Complex Health Care Research Articles

Artificial intelligence governance framework for healthcare.

Recent advancements in the field of Artificial Intelligence (AI) provide promising applications of this technology with the aim of solving complex healthcare challenges. These include optimizing operational efficiencies, supporting clinical administrative functions, and improving care outcomes. Numerous AI models are validated in research settings but few make their way into useful applications due to challenges associated with implementation and adoption. In this article, we describe some of these challenges, along with the need for a facilitating entity to safely translate AI systems into practical use. The authors propose a new AI governance framework to enable healthcare organizations with a mechanism to implement and adopt AI systems.

Leveraging digital adherence technologies to enhance public health: insights from TB care in Ukraine

Abstract Background Effective tuberculosis (TB) care is vital for public health, especially in war-affected Ukraine. In response to the complex healthcare delivery landscape, where traditional directly observation treatment methods became impractical, digital adherence technologies (DATs) emerged as a promising solution, offering more autonomy for people, and remote monitoring capabilities for healthcare providers. Intervention The PATH-led USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project implemented smart pill boxes in eleven Ukrainian regions. These devices equipped with built-in reminders helped people adhere to their medication regimen, and signaled healthcare providers when the box was opened. Results Since April 2022, STBCEU has supported 2,022 people with TB who used smart pill boxes during their treatment, including 489 (24%) with drug-resistant TB (DR-TB). A total of 482 people continue utilizing boxes. Of 1,540 people with TB who completed the use of boxes, 1,207 people (78%) successfully completed TB treatment with an average of 84% treatment adherence rate digitally reported by the technology. Conclusions The integration of smart pill boxes in TB management has enhanced people-centered care, ensuring treatment continuity even in challenging circumstances and providing healthcare providers with real-time adherence data. The innovation contributed to TB control efforts and health equity through expanding opportunities for people to choose their treatment model based on their needs, available resources and community support programs. Leveraging digital solutions proved to be essential in strengthening healthcare systems. In the realm of TB management, DATs enhance differentiated care, embodying a harmonious integration of technology automation and provider interventions. Key messages • Integration of smart pill boxes enhanced patient-centered care, providing real-time adherence data and empowering individuals to choose personalized treatment models. • Digital technologies like smart pill boxes transformed TB care, offering tailored support for patients and remote monitoring capabilities for healthcare providers even in challenging circumstances.

A nurse-led multidisciplinary service for Nipple-Areola complex tattooing after breast cancer: reporting on a complex intervention with TIDieR analysis

BackgroundThe Nipple-Areola Complex (NAC) tattooing can restore physical and mental integrity after breast cancer, but it is not always easily accessible for women. This paper aims to report on the development of a multidisciplinary nurse-led service for NAC tattooing for women who underwent breast cancer surgery with NAC removal to allow its thorough review and replication.MethodsThe Medical Research Council’s framework for developing complex healthcare interventions was followed. According to the results of a literature review, and the context analysis, an initial intervention was planned. The Template for Intervention Description and Replication checklist was chosen to ensure the quality and completeness of the intervention description.ResultsThe Breast Unit and the Research departments were engaged; three nurse-tattooists were selected; the informative material was created and shared with patients, families and local associations, involving them actively. Finally, the setting and the materials were defined. A monthly schedule of activities was set: patients with the indication for NAC tattooing were contacted by the nurse case manager. Each treatment involves 3–4 sessions, 30–40 days apart, in an ambulatory setting. It consists of NAC shaping and tattooing with a dermographer and sterile needles.ConclusionImplementing freely and equally multidisciplinary nurse-led clinics might provide this treatment ensuring the patient’s quality of life and nurse competence. The NAC tattooing is a complex intervention that represents the final part of the breast cancer surgical care pathway.

Workplace stressors and their impact on the nurse managers role

Background: Nursing is one of the professions that is known to expose its members to stress. Additionally, nurse managers work in complex health care environments that expose them to a substantial amount of stress. Workplace stressors have a negative impact on the nurse managers’ performance. Objective: To explore workplace stressors and their impact on the nurse managers’ role. Methodology: The study followed a qualitative exploratory inquiry. Participants were nurse managers working in 11 public hospitals in Botswana. A total of 49 nurse managers participated in this study. A semi-structured interview guide was used to collect data through written narratives. Emerging themes were identified through the use of thematic analysis. Results: The study identified 6 themes that outlined workplace stressors as experienced by nurse managers as follows: shortage of resources; lack of managerial and leadership skills; lack of progression; lack of support from supervisors; staff indiscipline, and nature of work. Participants perceived that exposure to workplace stressors resulted in low morale, customer complaints, and compromised quality of care. Conclusions: The study revealed that nurse managers were exposed to various workplace stressors in the healthcare environment. It was identified that the stress impacted negatively on the quality of care delivered to patients.

