Enhance Patient Empowerment Research Articles

Enhancing patient education and engagement through digital intelligence tools in dermatology

This comprehensive digital health review examines the expanding landscape of digital intelligence tools within dermatology, specifically examining the innovative role of AI-powered applications aimed at educating and engaging patients in managing their skin health. Drawing upon a wide array of existing research, this review scrutinizes the evolution and impact of various digital tools. These include interactive apps that leverage AI algorithms to deliver tailored skincare guidance, considering factors such as skin type, concerns, and environmental factors. Additionally, the review explores the emerging use of immersive virtual reality experiences to deepen patients’ understanding of skin conditions, offering vivid simulations and educational content. These innovative approaches showcase significant promise in not only improving patient outcomes but also fostering greater treatment adherence and overall satisfaction with dermatological care. Looking ahead, future research should prioritize fine-tuning AI algorithms to further personalize patient recommendations, exploring the integration of wearable technology for real-time monitoring, and conducting longitudinal studies to evaluate the sustained effectiveness and scalability of digital intelligence tools in promoting patient education and engagement. Moreover, innovative strategies such as gamification techniques and social support platforms hold considerable potential for enhancing patient empowerment and involvement in managing their skin health. Leveraging digital intelligence tools will eventually redefine the landscape of dermatological care, empowering patients and optimizing treatment outcomes through enhanced education and engagement.

Enhancing Patient Empowerment and Health Literacy: Integrating Knowledge Graphs with Language Models for Personalized Health Content Delivery.

Health literacy empowers people to access, understand and apply health information to effectively manage their own health and to be an active participant in healthcare decisions. In this paper we propose a conceptual model for cognitive factors affecting health literacy and related socioeconomic aspects. Then we develop the HEALIE Knowledge Graph to represent the model, drawing from various medical ontologies, resources, and insights from domain experts. Finally, we combine the Knowledge Graph with a Large Language Model to generate personalised medical content and showcase the results through an example.

How to Tell Whether Patients Engage and Use a Patient Portal - An Analysis of Five Functions.

The road to a more sustainable healthcare system includes creating a digital interface to the healthcare system that patients can use to engage in their health problems while outside the consultation room. The aim of the study was to evaluate trends in the use of functions in a patient portal and assess which functions were most likely to contribute to sustainable healthcare. Open, uncontrolled retrospective analysis of citizens' use of the patient portal. Extraction and statistical analysis of log data. Log analysis revealed that patients engaged with the patient portal to make appointments, fill out and submit questionnaires, send messages to their care provider, inspect their laboratory results, and view notes about themselves. The functions that displayed a significantly increasing trend were the number of appointments made, the number of messages sent, and the number of checked test results. While portal engagement can reduce patient dependency on healthcare services, external factors also influence this outcome. Further research is needed to investigate which functions support healthcare sustainability and enhance patient empowerment, possibly through other study designs.

Level of empowerment of hospitalized patient in Taiwan clinical practice

PurposeIn the health-care system within hospitals, Taiwanese patients usually play the role of passively cooperating with health-care professionals. Therefore, patients rarely make their own treatment decisions. This study evaluated the level of patient education and patient satisfaction in relation to empowerment level in Taiwan. MethodsA cross-sectional survey by a self-administered structured questionnaire was carried out with 618 inpatients from the four hospitals. Statistical analyses were then conducted. Analysis of covariance and post-hoc comparison was used to compare differences between the level of patient empowerment, age, and education as covariates in the model. ResultsThis study found that 21.2% and 35.6% of participants were highly empowered and well empowered, respectively. Years of education is a significant covariate in the counselling domain of patient education. Even after controlling for age and education level, the counselling, answer question and justifying action, providing information scores remain significant for all levels after adjusting for the effects of degree of patient empowerment. Patients with higher empowerment also having more-sufficient patient education, indicating a tendency toward higher patient satisfaction. Patient education and counselling practices in Taiwan's clinical practice could be improved to enhance patient empowerment and ensure health-care systems are person-centred. ConclusionTo move more toward highly patient empowerment, we suggest that health-care professionals advocate a patient-empowerment approach and to provide more counselling related to patients’ illnesses and possible treatments.

