Electronic Letters Research Articles

P-101. Patient-reported outcomes and home-based self-swabs for influenza-like illness events - Lessons learned from the DANFLU-2 HomeSwab PRO Study

Abstract Background Patient-reported outcomes (PRO) and self-swab studies may offer to improve monitoring of infectious diseases. The DANFLU-2 HomeSwab PRO study aimed to assess the practicality of self-administered swabs and digital PRO tracking to monitor influenza-like illness (ILI). Methods As part of a sub-study of the DANFLU-2 trial, participants were instructed to self-report ILI and quality of life (QoL) using the Respiratory Intensity and Impact Questionnaire (RiiQ) for 14 days following symptom onset. If symptomatic, a home-based self-swab was performed, registered via a web app, and mailed to a central center for PCR testing by the participant. Weekly compliance reminders were sent through a governmental electronic letter system. Results Overall, 1,976 DANFLU-2 participants were enrolled. During the study period, 208 participants (10.5%) filled out at least one RiiQ, among which 171 (82.2%) reported symptoms fulfilling the ILI case definition. Response rate for completing all 14 days of RiiQs following an ILI event was 85.7% [IQR: 64.3; 100]. In total, 51.4% required phone reminders due to a 48-hour non-response period within the 14 days, with a median of 1 [IQR: 1; 1] contact attempts per non-responding participant. Overall, 89.4% of participants with an ILI event reported having performed a self-swab within a median of 1 day [IQR: 0; 3] from ILI symptom onset. In total, 65.8% of swabs were correctly registered in the web app, and 96.5% of all swabs tested RNaseP positive. During the study, 36 participants (1.8%) withdrew from the study after a median of 59 days [IQR: 25; 108], primarily due to bother from weekly reminders. To reduce dropouts, the possibility of adjusting frequency of reminders was offered, with 40 participants (2.0%) opting to receive monthly reminders and 47 (2.4%) opting to receive no further reminders. The DANFLU-2 staff received 323 e-mails with participant queries about the study. Responses were given to 167 queries via e-mail and 156 via phone calls. Conclusion The study confirmed the feasibility of using home-based self-swabs and digital PRO tracking within influenza studies. While the approach proved viable, the findings also highlighted areas for improvement in participant engagement and data collection efficiency. Disclosures Kristoffer Grundtvig Skaarup, MD, Sanofi: Board Member Nabila Shaikh, MSc, Sanofi: Stocks/Bonds (Public Company) José Bartelt-Hofer, Dr., Sanofi: Employee|Sanofi: Stocks/Bonds (Private Company) Erica Dueger, Dr., Sanofi: Employee|Sanofi: Stocks/Bonds (Private Company) Matthew M. Loiacono, PhD, MSc, Sanofi: full-time employee|Sanofi: Stocks/Bonds (Public Company) Rebecca C Harris, MBioch, MSc, PhD, Sanofi vaccines: Stocks/Bonds (Private Company) Robertus van Aalst, PhD, MSc, Sanofi: Employee|Sanofi: Stocks/Bonds (Public Company) Marine Dufournet, PhD, Sanofi: Work|Sanofi: Ownership Interest Carsten Schade Larsen, MD, DMSc, Danske Lægers Vaccinations Service: Employee|GSK: Advisor/Consultant|GSK: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Takeda: Advisor/Consultant|Takeda: Honoraria|Valneva: Advisor/Consultant|Valneva: Honoraria Brian L Claggett, PhD, Amgen: Honoraria|Cardurion: Honoraria|Corvia: Honoraria|Myokardia: Honoraria|Novartis: Honoraria Scott D. Solomon, MD, Actelion: Grant/Research Support|Alnylam: Grant/Research Support|Amgen: Grant/Research Support|AstraZeneca: Grant/Research Support|Bayer: Grant/Research Support|Bellerophon: Grant/Research Support|BMS: Grant/Research Support|Celladon: Grant/Research Support|Cytokintetics: Grant/Research Support|Eidos: Grant/Research Support|Gilead: Grant/Research Support|GSK: Grant/Research Support|Ionis: Grant/Research Support|Lilly: Grant/Research Support|Mesoblast: Grant/Research Support|Myokardia: Grant/Research Support|Neurotronik: Grant/Research Support|NIH/NHLBI: Grant/Research Support|Novartis: Grant/Research Support|Novartis: Honoraria|Novo Nordisk: Grant/Research Support|Sanofi: Grant/Research Support|Theracos: Grant/Research Support|US2.AI: Grant/Research Support Lars Køber, MD, DMSc, AstraZeneca: Honoraria|Bayer: Honoraria|Boejringer Ingelheim: Honoraria|Novartis: Honoraria|Novo Nordisk: Honoraria Tor Biering-Sørensen, MD, PhD, Amgen: Advisor/Consultant|Bayer: Honoraria|Boston Scientific: Honoraria|CSL Squirus: Honoraria|GE Healthcare: Honoraria|GSK: Honoraria|Novartis: Honoraria|Novo Nordisk: Honoraria|Sanofi: Honoraria

Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction

Influenza vaccination in patients with acute myocardial infarction (AMI) reduces major adverse cardiac events and is strongly recommended in clinical practice guidelines. Effective strategies to improve vaccination are needed in these high-risk patients. To evaluate whether electronically delivered behavioral nudges improve influenza vaccine uptake in patients with AMI across 3 nationwide implementation randomized clinical trials (RCTs). Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake (NUDGE-FLU), Nationwide Utilization of Danish Government Electronic Letter System for Confirming the Effectiveness of Behavioral Nudges in Increasing Influenza Vaccine Uptake Among Older Adults (NUDGE-FLU-2), and Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake Among Adults With Chronic Disease (NUDGE-FLU-CHRONIC) were RCTs conducted during the 2022 to 2023 and 2023 to 2024 influenza seasons in Denmark. Participants were randomized to either usual care or various behaviorally informed, electronically delivered, letter-based nudges. In a prespecified participant-level pooled meta-analysis, interaction of AMI status on the effects of letter-based nudges vs usual care was examined. Pooled treatment effects were estimated using binomial regression models with identity link, adjustment for trial, and 2-way clustered SEs at the household and participant levels. Effect modification by recency of AMI as a continuous variable was assessed using restricted cubic spline modeling in NUDGE-FLU-CHRONIC. Behaviorally informed, electronically delivered, letter-based nudges or usual care. The primary end point was influenza vaccination receipt. Of 2 146 124 individual randomizations (mean [SD] age, 71.1 [11.6] years; 1 114 725 female [51.9%]) across all 3 trials, 59 458 (2.8%) had a history of AMI. Improvement in vaccine uptake was similar in patients with vs without a history of AMI who received any nudge letter compared with usual care (+1.81 vs +1.32 percentage points; P for interaction by AMI status = .09). A letter highlighting the cardiovascular benefits of vaccination (ie, cardiovascular-gain frame) resulted in larger improvements in vaccine uptake among patients with (vs without) a history of AMI (+3.91 vs +2.03 percentage points; P for interaction by AMI status = .002). Among patients with AMI, the benefits of the cardiovascular-gain frame letter were more pronounced in those not vaccinated in the prior season (+13.7 vs +1.48 percentage points; P for interaction <.001). Among younger participants with chronic disease, the cardiovascular-gain frame letter was particularly effective in patients with more recent AMI (P for interaction by continuous recency of AMI <.001). Across 3 nationwide RCTs of Danish citizens, messaging emphasizing the cardiovascular benefits of vaccination improved influenza vaccination uptake, with greater benefits observed in patients with a history of AMI. This low-cost, scalable implementation strategy should be considered to encourage influenza vaccination in high-risk patients. ClinicalTrials.gov Identifiers: NCT05542004, NCT06030726, NCT06030739.

Electronic nudge letters to increase influenza vaccination uptake in younger and middle-aged individuals with diabetes: a prespecified analysis of the NUDGE-FLU-CHRONIC trial

