS: Most (76%) supported identifiable data sharing for direct clinical care without explicit consent, but 20% opposed this. Preference for clinical/identifiable sharing decreased with geographical distance and was slightly less for MH than PH data, with small framing effects. Preference for research/de-identified data sharing without explicit consent showed the same small PH/MH and framing effects, plus greater preference for sharing structured data than de-identified free text. There was net support for research sharing to the NHS, academic institutions, and national research charities, net ambivalence about sharing to profit-making companies researching treatments, and net opposition to sharing to other companies (similar to sharing publicly). De-identified linkage to non-health data was generally supported, except to data held by private companies. We report demographic influences on preference. A majority (89%) supported a single NHS mechanism to choose uses of their data. Support for data sharing increased during COVID-19. CONCLUSIONS: Support for healthcare data sharing for direct care without explicit consent is broad but not universal. There is net support for the sharing of de-identified data for research to the NHS, academia, and the charitable sector, but not the commercial sector. A single national NHS-hosted system for patients to control the use of their NHS data for clinical purposes and for research would have broad support. TRIAL REGISTRATION NUMBER: ISRCTN37444142. | input | 2 | 77,279 | 74 | 231,429 |
Please summerize the given abstract to a title | instruction | 0 | 77,293 | 74 | 231,469 |
Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team. | output | 1 | 77,293 | 74 | 231,470 |
A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada. | input | 2 | 77,293 | 74 | 231,471 |
Please summerize the given abstract to a title | instruction | 0 | 77,306 | 74 | 231,508 |
Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation | output | 1 | 77,306 | 74 | 231,509 |
OBJECTIVES: To understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales. DESIGN AND SETTING: A qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents. RESULTS: We interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial. CONCLUSIONS: Vertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation. | input | 2 | 77,306 | 74 | 231,510 |
Please summerize the given abstract to a title | instruction | 0 | 77,329 | 74 | 231,577 |
How do community pharmacies in Ontario manage drug shortage problems? Results of an exploratory qualitative study. | output | 1 | 77,329 | 74 | 231,578 |
Background Pharmacists report spending a considerable amount of time dealing with drug shortages. There is no research in Canada identifying and describing the strategies and resources that pharmacists use to minimize disruption and continuity of care for patients. Methods An exploratory qualitative methodology was used. Community pharmacists and technicians in Ontario were interviewed using a semi-structured protocol. Verbatim transcripts were generated and coded by at least 2 independent reviewers using content analysis methods to identify management strategies. Results and Discussion A total of 14 pharmacists and 7 regulated pharmacy technicians participated in this study. The following 5 main strategies for managing drug shortages were identified: (1) using the supplier, (2) generic options, (3) brand options, (4) contacting other pharmacies and (5) switching to a different medication. Conclusion The strategies identified through this research can provide pharmacists with some guidance in approaching the real-world problem of drug shortages. It also highlights opportunities for organizations, government and manufacturers to provide additional support for pharmacists to minimize disruptions for patients and to ensure current ad hoc practices do not further compound shortage issues. Can Pharm J (Ott) 2020;153:xx-xx. | input | 2 | 77,329 | 74 | 231,579 |
Please summerize the given abstract to a title | instruction | 0 | 77,525 | 74 | 232,165 |
Towards an open and effective dialogue on complementary medicine in oncology: protocol of patient participatory study ‘COMMON’ | output | 1 | 77,525 | 74 | 232,166 |
INTRODUCTION: Approximately half of patients with cancer use some form of complementary medicine alongside conventional cancer treatment. The topic of complementary medicine often remains undiscussed in consultations between patients with cancer and their healthcare providers. This results in increased risks for adverse or interaction effects and decreased access to the benefits of evidence-based complementary medicine for patients with cancer. This paper describes the design of patient participatory study titled ‘COMMON’ that aims to explore and enhance open and effective communication about complementary medicine in oncology. The study is carried out in collaboration with 12 (former) patients with breast cancer as coresearchers. METHODS AND ANALYSIS: The study complies with the six steps of the intervention mapping framework. Three non-academic hospitals recruit participants (patients with cancer, oncology healthcare providers and managers) for interviews about the organisation, experiences and needs regarding complementary medicine. To assess communication about complementary medicine, recorded oncology consultations are analysed. For an overview of evidence-based complementary medicine available to patients with cancer, a review of reviews is conducted on the evidence on cancer patient-reported outcomes of complementary medicine frequently used by patients with cancer, supplemented with an online search and survey among organisations and persons providing complementary medicine to patients with cancer. Together, these steps generate input for the development of a toolbox that supports an open and effective discussion on complementary medicine in oncology. In a pilot study, acceptability and usability of the toolbox are assessed among patients with cancer and oncology healthcare providers. Dissemination of the toolbox is covered by the commitment of stakeholder parties. ETHICS AND DISSEMINATION: The Medical Ethics Committee Arnhem-Nijmegen declared the study was exempted from formal approval under the Dutch Medical Research Involving Human Subjects Act. The results will be disseminated through open-access, peer-reviewed publications, stakeholder-reporting and presentations at relevant conferences. | input | 2 | 77,525 | 74 | 232,167 |