Advancements in Wearable Digital Health Technology: A Review of Epilepsy Management.

This review explores recent advancements in wearable digital health technology specifically designed to manage epilepsy. Epilepsy presents unique challenges in monitoring and management due to the unpredictable nature of seizures. Wearable devices offer continuous monitoring and real-time data collection, providing insights into seizure patterns and trends. Wearable technology is important in epilepsy management because it enables early detection, prediction, and personalized intervention, empowering patients and healthcare providers. Key findings highlight the potential of wearable devices to improve seizure detection accuracy, enhance patient empowerment through real-time monitoring, and facilitate data-driven decision-making in clinical practice. However, further research is needed to validate the accuracy and reliability of these devices across diverse patient populations and clinical settings. Collaborative efforts between researchers, clinicians, technology developers, and patients are essential to drive innovation and advancements in wearable digital health technology for epilepsy management, ultimately improving outcomes and quality of life for individuals with this neurological condition.

Designing the Empowerment Model of Patients Hospitalized in the Hospitals Affiliated to Shahid Sadoughi University of Medical Sciences, Yazd

Introduction: Identifying factors that influence the patient experience are critical to implementing strategies that support patient engagement and ultimately achieve better health outcomes. The present study was conducted with the aim of presenting a model of empowerment of hospitalized patients.
 Methods: The current research was a qualitative-quantitative study that was cross-sectional by stratified sampling method with proper allocation in hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran, on 230 heads, managers, matrons, supervisors, heads of clinical and paraclinical departments and hospital headquarters units, nurses and doctors were done. The data were collected using the demographic information tool and the questionnaire made by the researcher to design a model of empowering patients admitted to the hospital. Determining the ability of the designed model by fitting the data was done with the confirmatory factor analysis method. Data were analyzed by SPSS version 16 software and Amos.v 24 software.
 Results: Questionnaire for designing a model of empowering patients in the hospital has 8 areas and 61 items or components. In the present study, the Chi-square ratio to the degree of freedom was significant (p<0.001), which indicated the appropriate fit of the model. The value of the GFI index was estimated at 0.93, which indicated that the model fits well. The values of GFI and AGFI for the empowerment model of hospitalized patients were higher than 0.8.
 Conclusion: Organizations and medical institutions have the opportunity to utilize this model to empower patients. The universities of medical sciences and affiliated hospitals should create an enabling environment for enhancing patient empowerment.

Identification and Prioritization of Dimensions for Empowering Hospitalized Patients in Public Hospitals of Shahid Sadoughi University of Medical Sciences, Yazd

Identifying factors that impact patient experience is crucial for implementing strategies that support patient engagement and ultimately achieve better health outcomes. This study aimed to present a model for empowering hospitalized patients. This study is a quantitative-qualitative cross-sectional study conducted using stratified sampling with appropriate allocation in public hospitals affiliated with Shahid Sadoughi University of Medical Sciences, Yazd. The study involved 230 participants, including hospital directors, managers, matrons, supervisors, clinical and paraclinical unit heads, staff units, nurses, and physicians. Data were collected using demographic information tools and a researcher-made questionnaire designed to create a model for empowering hospitalized patients. The model's capability was determined by fitting the data using confirmatory factor analysis. Data were analyzed using SPSS version 16 and Amos version 24 software. The questionnaire designed for the patient empowerment model in hospitals comprised 8 domains and 61 items or components. In this study, the chi-square ratio to degrees of freedom was significant (p < 0.0001), indicating a good fit for the model. The Goodness of Fit Index (GFI) was estimated at 0.93, showing that the model fit was appropriate. The values of GFI and the Adjusted Goodness of Fit Index (AGFI) for the hospitalized patient empowerment model were above 0.8. Organizations and educational healthcare centers can use this model to empower patients. The necessary groundwork for enhancing patient empowerment should be provided by medical universities and affiliated hospitals.