Abstract Background Despite evidence demonstrating that influenza vaccination is associated with reduced risk of adverse cardiovascular events and all-cause mortality, influenza vaccine uptake remains suboptimal in persons with diabetes mellitus (DM). Purpose In this prespecified analysis of the NUDGE-FLU-CHRONIC trial we assessed the effectiveness of electronically delivered nudges on influenza vaccine uptake according to DM status. Methods NUDGE-FLU-CHRONIC was a nationwide, randomized, pragmatic implementation trial among younger and middle-aged (18-64 years) Danish citizens with chronic disease during the 2023/2024 influenza season. All trial participants were eligible for a free influenza vaccination through the Danish governmental vaccine program. Participants were randomized in a 2.45:1:1:1:1:1:1 ratio to usual care (no electronic letter) or one of 6 different electronic nudge letters delivered on Sep 26, 2023. Baseline and outcome data were obtained using the Danish nationwide registries. The endpoint was receipt of a seasonal influenza vaccine on or before Jan 1, 2024. Results Of 299,881 NUDGE-FLU-CHRONIC participants, 57,666 (19.2%) had DM at baseline. Participants with DM had a median age of 51.6 years, 43.0% were female, median Hba1c of 53 mmol/mol, median DM duration of 10.0 years, and 51.2% were insulin dependent. During follow-up, 43.0% of those with DM vs. 34.6% of those without DM received the seasonal influenza vaccine (p&amp;lt;0.001). Any electronic letter vs. usual care was highly effective in increasing vaccine uptake in participants with DM at baseline (45.6% vs. 36.5%, difference: +9.1 percentage points [99.29%CI: 7.9-10.3], relative risk ratio [RR]: 1.42, 99.29%CI: [1.39-1.44]). However, DM status modified the effect of any electronic letter such that participants without DM at baseline experienced a slightly greater effect than those with DM (37.3% vs. 25.9%, difference: +12.3 percentage points [11.7-12.8], RR: 1.47 [1.45-1.50]; p-interaction &amp;lt;0.001). For each individual electronic nudge letter, the effect of the intervention was slightly lower in participants with DM compared to those without (Figure 1; all p-interaction &amp;lt; 0.015). When assessing DM subgroups, the effect of any electronic letter vs. usual care was greater in participants with DM and concomitant cardiovascular disease than in those without, greater in non-insulin treated than in insulin-treated individuals, and greater in those with shorter diabetes duration. Effectiveness of nudges were consistent across all other DM subgroups including HbA1c level (Figure 2). Conclusions Electronic nudge letters significantly boosted vaccine uptake in a broad range of individuals with DM, but the effect was slightly lower compared to those without DM. Future studies should test whether behaviorally designed nudges may positively influence other health behaviors in people with diabetes.

Electronic nudges to increase influenza vaccination in patients with chronic kidney disease: a prespecified analysis of NUDGE-FLU-CHRONIC

Abstract Background Annual influenza vaccination is recommended for individuals with chronic kidney disease (CKD); however, guideline adherence is suboptimal potentially related to lack of awareness of vaccine availability and effectiveness. Purpose This prespecified analysis of the NUDGE-FLU-CHRONIC trial investigated the effectiveness of digital behavioral nudges on influenza vaccine uptake based on the presence or absence of CKD. Methods NUDGE-FLU-CHRONIC was a randomized, nationwide trial, conducted during the 2023/2024 influenza season including younger and middle-aged (18-64 years) Danish citizens with chronic illnesses (making them eligible for the free Danish vaccine program). Participants were randomized in a ratio of 2.45:1:1:1:1:1:1 to receive either usual care (no letter) or one of six different letter-based nudges, delivered via the governmental electronic letter system on September 26, 2023. Baseline and outcome data were obtained with the Danish nationwide registers. Primary endpoint was receipt of an influenza vaccine no later than January 1, 2024. Results A total of 299,881 individuals were randomized in NUDGE-FLU-CHRONIC trial, among them, 15,208 (5.1%) had a history of CKD. Participants with CKD had a median age was 53.1 years (IQR, 42.2-59.6) and 46.0% were female. During follow-up, 43.7% of participants with CKD were vaccinated compared with 35.8% of participants without CKD (p&amp;lt;0.001). Any letter was highly effective in increasing influenza vaccination in the overall population but was slightly less effective in those with a history of CKD (p for interaction = 0.005). In participants with CKD, any letter increased vaccination by 25% versus no letter (46.3% vs. 37.1%; difference, 9.3 percentage points; 99.29%CI, 6.9-11.6; RR, 1.25; 99.29%CI, 1.18-1.33). In participants without CKD, any letter increased vaccination by 43% (39.2% vs. 27.4%; difference, 11.8 percentage points; 99.29%CI, 11.3-12.3; RR, 1.43; 99.29%CI, 1.41-1.45). Similar patterns were observed when assessing each intervention letter individually (Figure 1). Effectiveness of any letter vs. usual care was consistent across CKD subgroups, except for concomitant diabetes vs no diabetes (Figure 2). There was no observed effect modification by CKD duration (p for interaction = 0.78) or by estimated glomerular filtration rate (p for interaction = 0.78) modelled continuously for any letter vs. usual care. Conclusion In this prespecified analysis from the nationwide NUDGE-FLU-CHRONIC trial, only approximately 1 in 3 younger and middle-aged adults with CKD received influenza vaccination. Digital nudge letters emphasizing the importance of annual influenza vaccination significantly boosted rates of vaccination across a broad range of individuals with CKD.Figure 1Figure 2

Electronic Nudges to Increase Influenza Vaccination in Patients With Chronic Diseases