Please summerize the given abstract to a title | instruction | 0 | 77,608 | 74 | 232,414 |
Implementation of a fracture liaison service for patients with hip fracture cared for on a hospital medicine service. | output | 1 | 77,608 | 74 | 232,415 |
OBJECTIVE Hip fracture is a common and morbid condition. Prior studies have shown that the majority of patients with fragility fracture are not treated for underlying osteoporosis. Our hospitalist-led co-management service for patients with acute hip fracture had no system for evaluating and treating osteoporosis in this cohort. Our objective was to implement a fracture liaison service (FLS) to assist patients with acute hip fracture and assess subsequent impact on diagnosis and treatment of osteoporosis. METHODS We conducted a pre-post study design at our tertiary academic center, including patients >50 years old hospitalized with acute hip fracture. We implemented a FLS, whereby all patients received endocrinology consultation. Outcome measures included the proportion of patients evaluated for osteoporosis by time of hospital discharge, comparing pre-implementation (12 months) and post-implementation (9 months) cohorts. We also measured the proportions of patients evaluated for and offered treatment for osteoporosis within three months of discharge for patients with post-discharge encounters visible in the medical record. RESULTS We identified 167 patients before and 124 after FLS implementation. In univariate analysis, the proportion of patients evaluated for osteoporosis before discharge increased from 0.6% to 72.6% (p<0.001) pre- vs. post-implementation. The proportion of patients offered osteoporosis treatment within three months after discharge increased from 25.3% to 46.3% (p=0.01). In multivariate analysis, post-implementation patients had higher odds of osteoporosis evaluation while hospitalized (OR = 470.4, p < 0.001) and higher odds of being offered osteoporosis treatment within three months (OR = 2.8, p = 0.008). CONCLUSIONS Establishment of a FLS partnered with a hospitalist-led co-management service for patients with hip fracture was associated with significant improvements in the proportions of patients evaluated and offered treatment for osteoporosis. Wider adoption of this model has the potential to improve care for patients with hip fracture by narrowing the osteoporosis treatment gap. | input | 2 | 77,608 | 74 | 232,416 |
Please summerize the given abstract to a title | instruction | 0 | 77,714 | 74 | 232,732 |
Qualified Nurses’ Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries | output | 1 | 77,714 | 74 | 232,733 |
Background: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. Methods: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants’ lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark’s phases for thematic analysis. Results: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. Conclusions: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting. | input | 2 | 77,714 | 74 | 232,734 |
Please summerize the given abstract to a title | instruction | 0 | 77,756 | 74 | 232,858 |
The protocol of a clinical quality registry for dementia and mild cognitive impairment (MCI): the Australian dementia network (ADNeT) Registry | output | 1 | 77,756 | 74 | 232,859 |
BACKGROUND: Dementia was identified as a priority area for the development of a Clinical Quality Registry (CQR) in Australia in 2016. The Australian Dementia Network (ADNeT) Registry is being established as part of the ADNeT initiative, with the primary objective of collecting data to monitor and enhance the quality of care and patient outcomes for people diagnosed with either dementia or Mild Cognitive Impairment (MCI). A secondary aim is to facilitate the recruitment of participants into dementia research and trials. This paper describes the Registry protocol. METHODS: The ADNeT Registry is a prospective CQR of patients newly diagnosed with either dementia or MCI. Eligible patients will be identified initially from memory clinics and individual medical specialists (e.g., geriatricians, psychiatrists and neurologists) involved in the diagnosis of dementia. Participants will be recruited using either an opt-out approach or waiver of consent based on three key determinants (capacity, person responsible, and communication of diagnosis). Data will be collected from four sources: participating sites, registry participants, carers, and linkage with administrative datasets. It is anticipated that the Registry will recruit approximately 10,000 participants by the end of 2023. The ADNeT registry will be developed and implemented to comply with the national operating principles for CQRs and governed by the ADNeT Registry Steering Committee. DISCUSSION: The ADNeT Registry will provide important data on current clinical practice in the diagnosis, treatment and care of people with dementia and MCI in Australia as well as long-term outcomes among these people. These data will help to identify variations in clinical practice and patient outcomes and reasons underlying these variations, which in turn, will inform the development of interventions to improve care and outcomes for people with dementia and MCI. | input | 2 | 77,756 | 74 | 232,860 |
Please summerize the given abstract to a title | instruction | 0 | 77,802 | 74 | 232,996 |
Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial | output | 1 | 77,802 | 74 | 232,997 |
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed. | input | 2 | 77,802 | 74 | 232,998 |
Please summerize the given abstract to a title | instruction | 0 | 77,907 | 74 | 233,311 |