Integrated transmural care pathway for stroke patients after discharge from the hospital: the growth towards a total concept in cooperation with primary care partners in southwest-Flanders

Every year, nearly 27,000 Belgians suffer a stroke. After discharge from the hospital there is follow-up. In this best practice, we want to discuss the initiatives that AZ Groeninge has taken over the years to achieve an integrated transmural care pathway for stroke patients after discharge from the hospital in collaboration with primary care, regional GP-associations and home care organizations. 
 Transmural care pathway for stroke care: Prof. Dr. Peter Vanacker, neurologist AZ Groeninge, took the initiative in 2017 to roll out the transmural clinical care pathway for stroke in the south West-Flanders region together with GP-associations and neurologists from various hospitals. Other primary care partners were also involved such as the Pharmacists Association and home care organizations. 
 Through uniform cooperation of health care providers and coordinated follow-up to support stroke patients, they succeeded in offering better care to stroke patients after discharge.
 Guidelines were developed for GP's, home care nurses and pharmacists. To ensure continuity of care and enhance patient empowerment, a diary was also given to the patient to record key parameters and issues.
 In 2020, the care pathway was expanded with the Chronic Care Project "De Brug". 
 The following additional items were added:
 - commitment to communication between the care providers of the stroke team
 - commitment to the conversation ""good use of medicines"" after stroke
 - focus on clarifying questions
 - commitment to lifestyle through health vouchers that encouraged stroke patients to make lifestyle changes.
 Strokecoach: In AZ Groeninge, the transmural care pathway was supplemented with a specific coaching program for stroke patients.
 The strokecoach is responsible for a personal follow-up of stroke patients to promote therapy compliance, disease insight, reduction of their cardiovascular risk profile. The coaching process runs between 6 and 24 months depending on patient preference.
 Jobcontent of our strokecoach is to:
 - play an intermediary role between GP's, home care services and the hospital.
 - be point of contact for stroke care in the region.
 - do more intensive screening for early and late complications and compliance. Thus, complications are captured more quickly. Together with the primary care team, the strokecoach will motivate the patient to achieve health goals and prevent for stroke recurrence.
 Stroke2Gether: Electronic stroke recovery pathway.AZ Groeninge is also participating in the EFRO project "Stroke2Gether". This is a digital recovery pathway for stroke patients after discharge by a smartphoneapp. Medical en therapy follow-up and health prevention are built in, through monitoring, education and coaching, live and remote. In addition, there is also a rights recognition module so that patients are also guided more proactively in the administrative and financial aspects and care support in collaboration with the social services of the insurance companies.
 Decision: AZ Groeninge has already completed a long journey in cooperation with its primary care partners to arrive at an integrated care pathway for stroke patients.
 In the following years, the main focus will be on the evaluation and adjustment of the developed instruments and the cooperation to further optimize the aftercare for this patient group.

Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study

BackgroundPatient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings. Methods. The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains. Results. Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results. Conclusions. Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.

Effect of depression, anxiety, and distress screeners on the need, intention, and utilization of psychosocial support services among cancer patients

PurposeIn clinical cancer care, distress screening is recommended to identify highly burdened patients in objective need for psychosocial support to improve psychological distress and quality of life and to enhance patient empowerment. It is however unclear whether distress screeners are suitable for psychosocial care planning and thus whether they can predict the willingness that is need, intention, and utilization, to seek psychosocial support.MethodsIn a secondary analysis of a cluster intervention study, we assessed cancer patients with three distress screeners (DT, PHQ-9, GAD-7) at baseline. The willingness to seek psychosocial support services was assessed binary for psychosocial services at 3 and 6 months. Logistic regression models were applied to examine the predictive effect of the screeners on need, intention, and utilization. We corrected all models for multiple testing.ResultsThe 660 patients included in the study were on average 60 years, 54% were male. At the 3- and 6-month follow-up, 353 and 259 patients participated, respectively. The screeners were best in predicting the need for support (OR reaching up to 1.15, 1.20, and 1.22 for the PHQ-9, GAD-7, and DT respectively). The intention was predicted by the PHQ-9 and GAD-7, whereas utilization of psychosocial support services was not predicted by the screeners.ConclusionThe three distress screeners might be useful in psychosocial care planning, as they are able to predict the need and to some degree the intention to seek psychosocial support. Future research needs to examine potential barriers and supporting factors that may explain utilization of psychosocial support.Trial registrationThe study was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).