Learning by Visualize a Nurse-Led CCOS Using the Functional Resonance Analysis Method.

Quality improvements (QIs) in dynamic and complex health care contexts require resilience and take variability into account in quality improvement. The Functional Resonance Analysis Method (FRAM) helps us understand resilience and gain insight into (un)desirable variability in the complex system of daily practice. We explored how using FRAM in the Deming cycle of a QI project can help professionals and researchers learn from, reflect upon, and improve complex processes. We used FRAM in a Dutch hospital to study a QI: Critical Care Outreach Service (CCOS). The aim was to use FRAM before and after implementation to create a FRAM model and reflect to health care professionals the mismatch between Work As Imagined (WAI) and Work As Done (WAD). The WAI FRAM model was co-created with professionals before the implementation of CCOS. We used descriptions of tasks and processes for ICU nurses and verified them in 30-minute semistructured interviews (N = 2). WAD was created by input of semistructured interviews with key professionals in CCOS (N = 21) and 3 nonparticipant observations of trained CCOS nurses. We validated WAD in 2 dialogue sessions with key professionals (N = 11). Data collection continued until saturation. Juxtaposing the WAI and WAD models showed that WAD contained additional functions and highlighted unexpectedly complex functions. Reflecting on the application of FRAM with health care professionals revealed opportunities and challenges, especially time investment. FRAM helps professionals outline processes and tasks (WAI), learn from, and reflect upon their daily practice (WAD). FRAM models help professionals identify variability proactively to improve practices that enhance resilient performance.

Web Scrapping Tools used in Healthcare Sector

Web scraping has become essential in the healthcare sector and provides vast opportunities for data access and analysis. This abstract outlines several key web scraping tools commonly used in healthcare:: Scrapy: A Python-based framework for structured data extraction from various medical sources, offering adaptability and scalability. Beautiful Soup: Facilitates seamless data extraction from medical websites and research articles with its user-friendly interface. Selenium: Particularly useful for extracting data from dynamic healthcare websites driven by JavaScript. Octoparse: Empowers healthcare professionals to extract data without programming expertise through an intuitive interface. ParseHub: Simplifies data extraction from complex healthcare websites with scheduling capabilities. Import.io: A visual API-based scraping solution for integrating and analyzing data from web pages and APIs. WebHarvy: Streamlines data retrieval from medical websites, journals, and forums with automatic configuration and diverse export options. Web scraping tools are invaluable for accessing and analyzing health information, enhancing assessment, decision-making, and patient outcomes. However, adherence to legal and ethical guidelines, including data privacy and consent considerations, is crucial for responsible use in the healthcare industry.

Onboarding Foreign-Educated Nurses: Best Practices for Nurse Educators.

For foreign-educated nurses (FEN) to effectively adapt to the complex healthcare system that exists in the United States, they need effective onboarding and integration into the workforce and community. A positive transition to practice promotes loyalty, confidence in clinical competence, and professional development. Using best practice guidelines in the literature, nurse educators can develop, implement, and evaluate transition programs for FEN practicing in the United States.

Registered Nurses' Attitudes Towards ChatGPT and Self-Directed Learning: A Cross-Sectional Study.