Mitigating the impact of the 'silos' between the disability and aged-care sectors in Australia: Development of a Best Practice Framework | output | 1 | 77,907 | 74 | 233,312 |
BACKGROUND: Although a 'person-centred focus' is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. METHODS: Mixed-methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in-depth interviews; and survey of health professionals. RESULTS: There is an urgent need to develop inter-sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well-being indicators; development and adoption of nationally consistent policies/standards across integrated aged- and disability-care sectors; improved strategies for workforce planning; and upskilling of existing staff including place-based collaboration. CONCLUSIONS: An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person-centred support systems. | input | 2 | 77,907 | 74 | 233,313 |
Please summerize the given abstract to a title | instruction | 0 | 77,946 | 74 | 233,428 |
A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial | output | 1 | 77,946 | 74 | 233,429 |
Background: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care Treatment access and self-management for these conditions can be supported through eHealth approaches Objective: This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women Methods: This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week Those with red-flag symptoms were excluded Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire Data were collected using another questionnaire and a 2-day bladder diary A telephone interview confirmed the symptom diagnosis Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)−Urinary Incontinence Short Form (ICIQ-UI SF) Urgency symptoms were assessed using the ICIQ−Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ−Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol) Incontinence episode frequency (IEF) was calculated per bladder diary entries Improvement was measured using the Patient’s Global Impression of Improvement All outcomes were self-reported Cure was defined as no leakages per the bladder diary Intention-to-treat analysis was performed Results: Between April 2017 and March 2018, 123 women (mean age 58 3, SD 9 6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group Of these, 35 (28%) women had UUI, and 88 (72%) had MUI Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference −3 1, 95% CI −4 8 to −1 3) The estimated between-group difference was −1 8 (95% CI −2 8 to −0 99) for mean ICIQ-OAB score and −6 3 (95% CI −10 5 to −2 1) for the mean ICIQ-LUTSqol score at follow-up IEF reduction from baseline to follow-up was greater in the treatment group (−10 5, IQR −17 5 to −3 5) than in the information group (P< 001) Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5 4, 95% CI 1 9-15 6;P= 002) About 67% (40/60) of the treatment group participants used the app more than thrice a week Conclusions: The treatment app was effective for improving urgency and mixed incontinence in women When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care Trial Registration: ClinicalTrials gov NCT03097549;https://clinicaltrials gov/ct2/show/NCT03097549 | input | 2 | 77,946 | 74 | 233,430 |
Please summerize the given abstract to a title | instruction | 0 | 78,026 | 74 | 233,668 |
Responding to the Under-Utilisation of Necessary Health Care in the Time of COVID-19: A Precision Public Health intervention. | output | 1 | 78,026 | 74 | 233,669 |
The Veterans' Medicines Advice and Therapeutics Education Services (MATES) program is a national data driven, behaviorally informed, health intervention to improve the use of medicines among Australian veterans. The program, which has been operating since 2004, has led the way in the use of government held data assets to generate evidenced-based health information, which, when provided to clinicians alongside educational materials, can make demonstrable improvements in health and promote practice change. | input | 2 | 78,026 | 74 | 233,670 |
Please summerize the given abstract to a title | instruction | 0 | 78,135 | 74 | 233,995 |
Advanced practice providers in the infectious disease workforce: A Nationwide utilization survey | output | 1 | 78,135 | 74 | 233,996 |
Background Shortages of infectious disease (ID) physicians is an identified workforce problem. The COVID-19 pandemic has exacerbated this care gap, leaving many communities without access to an ID physician. More advanced practice providers (APPs), nurse practitioners/physician assistants, work as healthcare extenders, yet are not well described in ID. Purpose Evaluate collaboration between ID physicians and APPs, and potential barriers to utilization of APPs. Methods Anonymous and voluntary surveys;one for physicians, another for APPs. We collected experience, practice setting, familiarity regarding APPs in ID, use of APPs, and perceived barriers/concerns for utilization of APPs. Discussion Nationwide, 218 ID physicians and 93 APPs in ID responded. 71% (155) of ID physicians use APPs. Of APPs, 53% (49) had > 5 years ID experience. Responses highlighted opportunities for dedicated ID education, collaboration, and clarification of practice scope. Conclusion APPs are an experienced group who provide ID care, working alongside physicians to meet ID workforce needs. | input | 2 | 78,135 | 74 | 233,997 |
Please summerize the given abstract to a title | instruction | 0 | 78,297 | 74 | 234,481 |
Patients’ Perspectives on User Involvement in General Practice. A Qualitative Analysis of Free-Text Comments | output | 1 | 78,297 | 74 | 234,482 |