The impact of informal patient navigation initiatives on patient empowerment and National Health Insurance responsiveness in Indonesia

BackgroundIndonesia introduced a universal National Health Insurance (NHI) programme Jaminan Kesehatan Nasional (JKN) in 2014. However, challenges in timely consultation and access to health services resulted in the introduction of...

How mHealth Can Contribute to Improving the Continuum of Care: A Scoping Review Approach to the Case of Human Immunodeficiency Virus in Sub-Saharan Africa.

Objectives: To determine mHealth’s contribution to improving the continuum of care in sub-Saharan Africa towards achieving treatment targets for human immunodeficiency virus (HIV) endorsed by the 2016 Political Declaration on ending acquired immunodeficiency syndrome (AIDS). Methods: PubMed, Medline, Embase, Web of Science Core Collection and Cochrane databases; three observatories and four repositories were searched to identify and select relevant articles, projects and guidelines published from 1 January 2017, to 30 April 2021. Records focusing on the use of mHealth related to HIV treatment cascade or healthcare provider/patient relationship were considered. Results: From 574 identified records, 381 (206 scientific manuscripts and 175 mHealth projects) were considered. After screening, 36 articles (nine randomized control trials, five cohort studies, 19 qualitative studies, and three economic studies) and 23 projects were included. Conclusion: The cross-cutting benefits of mHealth that enhance patient empowerment have been identified. Important challenges such as gaps between research and implementation, lack of transdisciplinary collaboration, and lack of economic evidence were identified to support future mHealth research and accelerate the achievement of treatment targets for HIV.

Home Monitoring of Glaucoma Using a Home Tonometer and a Novel Virtual Reality Visual Field Device: Acceptability and Feasibility

Our aim was to assess the acceptability and feasibility of iCare HOME tonometer (HT) and Virtual Field (VF) devices in the home monitoring of glaucoma. Prospective feasibility and acceptability study. Twenty patients (39 eyes) with primary open-angle glaucoma, open-angle glaucoma, ocular hypertension, or suspected glaucoma. Patients were trained and instructed to bring 2 devices home for 1 week and use the HT 4 times/day for 4 days and the VF 3 times total. For acceptability, we conducted satisfaction surveys and semistructured, qualitative interviews with a thematic analysis. Feasibility was assessed by device usage and quality of tests. Most patients (73.7%) felt that the HT was easy to use, and 100% of them found the HT useful. All patients (100%) felt that VF was easy to use, and 94.4% of them found the VF useful. All patients (100%) obtained acceptable intraocular pressure and completed a VF test at home. We identified 4 key themes, with 33 subthemes. The key themes include the following: (1) advantages of home monitoring; (2) difficulties with home monitoring; (3) future considerations in home monitoring; and (4) the experience of patients with glaucoma. The HT and VF were acceptable and feasible in a small cohort of motivated subjects. Patients were able to perform these tests proficiently at home, and they were generally enthused to obtain more data about their intraocular health, as it allowed them a heightened sense of security and insight about their chronic disease, as well as a reduction in foreseeable barriers to care. Home monitoring may also improve upon glaucoma care by enhancing patient empowerment and fostering community bonds. The VF should be further evaluated to ensure validity. Proprietary or commercial disclosure may be found after the references.

Developing and piloting a communication assessment tool assessing patient perspectives on communication with pharmacists (CAT-Pharm)

BackgroundEffective communication strategies in health care help to enhance patient empowerment and improve clinical outcomes.ObjectiveAdapt the original Communication Assessment (CAT) instrument for the pharmacist profession (CAT-Pharm) and to test its validity and reliability in two different settings.SettingFive hospital pharmacies in Italy and five community pharmacies in Malta.MethodPilot study involving a standardized multi-step process adhering to internationally accepted and recommended guidelines. Corrections and adjustments to the translation addressed linguistic factors and cultural components. CAT-Pharm, compared to the original CAT, maintained 10 out of the 14 items: one was slightly modified; three were changed to better fit the pharmacist role; one was added.Main outcome measuresCAT-Pharm development and testing its practicality to assess patient perceptions of pharmacists’ interpersonal and communication skills.ResultsCAT-Pharm was tested on 97 patients in the Italian setting and 150 patients in the Maltese setting to assess the practicality of the tool and its usefulness in investigating gaps and priorities for improving pharmacist-patient communication. Results Show reliability and internal validity of the CAT-Pharm tool. The analysis of patient perceptions of communication with the pharmacist in Italy indicated differences from that in Malta. The different settings provided insight into the utility of CAT-Pharm.ConclusionThis study provided a valid and reliable tool that could be applied to assess patient perception of the pharmacist's communication abilities.