Self-directed, lifelong learning is essential for nurses' competence in complex healthcare environments, which are characterised by rapid advancements in medicine and technology and nursing shortages. Previous studies have demonstrated that ChatGPT technology fosters self-directed learning by motivating users to engage with it. To explore the relationships amongst socio-demographic data, attitudes towards ChatGPT use, and self-directed learning amongst registered nurses in Taiwan. A cross-sectional study design with an online survey was adopted. Registered nurses from various healthcare settings were recruited through Facebook and LINE, a widely used messaging application in East Asia, reaching over 1000 nurses across five distinct online groups. An online survey was used to collect data, including socio-demographic characteristics, attitudes towards ChatGPT use, and a self-directed learning scale. Data were analysed using descriptive statistical methods, t-tests, Pearson's correlation, one-way analysis of variance, and multiple linear regression analysis. Amongst the 330 participants, 50.6% worked in hospitals, 51.8% had more than 15 years of work experience, and 78.2% did not hold supervisory positions. Of the participants, 46.7% had used ChatGPT. For all nurses, work experience and awareness of ChatGPT statistically significantly predicted self-directed learning, explaining 32.0% of the variance. For those familiar with ChatGPT, work experience in nursing and the technological/social influence of ChatGPT statistically significantly predicted self-directed learning, explaining 35.3% of the variance. Work experience in nursing provides critical opportunities for professional development and training. Therefore, ChatGPT-supported self-directed learning should be customised for degrees of experience to optimise continuous education. This study explores nurses' diverse use of and attitudes towards ChatGPT for self-directed learning. It suggests that administrators customise support and training when incorporating ChatGPT into professional development, accounting for nurses' varied experiences to enhance learning outcomes. No patient or public contribution. This study adhered to the relevant cross-sectional STROBE guidelines.

Role of caregivers being trained in assisting in end of life care - Latin American perspective.

Palliative care in Latin America is evolving, but training for informal caregivers remains underexplored. This review summarizes recent interventions to educate or train caregivers in end-of-life care. The literature search identified three interventions published by 2023, two with reception evaluations, all with small sample sizes and no control groups. Needs of caregivers have been more frequently described and include training on aspects of the disease, nursing skills, how to handle patients´ and own emotions; help in navigating the complex healthcare systems in Latin America; help in conversations about the end of life and dying, still taboos in the region; help in finding additional caregivers or other types of support to make the caregiving role sustainable over time for the caregiver. Interventions mainly focused on emotional support and identifying additional caregivers without guilt; two included nursing skills training. There are very few formal interventions described and evaluated to assist caregivers in end-of-life care in Latin America described in the literature. This illustrates the rather invisible but very important role of these important stakeholders in the care for patients. Multidimensional interventions should be developed and evaluated to support caregivers.

Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy

There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring – aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.

Hospital stays and probable dementia as predictors of relocation to long-term care facilities.

This study aims to investigate the relocation of older adults in the US from community living to long-term care facilities (LTCFs). Specifically, it examines the predictive roles of possible and probable dementia and hospital stays in this complex health care transition. Utilizing data from the National Health and Aging Trends Study, a longitudinal cohort study (2011-2019), we employed a panel data approach, which consists of multiple observations over time for the same participants, allowing us to account for both cross-sectional variations (differences between participants) and time-series variations (changes in the same participant over time). The analysis involved longitudinal logistic regression models. Using the AD8 dementia screening interview, clock drawing test, immediate and delayed word recall test, orientation, and history of dementia diagnosis, we placed participants into categories of having no dementia, possible dementia, and probable dementia. A survey asked about hospital stays in the past year. Relocation to LTCFs was examined based on the changes to the living location. The proportion of individuals transitioning to LTCFs tripled between 2011 and 2019, emphasizing the need to understand and manage this health care transition. Hospital stays significantly increased the probability of moving to LTCFs, especially nursing homes. Probable dementia demonstrated a 3-fold increase, aligning with the rising prevalence of Alzheimer disease. Difficulty walking and climbing stairs significantly increased relocation probabilities. The study findings emphasize complexity in late-life relocations influenced by dementia and hospital stays. Screening for cognitive function among community-dwelling older adults, particularly those with a history of hospital stays and mobility difficulties, can inform interventions and policies. Implications extend to health care policy, geriatric care, and the imperative for targeted interventions considering demographic variations. Future research should explore additional variables and address limitations to refine our understanding of the relocation process.

Conceptual Considerations for Understanding Resilience in Healthcare Students.