Background: : General practice plays a core role in managing the pathways of patients with chronic diseases. Despite the increased focus on patient involvement in healthcare practice and well-established knowledge of the benefits of involvement and personalized care, involvement in general practice appears to be challenged. This study aimed to explore patient involvement in general practice from the patients’ perspectives. Method: : The study involved a questionnaire survey investigating patient involvement in general practice from the patients’ perspectives. The validated questionnaire includes an open-ended question encouraging responders to provide additional comments regarding their involvement in general practice. The results from these comments are presented in this paper. A thematic analysis was applied. Results: : Of the 468 responses, 139 included additional comments to the free-text question. Through our analysis, six analytic themes were generated— To be seen, met, or heard , To feel safe or not , To be involved or dictated to , Accessibility , COVID-19 , and For the resourceful— across 116 codings and 25 descriptive themes. The themes’ interwovenness underscores the complexity of both involvement and how it is to live with a chronic disease. Our analysis indicates that involvement in general practice is for the resourceful. Conclusion: : The six themes describing involvement in general practice from the perspectives of patients with T2DM and/or COPD were deeply intertwined. Involvement is dependent on being seen, met, and heard, all of which contribute to the patients’ sense of feeling safe (or not). These aspects are dependent on accessibility to a general practitioner;thus, COVID-19 was a barrier during the data-collection period. Furthermore, it appeared that being resourceful not only contributed to a sense of being involved in general practice but was perhaps even a prerequisite for being involved. | input | 2 | 78,297 | 74 | 234,483 |
Please summerize the given abstract to a title | instruction | 0 | 78,338 | 74 | 234,604 |
Hospice@Home to palliative response team | output | 1 | 78,338 | 74 | 234,605 |
BackgroundOur Hospice at Home (H@H) service supports 31 GP practices (population 315,000 patients).Pre- COVID-19 pandemic service provision of seven-days 9am-5pm was reviewed.Enhanced model developed supporting people wishing to die at home. (DIUPR local CCG 45.9 vs 46.6 England 2017 ONS).DIUPR increased during the pandemic.AimsIncrease ease of access to care provision at home through increased service hours.Increase medical support to develop a specialist palliative care virtual beds model.Uphold hospice’s strategic aims and values of ‘widening access’ and ‘reaching more people’.Uphold ‘Ambitions for Palliative Care’ - ‘each person gets fair access to care’ (National Palliative and End of Life Care Partnership, 2015).MethodsCollaborative appointment (Hospice and NHS) of new community palliative consultant.Use of triage priority rating.Agreed a rapid service pathway for those unstable/dying.New service launched September 2020 with increased hours (8 am to 10 pm) and ability to review patients same day.Supported out of hours by on-call palliative consultants.Virtual beds model supported by daily ‘ward rounds’ and updated plan of care.Data collection – number of referrals, referral source, diagnosis, place of death.Results Nov 20-May 21 Referrals 362 Patients seen 144 Died 166 Discharged 221 Death Location% Hospital 4% Patient‘s own home 80% Hospice 11% Care Home 4% ConclusionService activity increased. 84% of patients died in their usual place of residence. Daily review of patient plans enabled continuity of care. Clear contact information required for patients and families as different service involvement can be confusing. Referral process between partner organisations needed re-discussion and review.Future planningPriority ratings to be reviewed.Strengthen relationships with GP practices by attending Gold Standards Framework meetings.Increase use of data collection including user feedback to support the development of service to enable more patients to be reached in line with identified growing demand. | input | 2 | 78,338 | 74 | 234,606 |
Please summerize the given abstract to a title | instruction | 0 | 78,417 | 74 | 234,841 |
Collaborative improvement in Scottish GP clusters after the Quality and Outcomes Framework: a qualitative study | output | 1 | 78,417 | 74 | 234,842 |
BACKGROUND: Scotland abolished the Quality and Outcomes Framework (QOF) in April 2016, before implementing a new Scottish GP contract in April 2018. Since 2016, groups of practices (GP clusters) have been incentivised to meet regularly to plan and organise quality improvement (QI) as part of this new direction in primary care policy. AIM: To understand the organisation and perceived impact of GP clusters, including how they use quantitative data for improvement. DESIGN AND SETTING: Thematic analysis of semi-structured interviews with key stakeholders (n = 17) and observations of GP cluster meetings (n = 6) in two clusters. METHOD: This analytical strategy was combined with a purposive (variation) sampling approach to the sources of data, to try to identify commonalities across diverse stakeholder experiences of working in or on the idea of GP clusters. Variation was sought particularly in terms of stakeholders’ level of involvement in improvement initiatives, and in their disciplinary affiliations. RESULTS: There was uncertainty as to whether GP clusters should focus on activities generated internally or externally by the wider healthcare system (for example, from Scottish Health Boards), although the two observed clusters generally generated their own ideas and issues. Clusters operated with variable administrative/managerial and data support, and variable baseline leadership experience and QI skills. Qualitative approaches formed the focus of collaborative learning in cluster meetings, through sharing and discussion of member practices’ own understandings and experiences. Less evidence was observed of data analytics being championed in these meetings, partly because of barriers to accessing the analytics data and existing data quality. CONCLUSION: Cluster development would benefit from more consistent training and support for cluster leads in small-group facilitation, leadership, and QI expertise, and data analytics access and capacity. While GP clusters are up and running, their impact is likely to be limited without further investment in developing capacity in these areas. | input | 2 | 78,417 | 74 | 234,843 |