Evaluation of two strategies to implement physical cancer rehabilitation guidelines for survivors of abdominopelvic cavity tumors: a controlled before-and-after study

PurposeThis study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies.MethodsWe tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility.ResultsIn total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies.ConclusionImplementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations.Implications for Cancer SurvivorsUsing implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies.

Filling the gaps of patient information needs and information perception in chronic myeloid leukemia with the patient-physician co-produced web-based platform CMyLife

BackgroundFor patients with chronic myeloid leukemia, a web-based platform CMyLife was developed. Its aim is to enhance patient empowerment, by adequate information provision, among others. Before evaluating its effect, information provision and needs in current care were assessed. ObjectiveTo assess patients’ evaluation of received information and information needs before CMyLife utilization and whether this information source is used correspondingly. Additionally, we explored predicting patient factors in information perception. Patient involvementCMyLife platform was developed with active patient participation. MethodsWe conducted a cross-sectional survey among 203 CML patients before launch of the CMyLife platform, using validated questionnaires on information provision and predictive factors. We focused on website utilization during the first 3 years, using Google Analytics. Regression analyses were performed to determine influence of patient factors on information perception. ResultsGlobal perceived information provision was scored 42.8 (0–100). Information on other services such as rehabilitation and psychological support, and effects of treatment on sexuality showed room for improvement. One out of 3 knew where to find useful health information online. But more information was desired by 36% of them. Age ≥65 years, time since diagnosis and low education were positively associated with this need. Pages on medication and side effects were visited the most. DiscussionTo fill the gap in perceived provision and needs, information should be adjusted more to the individual in content, manner and timing. Age, time since diagnosis, and educational level are of influence in perceived information, and specific needs within these groups should be further explored. Practical valueCMyLife provides reliable and up-to-date information for low eHealth literacy skilled patients concerning multiple topics indicated by patients.

698 A Systematic Review of Smartphone Applications for Enhanced Recovery After Surgery (ERAS) Following Colorectal Surgery

IntroductionLength of stay (LOS) following colorectal surgery has reduced due to enhanced recovery after surgery (ERAS) programs. Telemedicine has shown potential for patients to remotely access support, communicate progress with their medical team and enhance patient empowerment. We conducted a systematic review of smartphone applications for ERAS following colorectal surgery measuring patient outcomes and experience.MethodThe review was performed adhering to PRISMA guidelines, using search terms pertaining to ERAS, colorectal surgery, and mobile applications via electronic databases. All peer-reviewed English articles were assessed for inclusion and quality by two reviewers. A qualitative analysis was conducted to evaluate methodologies, patient experience, and outcomes.Results206 abstracts were identified from which 5 articles (2 RCTs and 3 cohorts) were included in the analysis. Studies surveyed patient adherence to ERAS, LOS, readmission, intra and postoperative complications. Four studies recorded patient satisfaction, whilst one assessed quality of life and application validation.ConclusionsThe review highlights paucity in the use of smartphone applications after ERAS in colorectal surgery but demonstrates high patient satisfaction levels. Service delivery in the NHS has increasingly moved to a virtual platform during the coronavirus pandemic. More research and engagement in the development and use of smartphone applications would enhance care for patients.

A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Qualitative Evaluation of Diverse Public and Patient Perceptions Using Focus Groups.