Increasing attention has been given to the concept resilience in the context of healthcare especially during and post the COVID pandemic. Much of the inquiry and evidence reported has focused on promoting or enhancing resilience in healthcare for improving the quality of care and reducing medical negligence. This discursive paper aims to highlight how resilience is conceptualised and identify any potential limitations or gaps in the context of healthcare students, acknowledging considerations for further development and research into this topic. This discursive discussion draws on relevant theoretical underpinnings from the fields of adjustment and coping psychology, and research and evidence from health sciences, for facilitating an understanding of resilience in supporting healthcare students to adapt into professional practice. Investigation of resilience in healthcare students is mainly identified at an individual level as personal traits or skills for working within complex healthcare systems and clinical environments. Less attention has been given to examining resilience at the organisation or systemic level. This is primarily because of limited frameworks for investigating resilience from a multidimensional perspective recognising a wider systemic level influenced by external factors including socioecological determinants, for example, available support services for healthcare students. The link between resilience and its function to mitigate against associated neuropsychological distress and subsequent pathopsychological disorders in healthcare student cohorts is recognised; however, greater understanding of resilience as a multidimensional construct is warranted. A multidimensional investigation of resilience is critical for the preparation and readiness of healthcare structures and organisations in facilitating the needs of healthcare students entering challenging and diverse healthcare working environments. No patient or public contribution.

Barriers and facilitators of healthcare professionals in integrating shared decision-making in pancreatic cancer treatment: A network approach.

Shared decision-making (SDM) is crucial in pancreatic cancer treatment due to its choice-sensitive nature and limited prognosis. Treatment of pancreatic cancer is organized in a network approach. Several obstacles exist on different levels-patient, healthcare professional, organizational, societal-that impede integration of SDM. This study aims to identify barriers and facilitators to SDM implementation within a comprehensive cancer network. A qualitative research design was applied, involving interviews and focus groups on barriers and facilitators with healthcare professionals involved in the implementation of SDM. In one comprehensive cancer network in the Netherlands, including seven hospitals, a project was initiated with the goal of empowering patients and healthcare professionals in SDM throughout primary, secondary and tertiary healthcare settings. A total of 17 participants were assessed. Directed qualitative content analysis was performed by two researchers. Main findings revealed barriers such as time constraints, lack of priority of physicians, little involvement of general practitioners, and insufficient social context of patients in referrals, alongside facilitators including learning communities with practical SDM examples, metro mapping, involvement of case manager in implementation and patient empowerment strategies. Addressing cultural, systemic barriers and developing innovative strategies are of importance to enhance SDM in pancreatic cancer treatment in a network approach. This study provides understanding of SDM implementation in complex healthcare settings and offers valuable guidance for future interventions seeking to improve decision-making processes in pancreatic cancer treatment and beyond.

Raising the Flag of Vigilance on Mpox Outbreak in Indonesia: Are We Prepared?

In the wake of the COVID-19 pandemic, the world has become acutely aware of the devastating impact of infectious diseases on public health, economies, and societies. As we gradually recover from the aftermath of COVID-19, another potential threat looms on the horizon, mpox, formerly known as monkeypox. The recent surge in mpox cases worldwide has prompted health authorities to sound an alarm, and Indonesia, as a populous nation with a complex healthcare system, must ask itself: Are we prepared for this emerging challenge?. The question "Are we prepared?" may not have a simple yes or no answer. Instead, it should serve as a reminder of the need for vigilance, adaptation, and continuous improvement in public health systems. As we navigate this new health challenge, the true measure of Indonesia's preparedness is its ability to respond swiftly, effectively, and equitably to protect the health and well-being of all citizens.

Níos Fearr Le Chéile/Together is Better: ICPOP Case Review of Intervention for an Older Carer of a Referred Patient

Abstract Background The Integrated Care Programme for Older Persons (ICPOP) aims to implement integrated services and care pathways for older adults with complex health and social care needs. The aim is to place patients at the center of their healthcare decision making and to support them to live well in their homes and communities. A Comprehensive Geriatric Assessment (CGA), which is the gold standard for the management of frailty in older persons, is carried out on all referred patients at the initial home visit. It is often as an ICPOP assessor delves deeply into the family unit that frailty makers such as decreased mobility, declining cognition, poor appetite, polypharmacy is identified in the non-referred cohabitating person who is also over 65 years of age (Potier et al., 2018). Methods The purpose of this poster is to demonstrate how a holistic approach to care within a household led to the incidental finding of frailty in a family carer who was also an older adult. This case review will illustrate how the referral of one half of a married couple led to opportunistic multi-disciplinary intervention for the second person. Following discussion, at MDT level, of both the referred patient and their spouse, a request for a formal referral to ICPOP for the second person was made to the GP, as it is a referral criteria for ICPOP referrals. Results ICPOP intervention ultimately led to home supports being put in place for both parties along with medical reviews, rationalisation of medications and assistive technology supports, this enabled both patients to live well and safely at home. Conclusion A comprehensive geriatric assessment using a holistic approach resulted in intervention for both parties with a positive outcome for the entire family.