Despite strong worldwide guideline recommendations, influenza vaccination rates remain suboptimal among young and middle-aged patients with chronic diseases. Effective scalable strategies to increase vaccination are needed. To investigate whether electronically delivered letter-based nudges informed by behavioral science could increase influenza vaccination uptake among patients aged 18 to 64 years with chronic diseases. Nationwide pragmatic registry-based randomized clinical implementation trial conducted between September 24, 2023, and May 31, 2024, enrolling all Danish citizens aged 18 to 64 years who met criteria for free-of-charge influenza vaccination in light of preexisting chronic disease. All trial data were sourced from nationwide administrative health registries. Randomized in 2.45:1:1:1:1:1:1 ratio to no letter (usual care) or 6 different behaviorally informed electronic letters. The primary end point was receipt of influenza vaccination on or before January 1, 2024, assessed in 7 prespecified coprimary comparisons (all intervention groups pooled vs usual care and each individual intervention group vs usual care). Absolute risk difference in proportions and a crude relative risk were calculated for each comparison. A total of 299 881 participants (53.2% [159 454] female, median age, 52.0 [IQR, 39.8-59.0] years) were randomized. Compared with usual care, influenza vaccination rates were higher among those receiving any intervention letter (any intervention letter, 39.6% vs usual care, 27.9%; difference, 11.7 percentage points; 99.29% CI, 11.2-12.2 percentage points; P < .001). Each individual letter type significantly increased influenza vaccination with the largest effect sizes observed with a repeated letter sent 10 days after the initial letter (repeated letter, 41.8% vs usual care, 27.9%; difference, 13.9 percentage points; 99.29% CI, 13.1-14.7 percentage points; P < .001) and a letter emphasizing potential cardiovascular benefits of vaccination (cardiovascular gain, 39.8% vs usual care, 27.9%; difference, 11.9 percentage points; 99.29% CI, 11.1-12.7 percentage points; P < .001). Vaccination rates were improved across major subgroups. In a nationwide randomized clinical implementation trial, electronically delivered letter-based nudges markedly increased influenza vaccination compared with usual care among young and middle-aged patients with chronic diseases. The results of this study suggest that simple, scalable, and cost-efficient electronic letter strategies may have substantial public health implications. ClinicalTrials.gov Identifier: NCT06030739.

Design of patient-facing immunization visualizations affects task performance: an experimental comparison of 4 electronic visualizations.

This study experimentally evaluated how well lay individuals could interpret and use 4 types of electronic health record (EHR) patient-facing immunization visualizations. Participants (n = 69) completed the study using a secure online survey platform. Participants viewed the same immunization information in 1 of 4 EHR-based immunization visualizations: 2 different patient portals (Epic MyChart and eClinicWorks), a downloadable EHR record, and a clinic-generated electronic letter (eLetter). Participants completed a common task, created a standard vaccine schedule form, and answered questions about their perceived workload, subjective numeracy and health literacy, demographic variables, and familiarity with the task. The design of the immunization visualization significantly affected both task performance measures (time taken to complete the task and number of correct dates). In particular, those using Epic MyChart took significantly longer to complete the task than those using eLetter or eClinicWorks. Those using Epic MyChart entered fewer correct dates than those using the eLetter or eClinicWorks. There were no systematic statistically significant differences in task performance measures based on the numeracy, health literacy, demographic, and experience-related questions we asked. The 4 immunization visualizations had unique design elements that likely contributed to these performance differences. Based on our findings, we provide practical guidance for the design of immunization visualizations, and future studies. Future research should focus on understanding the contexts of use and design elements that make tables an effective type of health data visualization.

ABOUT BUSINESS E-MAIL AS A GENRE OF PROFESSIONAL INTERNET COMMUNICATION IN THE COURSE OF “LANGUAGE OF BUSINESS COMMUNICATION”

The research focuses on exploring lexical-grammatical, syntactic, punctuation features of the text of business e-mail as a genre of professional Internet communication in the course of “Language of business communication”. The tasks are outlined as follows: 1) to reveal the contents of the course of “Language of business communication”; 2) to highlight the importance of the content module on professional Internet communication; 3) to analyze business e-mail as a genre of professional Internet communication. The descriptive method and various types of linguistic analysis are applied. Emphasis is placed on the motivational-practical (speech) component of the course as a defining feature of the “Language of business communication” discipline, which determines the approach to the thematic content of the four content modules. The proposed research highlights the fourth content module, which reveals the peculiarities of Internet business communication and encompass follows themes: “Internet communication: specifics, types, genres”, “Language organization of business Internet communication”. The analyzed content module involves familiarizing students with the concept of Internet style, types of network communication, genres of business Internet communication, types of posts in social networks, and the culture of Internet communication. To improve the practical skills of business electronic correspondence, an educational model (formulated in linguistics) was used, which consists in the synthesis of four interrelated aspects. The first aspect is based on mastering the theoretical foundations of the researched problem: philology students reveal the essence of the concept of an electronic business letter, systematize the basic principles of creating and rules for writing business e-mails. The second aspect is practical. It consists primarily in the formation of skills and abilities to analyze the texts of business letters. For example, the structural-compositional, lexical-grammatical, and punctuation features of an electronic Cover Letter and a Request Letter are considered. The third aspect is research. It involves independent processing of the text of an electronic business letter in accordance with the proposed algorithm. The fourth stage is creative. It provides for the independent creation of an electronic business letter taking into account the specified requirements. The results of the research can be used as materials for practical classes on the language of business communication, Ukrainian language for professional purposes, language culture, etc. Key words: “Language of business communication”, business e-mail, professional Internet communication, etiquette of business correspondence.