BackgroundMySurgery is a smartphone app designed to empower patients and their caregivers to contribute toward safer surgical care by following practical advice to help reduce susceptibility to errors and complications.ObjectiveThe aim of this study is to evaluate service users’ perceptions of MySurgery, including its perceived acceptability, the potential barriers and facilitators to accessing and using its content, and ideas about how to facilitate its effective implementation. The secondary aim is to analyze how the intended use of the app might differ for diverse patients, including seldom-heard groups.MethodsWe implemented a diversity approach to recruit participants from a range of backgrounds with previous experience of surgery. We aimed to achieve representation from seldom-heard groups, including those from a Black, Asian, and minority ethnic (BAME) background; those with a disability; and those from the lesbian, gay, bisexual, transgender, queer (LGBT+) community. A total of 3 focus groups were conducted across a 2-month period, during which a semistructured protocol was followed to elicit a rich discussion around the app. The focus groups were audio recorded, and thematic analysis was carried out.ResultsIn total, 22 individuals participated in the focus groups. A total of 50% (n=11) of the participants were from a BAME background, 59% (n=13) had a disability, and 36% (n=8) were from the LGBT+ community. There was a strong degree of support for the MySurgery app. The majority of participants agreed that it was acceptable and appropriate in terms of content and usability, and that it would help to educate patients about how to become involved in improving safety. The checklist-like format was popular. There was rich discussion around the accessibility and inclusivity of MySurgery. Specific user groups were identified who might face barriers in accessing the app or acting on its advice, such as those with visual impairments or learning difficulties and those who preferred to take a more passive role (eg, some individuals because of their cultural background or personality type). The app could be improved by signposting further specialty-specific information and incorporating a calendar and notes section. With regard to implementation, it was agreed that use of the app should be signposted before the preoperative appointment and that training and education should be provided for clinicians to increase awareness and buy-in. Communication about the app should clarify its scientific basis in plain English and should stress that its use is optional.ConclusionsMySurgery was endorsed as a powerful tool for enhancing patient empowerment and facilitating the direct involvement of patients and their caregivers in maintaining patient safety. The diversity approach allowed for a better understanding of the needs of different population groups and highlighted opportunities for increasing accessibility and involvement in the app.

Development and evaluation of an interactive web-based decision-making programme on relapse management for people with multiple sclerosis (POWER@MS2)\u2014study protocol for a randomised controlled trial

IntroductionMultiple sclerosis is a chronic inflammatory, degenerative disease of the central nervous system manifesting at first with relapses in about 85% of cases. In Germany, intravenous therapy with high-dose corticosteroids is the treatment standard of acute relapses. The treatment leads to a faster reduction of symptoms in about 25 of 100 treated patients but has no proven long-term benefits over placebo treatment. Intravenous treatment is not superior to oral treatment. Therefore, informed decisions on relapse management are required. An earlier randomised controlled trial showed that evidence-based patient information and education on relapse management leads to more informed decisions and more relapses not treated or treated with oral corticosteroids. This study aims to evaluate whether a web-based relapse management programme will positively change relapse management and strengthen autonomy in people with multiple sclerosis.MethodsThe pragmatic double-blind randomised controlled trial is accompanied by a mixed-methods process evaluation and a health economic evaluation and follows the UK Medical Research Council guidance on developing and evaluating complex interventions. A total of 188 people with possible or relapsing-remitting multiple sclerosis with ≥ 1 relapse within the last year and/or ≥ 2 relapses within the last 2 years will be recruited and randomised using blocks. The intervention group receives a web- and dialogue-based decision aid on relapse management, a nurse-led webinar and access to a monitored chat forum. The control group receives standard information, which will be made available via the same online platform as the intervention. The primary endpoint is the proportion of relapses not treated or treated with oral corticosteroids. Key secondary endpoints are the annualised relapse rate, decision-making, empowerment, quality of life and cost-effectiveness. Facilitators and barriers will be assessed by mixed-methods process evaluation measures. The study ends when 81 relapses have been documented or after 24 months of observation per individual patient. Analyses will follow the intention-to-treat principle.DiscussionWe hypothesise that the intervention will enhance patient empowerment and have a positive impact on patients’ relapse management.Trial registrationClinicalTrials.govNCT04233970. Registered on 18 January 2020

Primary and Secondary Prevention of Cardiovascular Disease in the Era of the Coronavirus Pandemic.

No abstract available Keywords: COVID-19; cardiovascular diseases; primary prevention; secondary prevention.