Please summerize the given abstract to a title | instruction | 0 | 78,456 | 74 | 234,958 |
Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services | output | 1 | 78,456 | 74 | 234,959 |
OBJECTIVES: In the UK, the National Health Service long-term plan advocates exercise as a key component of clinical services, but there is no clearly defined workforce to deliver the plan. We aimed to provide an overview of current UK clinical exercise services, focusing on exercise staff job titles, roles and qualifications across cardiovascular, respiratory, stroke, falls and cancer services. METHODS: Clinical exercise services were identified electronically between May 2020 and September 2020 using publicly available information from clinical commissioning groups, national health boards and published audit data. Data relating to staff job titles, roles, qualifications and exercise delivery were collected via electronic records and telephone/email contact with service providers. RESULTS: Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services provided both clinical (phase III) and community (phase IV) exercise interventions delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services provided a clinical exercise intervention only, mostly delivered by physiotherapists and occupational therapists. Cancer services provided a community exercise service only, delivered by vocationally qualified exercise instructors. Job titles of ‘exercise physiologists’ (n=115) bore little alignment to their qualifications, with a large heterogeneity across services. CONCLUSION: In the UK, clinical exercise services job titles, roles and qualifications were inconsistent. Regulation of exercise job titles and roles is required to remove the current disparities in this area. | input | 2 | 78,456 | 74 | 234,960 |
Please summerize the given abstract to a title | instruction | 0 | 78,503 | 74 | 235,099 |
Digital Health Technology in Asthma: A Comprehensive Scoping Review. | output | 1 | 78,503 | 74 | 235,100 |
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the last decade, with different levels of interactivity and personalization, with a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regards to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology via literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden, and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive usage. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization and patient engagement aspects. | input | 2 | 78,503 | 74 | 235,101 |
Please summerize the given abstract to a title | instruction | 0 | 78,554 | 74 | 235,252 |
Bereavement Support for Siblings after Neonatal Loss: an Online Survey of U.S. Training Centers | output | 1 | 78,554 | 74 | 235,253 |
OBJECTIVE: The aim of this study was to examine bereavement support for siblings of patients who die in the neonatal intensive care unit (NICU) given the adverse effects of unprocessed grief and the paucity of information on children whose newborn siblings die STUDY DESIGN: This was an anonymous online original survey assessing pre-COVID-19 pandemic bereavement services for NICU families, clinicians' attitudes toward support interventions, challenges, and center characteristics. In spring 2020, nurse managers at 81 U.S. centers with neonatology and maternal-fetal medicine fellowship programs were asked to identify the individual most knowledgeable in their NICU's bereavement support services; these individuals were invited by email to complete an original online survey. Chi testing and odds ratios (ORs) compared responses from centers reporting involvement of palliative care teams (PCT) in NICU sibling bereavement versus no PCT. RESULTS: Fifty-six percent (45 of 80) of invitees responded. Most (77%) NICUs permitted perimortem sibling visitation. Challenges included sparse community resources and limited direct sibling contact. Sixty-nine percent (n = 31) of centers were grouped as PCT. PCT respondents reported eightfold higher chances of providing direct education to the sibling (OR, 7.7; 95% confidence interval, 1.7-34; p = 0.01). Views on appropriateness of sharing educational information with extended family, babysitters, and teachers did not differ. While notifying pediatricians of families experiencing NICU death was more common in PCT (p = 0.02), most respondents reported having "no individual responsible for such communications" (52% PCT vs. 100%, p = 0.001). CONCLUSION: Despite limited direct contact with siblings of NICU patients who die, efforts are made to involve them in bereavement activities. Opportunities to support these children were identified. Where available, palliative care teams can help provide bereaved siblings with direct education. We recommend formalizing communication mechanisms to ensure that if a NICU patient dies and has surviving siblings, the outpatient physicians caring for these siblings are informed. KEY POINTS: · Palliative care enhanced sibling support.. · Resource and visitation limits hinder support.. · Teams sporadically briefed siblings' physicians.. | input | 2 | 78,554 | 74 | 235,254 |
Please summerize the given abstract to a title | instruction | 0 | 78,582 | 74 | 235,336 |
How to embed qualitative research in trials: insights from the feasibility study of the SAFER trial programme | output | 1 | 78,582 | 74 | 235,337 |