Filling the gaps in the COVID-19 pandemic response: medical personnel in the US military health system

BackgroundThe COVID-19 pandemic was an unprecedented public health emergency that heavily affected the healthcare workforce. Although the Military Health System (MHS) has robust capabilities and was able to deploy medical staff to support civilian hospitals during the crisis, it too was adversely impacted by personnel issues. We aimed to identify and address gaps in understanding the impact of the COVID-19 pandemic on healthcare personnel in the MHS.MethodsWe conducted semi-structured key informant interviews with 28 MHS stakeholders, including policymakers, program managers, and healthcare providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo.ResultsBurnout and mental health concerns across the workforce increased during the pandemic, although some felt military culture facilitated resilience. Reduction in personnel was noted and slow hiring processes and noncompetitive wages hindered hiring, contributing to staffing shortages. Initial disruptions occurred in training and skills readiness, although these issues were reduced over time. Concerns remain about newer trainees’ preparedness and teaching staff’s availability in the MHS.ConclusionThis study uniquely assessed the impact of the COVID-19 pandemic response on the MHS healthcare workforce through in-depth key informant interviews. Multi-pronged strategies are needed to promote personnel well-being in complex healthcare systems like the MHS.

When Things Go Right: Safety II in an Academic Emergency Department.

Objectives Historically, "safety" has been defined as an absence of error. Practice variability of any kind has been viewed as a threat. This is termed Safety I. Meanwhile, Safety II posits that clinician practice variability is a necessary adaptation required to meet patient needs in a complex healthcare system. We hypothesize that clinicians in the emergency department (ED) make proactive adaptations and utilize practice variability to enhance safety. Methods This is a cross-sectional survey-based study of clinical team members at a tertiary care academic ED with an annual census of 76,000. Qualitative data on instances of proactive safety were collected and analyzed via inductive response analysis. Ratings of support for practice adjustments and experiences of negative emotions during practice variability were collected using 5-point Likert scales. Results There were 84 respondents, of which 33 (39%) were nurses, 28 (33%) were physicians, and 23 (27%) held other clinical roles. Qualitative data included 128 instances of harm prevention, with some respondents describing more than one. Instances include proactive safety via collaboration (n = 47; 36.72%), time-based interventions (n = 46; 35.94%), physical harm prevention (n = 27; 21.10%), and patient/visitor interactions (n = 8; 6.25%). Of respondents, 73.17% (n = 30) felt that policies matched daily work most of the time, and 92.68% (n = 38) felt enabled to adapt to the needs of a patient most of the time. Experiences of self-doubt, fear of repercussion, or anxiety occurred most when adhering to a policy despite patient needs (n = 20; 48.78%). Conclusions Clinical team members report keeping patients safe through various forms of behavior adaptations, most frequently reporting collaboration beyond usual expected practice. Respondents report policies to match daily work most of the time and feel enabled to adapt to the needs of patients. Feelings of self-doubt, fear of repercussion, or anxiety were reported most frequently when clinicians adhered to a policy despite the needs of a patient.

Adapting citizens’ jury methodology for use in Uganda: use of creative arts as a tool in deliberative, participatory research

ABSTRACT A citizens’ jury is a method of deliberative action research to determine the perspectives of community members regarding complex healthcare issues. This approach is a novel paradigm in settings such as Uganda. Implementation of electronic medical records brings the potential to use routinely collected data for health research. It is important to understand community perspectives. A two-day citizens’ jury was hosted in Kampala. ‘Expert witnesses’ provided topical evidence. Three creative arts techniques were implemented to enable interaction and reflection. First, a local Ugandan film team produced summaries. Secondly, a local artist painted emerging themes. Finally, a drama team comprised community members living with HIV developed an interactive sketch highlighting key points. This creative methodology enabled vibrant interaction. Jurors reached a unanimous verdict that with appropriate consent and data protection, electronic medical data could be used for research. This adapted citizens’ jury methodology could be used in other similar settings.

User-Centered Design and Usability of Voxe as a Pediatric Electronic Patient-Reported Outcome Measure Platform: Mixed Methods Evaluation Study.