Determinants of Sporadic Shiga Toxin-Producing Escherichia coli (STEC) Infection in Denmark, 2018-2020: A Matched Case-Control Study.

Infections with Shiga toxin-producing Escherichia coli (STEC) are increasing in Denmark and elsewhere. STEC is also the most frequent cause of haemolytic uraemic syndrome (HUS) in Danish children. Most cases are considered sporadic, while approximately one-third can be attributed to a known source of infection. Hence, we examined sources of sporadic STEC infection in Denmark. From January 2018 to December 2020, we conducted a prospective nationwide case-control study among Danish adults and children. Cases with confirmed positive STEC infection were notified infections within the national laboratory surveillance system. Control persons were randomly selected from the Danish Civil Registration System, individually matched in age in 5-year bands and sex. Participants were invited by an electronic letter to complete either an adult or child questionnaire online. Univariate and adjusted matched odds ratios were computed for adults and children using conditional logistic regression. The study recruited 1583 STEC cases and 6228 controls. A total of 658 cases (42%) and 2155 controls (35%) were included in the analysis. Depending on age, univariate analysis adjusted for socio-demographic determinants showed that the consumption of boiled beef (mOR = 2.2, 95% confidence interval (CI): 1.6-3.1) and fried minced beef (mOR = 1.6, CI: 1.2-2.1), drinking raw (unpasteurized) milk (mOR = 11, CI 1.1-110), eating grilled food (mOR = 9.8, CI: 5.6-17) and having a household member using diapers (mOR = 2.1, CI: 1.4-3.2) were determinants of sporadic STEC infection. Further multivariate adjusted analysis resulted in the same determinants. This study confirms that beef is an overall important risk factor for STEC infection in Denmark. We also present evidence that a proportion of sporadic STEC infections in Denmark are determined by age-specific eating habits, environmental exposures and household structure, rather than being exclusively food-related. These findings are relevant for targeted public health actions and guidelines.

Pengelolaan Surat Berbasis Elektronik Pada Lembaga Pendidikan

An increasingly advanced, modern and sophisticated era is developing because of human needs and problems that encourage creativity and innovation. Good management of correspondence in government agencies is very important because good management of correspondence will help communicate information and communication to agencies which is a determining factor in development policies and strategies. The aim of this research is to develop an effective and efficient electronic mail management system in educational institutions, as well as determine its impact on the mail management process and service quality in educational institutions. The research studied is qualitative research using the literature review method. Literature review by utilizing information from secondary data from various published research articles. This secondary data was used as review material for a number of articles, originating from international and national scale articles. The results of this research are that the electronic letter management system includes the activities of creating, recording and organizing letters which are stored on hardware and then organized using software and controlled by the user or brainware. Implementing an electronic mail management system in educational institutions also requires training so that employees can be skilled in using it. Management of electronic incoming mail at educational institutions, namely receiving, sorting, recording, distributing and storing. Management of electronic outgoing mail, namely the concept of letters, typing, signing, recording, sending and storing letters.

Obstetrician, Family Physician, or Midwife: Preferences of the Next Generation of Maternity Care Consumers

Objective: The purpose of this study was to identify the views of a cohort of Canadian university students related to maternity care provider preferences and the reasons for these preferences. Relationships between care provider preferences, childbirth attitudes, and desire for epidural anesthesia and cesarean section (CS) were also examined. Methods: This was a large cross-sectional survey (N = 3,680) of male and female university students at the University of British Columbia (male, 991; female, 2,676). Students were invited to participate via an electronic letter of invitation containing a link to this online survey.Results: Approximately half of all participants (51.8% for women and 43.7% for men) selected an obstetrician as one of their preferred care providers; somewhat fewer selected a family physician (40.1% for women and 32.8% for men), and even fewer selected a registered midwife (30.1% for women and 18.0% for men). Among the 11 reasons for these preferences (coded from open-ended responses), the most common were expert/specialist, safety, and quality of relationship with care provider. Attitudes toward vaginal birth as well as mode of delivery and pain management preferences were found to relate to caregiver preferences.Conclusion: Provider preferences among university students are largely driven by perceived risk, level of confidence in birth, and attitudes toward obstetric interventions. These preferences, in combination with the current shortage of maternity providers in Canada, indicate a need for restructuring maternity care human resources.