Qualitative research can enhance the design, conduct and interpretation of trials. Despite this, few trials incorporate qualitative methods, and those that do may not realise their full potential. In this commentary, we highlight how qualitative research can contribute to the design, conduct and day-to-day running of a trial, outlining the working arrangements and relationships that facilitate these contributions. In doing so, we draw on (i) existing frameworks on the role of qualitative research alongside trials and (ii) our experience of integrated qualitative research conducted as part of the feasibility study of the SAFER trial (Screening for Atrial Fibrillation with ECG to Reduce stroke), a cluster randomised controlled trial of screening people aged 70 and above for atrial fibrillation in primary care in England. The activities and presence of the qualitative team contributed to important changes in the design, conduct and day-to-day running of the SAFER feasibility study, and the subsequent main trial, informing diverse decisions concerning trial documentation, trial delivery, timing and content of measures and the information given to participating patients and practices. These included asking practices to give screening results to all participants and not just to ‘screen positive’ participants, and greater recognition of the contribution of practice reception staff to trial delivery. These changes were facilitated by a ‘one research team’ approach that underpinned all formal and informal working processes from the outset and maximised the value of both qualitative and trial coordination expertise. The challenging problems facing health services require a combination of research methods and data types. Our experience and the literature show that the benefits of embedding qualitative research in trials are more likely to be realised if attention is given to both structural factors and relationships from the outset. These include sustained and sufficient funding for qualitative research, embedding qualitative research fully within the trial programme, providing shared infrastructure and resources and committing to relationships based on mutual recognition of and respect for the value of different methods and perspectives. We outline key learning for the planning of future trials. Trial registration: Screening for atrial fibrillation with ECG to reduce stroke ISRCTN16939438 (feasibility study); Screening for atrial fibrillation with ECG to reduce stroke – a randomised controlled trial ISRCTN72104369. | input | 2 | 78,582 | 74 | 235,338 |
Please summerize the given abstract to a title | instruction | 0 | 78,629 | 74 | 235,477 |
A prospective assessment of the Medicaid Web portal for admission medication reconciliation at a community hospital in Montana | output | 1 | 78,629 | 74 | 235,478 |
DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients' discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient's medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission. SUMMARY: A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient's current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care. CONCLUSION: EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission. | input | 2 | 78,629 | 74 | 235,479 |
Please summerize the given abstract to a title | instruction | 0 | 78,736 | 74 | 235,798 |
Development and validation of a multiple-choice question-based delirium care knowledge quiz for critical care nurses | output | 1 | 78,736 | 74 | 235,799 |
Aims: To develop and psychometrically test a multiple choice questions (MCQs) based quiz of delirium care knowledge for critical care nurses. Design: Instrument development and psychometric evaluation study. Methods: The development and validation process including two phases. Phase I focused on the quiz development, conducted by the following steps: (1) generated initial 20 items pool; (2) examined content validity and (3) face validity; (4) conducted pilot testing, data were collected from 217 critical care nurses via online survey during 01 October to 07 November, 2020; (5) performed item analysis and eliminated items based on the item difficulty and discrimination indices. The MCQs quiz was finalised through the development process. Then, phases II emphasised the quiz validation, to estimate the internal consistency, split half and test-retest reliability, and construct validity using parallel analysis with the exploratory factor analysis (EFA). Results: A final 16 items MCQs quiz was emerged from the item analysis. The Kuder Richardson Formula 20 coefficient for the overall quiz showed good internal consistency (0.85), and the intraclass correlation coefficient with a 30 days interval also indicated that the questionnaire had satisfactory stability (0.96). The EFA confirmed appropriate construct validity for the quiz, four factors could explain the total variance of 60.87%. Conclusion: This study developed the first MCQs quiz for delirium care knowledge and it is a reliable and valid tool that can be implemented to assess the level of delirium care knowledge. Impact: This study offers an evidence based quiz designed for future research and education purposes in delirium care that has significant implications for knowledge test by using MCQs in clinical practice. | input | 2 | 78,736 | 74 | 235,800 |
Please summerize the given abstract to a title | instruction | 0 | 78,775 | 74 | 235,915 |
How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems. | output | 1 | 78,775 | 74 | 235,916 |
BACKGROUND Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]). METHODS Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries. RESULTS Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers. CONCLUSION Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems. | input | 2 | 78,775 | 74 | 235,917 |
Please summerize the given abstract to a title | instruction | 0 | 78,850 | 74 | 236,140 |
A multidisciplinary approach to online support for device research translation: regulatory change and clinical engagement | output | 1 | 78,850 | 74 | 236,141 |