Electronic patient-reported outcome measures (ePROMs) are standardized digital instruments integrated into clinical care to collect subjective data regarding patients' health-related quality of life, functional status, and symptoms. In documenting patient-reported progress, ePROMs can guide treatment decisions and encourage measurement-based care practices. Voxe is a pediatric and user-centered ePROM platform for patients with chronic health conditions. We aimed to describe the user-centered design approach involving feedback from end users and usability testing of Voxe's platform features to support implementation in a pediatric health care setting. Purposive sampling was used to recruit patients aged 8-17 years from 2 chronic illness populations in 2 pediatric hospitals in Canada. Patients' health care team members were also purposively recruited. One-on-one iterative testing sessions were conducted digitally by research team members with participants to obtain feedback on the appearance and functionalities of the Voxe platform prototype. Patients and health care providers (HCPs) completed Voxe-related task-based activities. International Organization for Standardization key performance indicators were tracked during HCP task-based activities. HCPs also completed the System Usability Scale. To test platform usability, the think-aloud technique was used by participants during the completion of structured tasks. After completing all task-based activities, patient participants selected 5 words from the Microsoft Desirability Toolkit to describe their overall impression and experience with the Voxe platform. Qualitative data about likes, dislikes, and ease of use were collected through semistructured interviews. Feedback testing sessions were conducted with patients and HCPs until Voxe was acceptable to participating end users, with no further refinements identified. Quantitative and qualitative data analysis were completed using descriptive statistics and content analysis. A total of 49 patients and 38 HCPs were recruited. Patients were positive about Voxe's child-centered design characteristics and notification settings. HCPs rated Voxe as user-friendly and efficient, with the time to complete tasks decreasing over time. HCPs were satisfied with the Voxe platform functionalities and identified the value of Voxe's system notifications, summarized display of ePROM results, and its capacity to integrate with electronic medical records. Patients' and HCPs' high satisfaction rates with the Voxe prototype highlight the importance of being responsive to user suggestions from the inception of eHealth platform developments to ensure their efficient and effective design. This paper describes the user-centered creation and usability testing of Voxe as an ePROM platform for implementation into clinical care for pediatric patients with chronic health conditions. As a patient-facing platform that can be integrated into electronic medical records, Voxe aligns with measurement-based care practices to foster quality patient-centered approaches to care. End users' positive feedback and evaluation of the platform's user-friendliness and efficiency suggest that Voxe represents a valuable and promising solution to systematically integrate patient-related outcome (PRO) data into complex and dynamic clinical health care settings. RR2-10.1136/bmjopen-2021-053119.

Development of Seizures Following Traumatic Brain Injury: A Retrospective Study.

Objectives: The multifaceted impact of Traumatic brain injury (TBI) encompasses complex healthcare costs and diverse health complications, including the emergence of Post-Traumatic Seizures (PTS). In this study, our goal was to discern and elucidate the incidence and risk factors implicated in the pathogenesis of PTS. We hypothesize that the development of PTS following TBI varies based on the type and severity of TBI. Methods: Our study leveraged the Nationwide Inpatient Sample (NIS) to review primary TBI cases spanning 2016-2020 in the United States. Admissions featuring the concurrent development of seizures during the admission were queried. The demographic variables, concomitant diagnoses, TBI subtypes, hospital charges, hospital length of stay (LOS), and mortality were analyzed. Results: The aggregate profile of TBI patients delineated a mean age of 61.75 (±23.8) years, a male preponderance (60%), and a predominantly White demographic (71%). Intriguingly, patients who encountered PTS showcased extended LOS (7.5 ± 9.99 vs. 6.87 ± 10.98 days, p < 0.001). Paradoxically, PTS exhibited a reduced overall in-hospital mortality (6% vs. 8.1%, p < 0.001). Notably, among various TBI subtypes, traumatic subdural hematoma (SDH) emerged as a predictive factor for heightened seizure development (OR 1.38 [1.32-1.43], p < 0.001). Conclusions: This rigorous investigation employing an extensive national database unveils a 4.95% incidence of PTS, with SDH accentuating odds of seizure risk by OR: 1.38 ([1.32-1.43], p < 0.001). The paradoxical correlation between lower mortality and PTS is expected to be multifactorial and necessitates further exploration. Early seizure prophylaxis, prompt monitoring, and equitable healthcare provision remain pivotal avenues for curbing seizure incidence and comprehending intricate mortality trends.