Logistic regression analysis of risk factors for post-operative morbidities in parotidectomy: a retrospective cohort study.

In this study, we reviewed the post-operative complications in parotidectomy and its association with various patient, tumour and surgical factors. All parotidectomies performed in our regional unit between 2013 to 2020 were identified. Electronic medical record and clinic letters were reviewed for any post-operative complications. A logistical regression model was applied on data collected on twelve patient factors, three tumour factors and four surgical factors. 379 cases of parotidectomy were identified in the eight-year study period. 55% (n = 210) were documented with nine types of post-operative complications. This study identified age >80 (odds ratio = 1.89, p = 0.018), active smoker (odds ratio = 0.94, p = 0.018), total parotidectomy approach (odds ratio = 1.77, p = 0.012), longer operation time (odds ratio = 0.006, p = 0.015) and hypertension (odds ratio = 1.23, p = 0.019) were associated with a higher risk of facial nerve palsy. Predictive factors were also identified for auricular nerve numbness and Frey syndrome. This study revealed the incidences and potential predictors of post-operative complications in parotidectomy. Notably, the grade of operator (consultants/ registrars) had no effect on the possibility of adverse outcome, reflecting patient safety was not compromised for training. These findings can be used in patient counselling and guide treatment options to minimise post-operative complications.

Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach.

Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.

Clinical Outcomes With Electronic Nudges to Increase Influenza Vaccination : A Prespecified Analysis of a Nationwide, Pragmatic, Registry-Based, Randomized Implementation Trial.

In the NUDGE-FLU (Nationwide Utilization of Danish Government Electronic letter system for increasing inFLUenza vaccine uptake) trial, electronic letters incorporating cardiovascular (CV) gain-framing and repeated messaging increased influenza vaccination by approximately 1 percentage point. To evaluate the effects of the successful nudging interventions on downstream clinical outcomes. Prespecified exploratory analysis of a nationwide randomized implementation trial. (ClinicalTrials.gov: NCT05542004). The 2022 to 2023 influenza season. 964 870 Danish citizens aged 65 years or older. Usual care or 9 different electronically delivered behavioral nudging letters. Cardiovascular, respiratory, and other clinical end points during follow-up from intervention delivery (16 September 2022) through 31 May 2023. The analysis set included 691 820 participants. Hospitalization for pneumonia or influenza occurred in 3354 of 346 327 (1.0%) participants in the usual care group, 396 of 38 586 (1.0%) in the CV gain-framing group (hazard ratio [HR], 1.06 [95% CI, 0.95 to 1.18]; versus usual care), and 403 of 38 231 (1.1%) in the repeated letter group (HR, 1.09 [CI, 0.98 to 1.21]; versus usual care). In the usual care group, 44 682 (12.9%) participants were hospitalized for any cause, compared with 5002 (13.0%) in the CV gain-framing group (HR, 1.00 [CI, 0.97 to 1.03]; versus usual care) and 4965 (13.0%) in the repeated letter group (HR, 1.01 [CI, 0.98 to 1.04]; versus usual care). A total of 6341 (1.8%) participants died in the usual care group, compared with 721 (1.9%) in the CV gain-framing group (HR, 1.02 [CI, 0.94 to 1.10]; versus usual care) and 646 (1.7%) in the repeated letter group (HR, 0.92 [CI, 0.85 to 1.00]; versus usual care). Prespecified but exploratory analysis, potential misclassification of events in routinely collected registry data, and results may not be generalizable to other health systems or countries with other racial compositions and/or cultural or societal norms. In a prespecified exploratory analysis, modest increases in influenza vaccination rates seen with electronic nudges did not translate into observable improvements in clinical outcomes. Seasonal influenza vaccination should remain strongly recommended. Sanofi.