OBJECTIVES: To promote medical device EU regulatory understanding in the biomedical research community and encourage greater levels of clinical engagement to further medical device research innovation, translation and effective clinical trials. METHODS: An interdisciplinary, iterative, needs-based design approach was used to develop medical device regulatory training, information and clinical expertise resources. RESULTS: A multimedia based self-paced e-Learning course focusing on the ‘Fundamentals of Medical Device Design and Regulation’ was produced in tandem with an interactive online web portal: Medtech Translate. CONCLUSIONS: Health research translation relies on both clinical input and regulation to drive progress and to ensure quality and safety standards from concept development to clinical investigation. A lack of regulatory awareness and access to clinical expertise has the potential to significantly impact on health research translation and ambition for market. Our interdisciplinary academic-regulator-clinical-industry led approach meets the need for a coordinated stakeholder response to support innovation and promote growth in the medical technology sector. | input | 2 | 78,850 | 74 | 236,142 |
Please summerize the given abstract to a title | instruction | 0 | 78,851 | 74 | 236,143 |
Workload and prevalence of open wounds in the community: French Vulnus initiative. | output | 1 | 78,851 | 74 | 236,144 |
OBJECTIVE To calculate the prevalence of open cutaneous wounds presented on a routine working day in community settings in metropolitan France, and to estimate the workload associated with the care of these wounds by nurses, GPs and specialists (dermatologists, diabetologists and phlebologists). METHOD A transversal epidemiological survey was conducted on a randomly selected sample of the above practitioners between June and July 2008. The percentage of patients presenting on a routine working day with open a cutaneous lesion of any origin, location, size and duration was assessed. All local and systemic care performed on the patient during that day because of the wound was also recorded. RESULTS In total, 475 GPs, 453 specialists and 238 nurses participated (n=1166) and saw a total of 29 663 patients, of whom 3037 presented with one or more cutaneous wound. The overall non-weighted prevalence of patients with a wound was 10.2% (95%CI: 9.9%;10.6%). This prevalence was similar for GPs (6.0%) and for specialists (6.9%), but was higher for nurses (22.0%). Forty-three per cent of all wounds had a duration of over 6 weeks. These chronic wounds were predominantly leg ulcers, diabetic foot ulcers or pressure ulcers, but also included wounds of all aetiologies. For 33% of all patients with wounds, the impact on their health status was serious to severe. The overwhelming majority of wounds (95%) required local care, including in 65% of cases cleansing and debridement. CONCLUSION Despite its limitations, this initiative, the first of its type in France, strongly suggests that wound care constitutes an important part of routine care given by health professionals in the community, and for a substantial number of these patients, wounds represent a serious morbidity. DECLARATION OF INTEREST The non-profit organisation 'Association Vivre avec une Plaie' financially supported this study. This association received unrestricted grants from the French Wound Healing Society (SFFPC) and a consortium of private companies (main sponsors: ConvaTec, Genevrier, Hartmann, KCI, Mölnycke, Smith & Nephew, Urgo; minor sponsors: Coloplast, Covidien, HNE) to fund the costs incurred by the methodological process and statistical analysis but had no input into the findings. The National Health Insurance Organisation provided non-financial support to this initiative. J.C. Kerihuel received support for the submitted work from 'Association Vivre avec une Plaie'. S. Meaume, I. Fromantin and L. Téot have no financial relationship with 'Association Vivre avec une Plaie', for either this or any work submitted in the previous 3 years. The authors have no non-financial interests that may be relevant to the submitted work, and their spouses, partners, or children have no financial relationships that may be relevant to the submitted work | input | 2 | 78,851 | 74 | 236,145 |
Please summerize the given abstract to a title | instruction | 0 | 78,911 | 74 | 236,323 |
Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh. | output | 1 | 78,911 | 74 | 236,324 |
BACKGROUND Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers' drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge. METHODS A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. 'Pharmacy workers' include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers. RESULTS Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p < 0.001) and anticonvulsant drugs (MgSO4) (82.2% vs 17.8%; p < 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3-12.3, P < 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3-18.1, P < 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training. CONCLUSIONS Pharmacy workers' knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families. | input | 2 | 78,911 | 74 | 236,325 |
Please summerize the given abstract to a title | instruction | 0 | 78,969 | 74 | 236,497 |
Experiences and Perspectives of Marketing Authorisation Holders towards Medication Safety Monitoring during Pregnancy: A Pan-European Qualitative Analysis | output | 1 | 78,969 | 74 | 236,498 |
Although marketing authorisation holders (MAHs) are involved in monitoring medication safety, it was unclear how they experience their role and current monitoring activities in pregnancy. Therefore, a qualitative study using online focus groups with MAHs and the Belgian umbrella organisation of MAHs was conducted in June–July 2021. In total, 38 representatives of nine organisations participated. Overall, participants reported multiple difficulties with data collection, including underreporting, collection of incomplete information, and loss to follow-up. The limited number of high-quality data collected, the unknown denominator and the lack of comparator data complicate MAHs’ data processing activities, preventing them to timely provide evidence in the pregnancy label. Three ‘conflicts’ inherent to the specific position of MAHs were identified explaining the difficulties they experience, i.e., (1) mistrust from patients and healthcare professionals (HCPs); (2) MAHs’ legal obligations and regulatory framework; (3) MAHs’ position outside the healthcare context. To overcome these barriers, MAHs suggested that data registration should occur in close collaboration with patients and HCPs, organised within the healthcare context and performed by using a user-friendly system. In conclusion, the reported difficulties and underlying conflicts of MAHs highlight the need for more effective, collaborative data collection strategies to generate new evidence on this topic. | input | 2 | 78,969 | 74 | 236,499 |