Rationale and design of NUDGE-FLU-CHRONIC and NUDGE-FLU-2: Two nationwide randomized trials of electronic nudges to increase influenza vaccination among patients with chronic diseases and older adults during the 2023/2024 influenza season

BackgroundYearly influenza vaccination is strongly recommended for older adults and patients with chronic diseases including cardiovascular disease (CVD); however, vaccination rates remain suboptimal, particularly among younger patients. Electronic letters incorporating behavioral nudges are highly scalable public health interventions which can potentially increase vaccination, but further research is needed to determine the most effective strategies and to assess effectiveness across different populations. The purpose of NUDGE-FLU-CHRONIC and NUDGE-FLU-2 are to evaluate the effectiveness of electronic nudges delivered via the Danish governmental electronic letter system in increasing influenza vaccination among patients with chronic diseases and older adults, respectively. MethodsBoth trials are designed as pragmatic randomized implementation trials enrolling all Danish citizens in their respective target groups and conducted during the 2023/2024 influenza season. NUDGE-FLU-CHRONIC enrolls patients aged 18-64 years with chronic diseases. NUDGE-FLU-2 builds upon the NUDGE-FLU trial conducted in 2022/2023 and aims to expand the evidence by testing both previously successful and new nudges among adults ≥65 years during a subsequent influenza season. Persons with exemptions from the electronic letter system are excluded from both trials. In both trials, participants are randomized in a 2.45:1:1:1:1:1:1 ratio to either receive no electronic letter (usual care) or to receive one of 6 different behaviorally informed electronic letters. NUDGE-FLU-CHRONIC has randomized 299,881 participants with intervention letters delivered on September 24, 2023, while NUDGE-FLU-2 has randomized 881,373 participants and delivered intervention letters on September 13, 2023. Follow-up is currently ongoing. In both trials, the primary endpoint is receipt of influenza vaccination on or before January 1, 2024, and the secondary endpoint is time to vaccination. Clinical outcomes including respiratory and cardiovascular hospitalizations, all-cause hospitalization, and mortality are included as prespecified exploratory endpoints. Prespecified individual-level pooled analyses will be conducted across NUDGE-FLU, NUDGE-FLU-CHRONIC, and NUDGE-FLU-2. DiscussionNUDGE-FLU-CHRONIC is the first nationwide randomized trial of electronic nudges to increase influenza vaccination conducted among 18-64-year-old high-risk patients with chronic diseases. NUDGE-FLU-2 will provide further evidence on the effectiveness of electronic nudges among older adults ≥65 years. Collectively, the NUDGE-FLU trials will provide an extensive evidence base for future public health communications. Trial RegistrationNUDGE-FLU-CHRONIC: Clinicaltrials.gov: NCT06030739, registered September 11, 2023, https://clinicaltrials.gov/study/NCT06030739. NUDGE-FLU-2: Clinicaltrials.gov: NCT06030726, registered September 11, 2023,https://clinicaltrials.gov/study/NCT06030726.

Revolutionizing trade finance: leveraging the power of blockchain and AI in electronic letters of credit

Abstract This article examines the innovative combination of blockchain and artificial intelligence (AI) technologies in the field of electronic letters of credit and international trade finance. It explores how the combined effect of this convergence may greatly improve the security, effectiveness, and clarity of trade finance procedures. The article presents a suggested framework for combining various technologies, focusing on important design considerations including security, trust, interoperability, and adherence to international trade norms. The technological design blends blockchain’s decentralized ledger with AI’s analytical capabilities, highlighting the need of smart contracts, data management, and application programming interfaces for smooth interoperability. The implementation plan and stages are meticulously detailed, emphasizing the systematic approach necessary for effective integration. The article also discusses the problems and dangers related to this technology integration, such as technical obstacles, regulatory compliance, security threats, stakeholder acceptance, and cost factors. The conclusion outlines the impact of blockchain and AI on trade finance, discusses their larger implications for international commerce, and advocates for the adoption of these advanced technologies by collective action. This article seeks to provide significant insights to financial institutions, policy-makers, technologists, and stakeholders in the trade finance sector, promoting the modernization of trade finance via new technology.

ALGORITMA K-MEANS DALAM PENGELOMPOKAN SURAT KELUAR DI KANTOR KEMENTERIAN AGAMA KOTA PEMATANG SIANTAR

The management of outgoing letters within the Office of the Ministry of Religious Affairs in Pematang Siantar City is a crucial aspect of its operations. In an effort to enhance the efficiency and effectiveness of outgoing letter management, this research introduces the implementation of the K-Means Algorithm as one of the solutions. The objective of this research is to evaluate the impact of using the K-Means Algorithm in grouping outgoing letters. The results of the research indicate that the K-Means Algorithm has significantly aided in the process of grouping outgoing letters by identifying relevant patterns and characteristics. Grouping outgoing letters based on specific attribute similarities has allowed for improved letter distribution efficiency and a better understanding of sending patterns. Furthermore, the potential for further development in terms of integration with an electronic letter management system is evident. Therefore, this research demonstrates that the K-Means Algorithm has the potential to enhance outgoing letter management within the Office of the Ministry of Religious Affairs in Pematang Siantar City and can be considered a valuable tool in improving operational efficiency and publicservice.

Efficacy and safety of topical analgesic agents for the treatment of chronic musculoskeletal pain

According to a prior systematic study, systemic NSAIDs effectively ease pain associated with chronic conditions such as osteoarthritis and tendinitis. A new evaluation is required in light of more trials, improved knowledge reclassification of some drugs, and trial quality and bias evaluation. Electronic database searches and letters to manufacturers assisted in finding studies for adults with persistent pain and discovered randomized, double-anonymized studies contrasting topical NSAID with a successful placebo treatment. At two weeks, 50% less pain was an important result; secondary results included local and systemic problems and withdrawals given negative incidents. Utilizing sensitivity and number-needed-to-harm (NNH) analyses as well as estimations of relative benefit, the impacts of reported outcome, trial size, reported trial quality, and condition treated are still assessed. There are 14 studies total, including 12 new trials and 13 trials of an earlier evaluation. Nearly 1,500 patients were involved in 14 double-blind, placebo-controlled studies. With a relative benefit of 1.9 and an NNT of 4.6, topical NSAID considerably outperformed a placebo. The trial's validity, quality, and size, a given outcome, treated affect findings. There was no difference in effectiveness between oral and topical NSAIDs in three studies, including 764 participants. Topical NSAIDs and placebos caused 6% of local adverse events, 3% of systemic adverse events, and patient withdrawals because of adverse events. Topically applied NSAIDs for two weeks offered a secure and effective treatment for long-term musculoskeletal conditions. Larger and longer studies are required to explain a part of topical NSAIDs in healthcare properly.

Implementation of E-Government Through E-Buddy in Sidoarjo Regency

This study examined the implementation of E-Buddy, an electronic official letter system, in a rural Indonesian village. Using observation, interviews, and document analysis, we found that while legal and technological frameworks were in place, human infrastructure posed significant challenges. Officials lacked training and understanding of E-Buddy, hindering its effectiveness. This highlights the crucial role of user-centric design and capacity building in successful e-government initiatives, particularly in resource-constrained settings. Highlight : The implementation of E-Buddy, an electronic official letter system, faced challenges due to inadequate communication and technical guidance The study revealed that the human resources, particularly the ability of village officials to adapt to the E-Buddy application, were not fully equipped for its implementation The research emphasizes the importance of user-centric design and capacity building in e-government initiatives, especially in resource-constrained settings Keywords: E-Government, E-Buddy, Implementation, Rural Village, Indonesia

ЭЛЕКТРОННОЕ ДЕЛОВОЕ ПИСЬМО КАК ДИАЛОГИЧЕСКИЙ Жанр ИНТЕРНЕТ-КОММУНИКАЦИИ

The article is devoted to the study of the specifics of an electronic business letter as a dialogic genre in network communication. The differences between a traditional business letter and its electronic version are indicated. The exchange of business correspondence via e-mail is considered as a communicative situation of dialogic interaction between the addresser and the addressee. The correlation of initiating business emails with stimulus cues, and reactive ones with response cues of natural (primary) dialogue is established, and the means of expressing dialogicity in business emails are analyzed.

Multi-centre Implementation of the SNAP Protocol for Paracetamol Overdose - reducing the length of stay

Aim/Objective/Background: Paracetamol stands as one of the most prevalent drugs of overdose in the UK. The conventional treatment for Paracetamol toxicity involves intravenous administration of N-acetylcysteine (NAC), typically administered over 21 hours in UK hospitals. However, an alternative 12-hour infusion, known as the &amp;apos;SNAP&amp;apos; regimen, has shown promise in reducing anaphylactoid reactions compared to the standard treatment. This study implemented the SNAP regimen in two District General Hospital Emergency Departments within the same NHS Trust as part of a quality improvement project (QIP), aiming to assess its impact on reducing adverse reactions and inpatient length of stay. Methods/Design: Trust guidelines were revised to recommend the 12-hour SNAP regimen for adult Paracetamol overdose cases, accompanied by a pre-filled prescription chart. A retrospective analysis of patient records and electronic discharge letters was conducted before and after the guideline change to identify NAC recipients and document any adverse reactions. Length of inpatient stay was also documented. Results/Conclusions: Over a three-month period from August to November 2020 across both sites, 60 adult patients received NAC for Paracetamol overdose, with four experiencing anaphylactoid reactions. Following the introduction of the SNAP regimen, spanning from April to June 2021, 36 adult patients received NAC, none of whom experienced adverse drug reactions. Before the guideline change, adult patients admitted for Paracetamol overdose had an average inpatient stay of 48.3 hours, which decreased to an average of 44.5 hours following the adoption of the SNAP regimen. The SNAP NAC regimen demonstrated comparable safety regarding adverse drug reactions while effectively reducing the length of inpatient stay for adults with Paracetamol overdose.