Please summerize the given abstract to a title | instruction | 0 | 78,974 | 74 | 236,512 |
Digital health literacy as a super determinant of health: More than simply the sum of its parts | output | 1 | 78,974 | 74 | 236,513 |
• Civic literacy refers to the ability to engage meaningfully with one's community. • Digital, health, and civic literacy are key predictors for digital health literacy. • The extent to which these three affect digital health literacy remains unclear. • Building digital health literacy is vital to limit inequalities from expanding. | input | 2 | 78,974 | 74 | 236,514 |
Please summerize the given abstract to a title | instruction | 0 | 78,989 | 74 | 236,557 |
Delivering clinical trials at home: protocol, design and implementation of a direct-to-family paediatric lupus trial | output | 1 | 78,989 | 74 | 236,558 |
INTRODUCTION: Direct-to-family clinical trials efficiently provide data while reducing the participation burden for children and their families. Although these trials can offer significant advantages over traditional clinical trials, the process of designing and implementing direct-to-family studies is poorly defined, especially in children with rheumatic disease. This paper provides lessons learnt from the design and implementation of a self-controlled, direct-to-family pilot trial aimed to evaluate the effects of a medication management device on adherence to hydroxychloroquine in paediatric SLE. METHODS: Several design features accommodate a direct-to-family approach. Participants meeting eligibility criteria from across the USA were identified a priori through a disease registry, and all outcome data are collected remotely. The primary outcome (medication adherence) is evaluated using electronic medication event-monitoring, plasma drug levels, patient questionnaires and pill counts. Secondary and exploratory endpoints include (1) lupus disease activity measured by a remote SLE Disease Activity Index examination and the Systemic Lupus Activity Questionnaire; and (2) hydroxychloroquine pharmacokinetics and pharmacodynamics. Recruitment of the initial target of 20 participants was achieved within 10 days. Due to initial recruitment success, enrolment was increased to 26 participants. Additional participants who were interested were placed on a waiting list in case of dropouts during the study. DISCUSSION AND DISSEMINATION: Direct-to-family trials offer several advantages but present unique challenges. Lessons learnt from the protocol development, design, and implementation of this trial will inform future direct-to-family trials for children and adults with rheumatic diseases. Additionally, the data collected remotely in this trial will provide critical information regarding the accuracy of teleresearch in lupus, the impact of adherence to hydroxychloroquine on disease activity and a pharmacokinetic analysis to inform paediatric-specific dosing of hydroxychloroquine. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04358302). | input | 2 | 78,989 | 74 | 236,559 |
Please summerize the given abstract to a title | instruction | 0 | 78,995 | 74 | 236,575 |
2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society | output | 1 | 78,995 | 74 | 236,576 |
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored. | input | 2 | 78,995 | 74 | 236,577 |
Please summerize the given abstract to a title | instruction | 0 | 79,015 | 74 | 236,635 |
A tale of ‘politics and stars aligning’: analysing the sustainability of scaled up digital tools for front-line health workers in India | output | 1 | 79,015 | 74 | 236,636 |
INTRODUCTION: India has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability. METHODS: We assessed five FLHW digital tools scaled at the national and/or state level in India. We conducted in-depth interviews with implementers, technology and technical partners (n=11); senior government stakeholders (n=5); funders (n=1) and evaluators/academics (n=3). Emergent themes were grouped according to a broader framework that considered the (1) digital solution; (2) actors; (3) processes and (4) context. RESULTS: The scale-up of digital solutions was facilitated by their perceived value, bounded adaptability, support from government champions, cultivation of networks, sustained leadership and formative research to support fit with the context and population. However, once scaled, embedding digital health solutions into the fabric of the health system was hampered by challenges related to transitioning management and ownership to government partners; overcoming government procurement hurdles; and establishing committed funding streams in government budgets. Strong data governance, continued engagement with FLHWs and building a robust evidence base, while identified in the literature as critical for sustainability, did not feature strongly among respondents. Sustainability may be less elusive once there is more consensus around the roles played between national and state government actors, implementing and technical partners and donors. CONCLUSION: The use of digital tools by FLHWs offers much promise for improving service delivery and health outcomes in India. However, the pathway to sustainability is bespoke to each programme and should be planned from the outset by investing in people, relationships and service delivery adjustments to navigate the challenges involved given the dynamic nature of digital tools in complex health systems. | input | 2 | 79,015 | 74 | 236,637 |
Please summerize the given abstract to a title | instruction | 0 | 79,207 | 74 | 237,211 |
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