Phone Calls Research Articles

Introduction: Familial hypercholesterolemia (FH) is a genetic dyslipidemia characterized by increased low-density lipoprotein cholesterol (LDL-C) and greater risk for early atherosclerotic disease and premature mortality. Despite being a fairly common disorder, most individuals with FH are undiagnosed. To combat this disparity, the Family Heart Foundation launched the Flag, Identify, Network Deliver TM initiative (FIND-FH), a multi-institution collaboration that integrates an artificial intelligence (AI) machine learning algorithm (MLA) into institutional structured electronic medical record (EMR) data to identify patients with high likelihood of having FH. This study describes the methods and progress to date of one academic center that is part of the FIND-FH TM initiative. Methods: The FIND- FH TM MLA identified 491 patients within the EMR of a single academic center between the years of 2017-2022. Of these 491 patients, 70 were excluded. Exclusion criteria were as follows: patient deceased, duplicate medical record number, existing FH diagnosis, and patient under 18 years old. Subsequently, patients were manually risk stratified using Dutch Lipid and Simon-Broome criteria. Outreach was prioritized by risk-stratification tier, with patients being deemed “high risk” for FH the first cohort to be contacted. Patient outreach was conducted by a team of medical students and a research coordinator. Outreach was multimodal and consisted of two phone calls, a message in the EMR, and an email to the patient and a message to the patient’s primary care clinician (PCC). Results: After manual risk stratification, patients were categorized as “established FH” (n=32), “likely FH” (n=113), or “suspected FH” (n=309). Outreach to the “likely FH” cohort was prioritized first. To date, outreach to all 113 “likely FH” patients has been completed, with 16 patients subsequently evaluated for FH in cardiology clinic. Of these 16 patients, 8 have been diagnosed with FH/probable FH and 8 have been considered possible FH. No patients have had FH ruled out. Conclusions: MLA-integrated models provide scalable approaches for systems level screening for undiagnosed diseases. Robust outreach systems are needed to complement AI-mediated screening. Future work aims to engage the suspected FH cohort for risk stratification and clinical evaluation, as well as real-time integration and implementation of the MLA for prospective, continuous screening.

Introduction: University Hospitals Dorset (UHD) relocated maternity services into a newly constructed building. Transformational simulation is an effective method for identifying safety threats and driving healthcare improvements [1]. Research is limited on transformative simulation for maternity relocations. This project aimed to use simulation to identify latent safety threats in a new maternity unit and explore the impact on staff. Methods: Prior to opening, twenty mandatory in situ Multidisciplinary Team (MDT) simulation days were delivered for 682 staff due to work in the new maternity unit. Simulations were co-produced and co-facilitated by simulation, maternity, obstetrics, anaesthetics, transfusion, theatres and porters. Participants received a day’s training, split into three groups of 10–15 people incorporating orientation and rotation through three simulations - Sepsis, Major Obstetric Haemorrhage and Eclampsia – running simultaneously. Simulations required transfers, with locations varied to identify safety risks throughout maternity. MDT debriefs identified safety threats, which were recorded on a risk log and escalated to senior management. Mixed-method data was collected via participant questionnaires after each day to assess impact on staff. Results: Main safety threats: • Increased time for blood collection, due to increased distance from transfusion. • Removal of dedicated maternity porter. • Staff not trained in blood collection. • Unfamiliarity with department name and location during emergency phone calls. • Lack of adequate signage. • Staff injured during pool evacuations due to new shaped birthing pool. Improvements: • Increased O-negative blood supply in Maternity emergency fridge. • Automatic printing of blood collection slips to transfusion. • Allocation of general porter for urgent blood collection. • Staff blood collection training. • Location prompt cards adjacent to phones. • Improved flag style wayfinding signage. • Suspension of new birthing pools until alternative evacuation equipment tested. Impact on staff: Most participants reported increased confidence; 25% reported no change, and 7% reported a decline. 92% felt positive their contributions were valued. Discussion: This project identified latent safety threats within a new maternity unit using in situ simulation, leading to real-time improvements. While the overall impact on staff was positive, the decrease in confidence for some - likely due to the identification of safety threats without immediate solutions - suggests the need for further research on managing staff confidence whilst identifying safety threats. Feedback highlighted the value staff placed on orientation simulations, expressing a desire for further sessions. Key lessons for future transformative simulation include the importance of sufficient equipment in proposed locations, formal safety escalation processes and timely feedback to participants. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

BackgroundDigital health interventions (DHIs) can broaden the reach of HIV prevention interventions and overcome barriers for young cisgender men who have sex with men (YMSM). Community-based organizations (CBOs) have delivered HIV prevention interventions for decades, but few studies have examined how CBOs implement DHIs, including recruitment and retention. Keep It Up! (KIU!) is a Centers for Disease Control and Prevention–designated best-evidence DHI that can promote risk reduction behaviors and reduce sexually transmitted infection incidence.ObjectiveWe sought to descriptively assess CBOs’ approaches to recruitment and retention, elucidate lessons learned, and provide examples of recruitment and retention for future implementers.MethodsTwenty-two CBOs in counties with high HIV rates and large proportions of YMSM were selected through a request for proposal process to implement KIU!. Data were extracted from request for proposal applications and notes from monthly calls with CBO staff. Twenty-five staff members across CBOs were interviewed in the middle of implementation. A descriptive thematic analysis of the lessons learned in recruiting and retaining participants was performed. The research team developed an application dashboard for CBO staff to register participants, track participant progress through the intervention, record and track participant contact, and export usage data. CBO logins to the KIU! dashboard were tracked across the implementation. To descriptively compare approaches to recruitment and retention, the study team divided CBOs according to annual HIV testing volume in the 3 years prior to implementation and years of HIV service provision to YMSM.ResultsThe most frequent modes of recruitment were outreach and community partnerships (21/22, 95%), and the least frequent modes were via hook-up apps (6/22, 27%) and participant referrals (5/22, 23%). CBOs with a low HIV testing volume used online recruitment slightly more frequently, while medium-volume CBOs most frequently used hook-up apps for recruitment. Low-volume CBOs more frequently used phone calls and emails to remind participants to complete intervention modules, while high- and medium-volume CBOs more frequently used text messages. CBOs with more years of HIV service provision to YMSM more frequently had a set reminder schedule for contact with participants. CBO staff identified a need to change how KIU! is pitched to clients by using personalized, recipient-centered language rather than technical jargon. CBOs changed intake forms to ensure that staff remembered to offer KIU! to participants. CBOs had a difficult time retaining participants despite holding in-person events for enrolled participants (eg, raffles and trivia nights) and altering the frequency with which they reminded participants to complete modules.ConclusionsAlthough CBOs had experience in implementing other evidence-based interventions with YMSM, there was no consensus on successful recruitment and retention strategies for this population. We have presented approaches that future CBOs may use in their own implementation of KIU!.

Ultrasound-guided percutaneous fasciotomy and debridement (USPFD) is a minimally invasive treatment for patients with plantar fasciopathy refractory to conservative management. Previous studies have shown clinical improvement with USPFD, but pain relief and patient satisfaction have not been demonstrated beyond 2 years. This retrospective case series included patients who underwent USPFD at a quaternary academic medical center between April 2013 and January 2018, with refractory plantar fasciopathy and at least 4 years' follow-up. Patient outcomes were assessed through electronic surveys and telephone interviews. Primary outcome measures included mean changes in visual analog scale pain (VAS-Pain) scores and patient satisfaction via Likert scale. Secondary measures included VAS-Pain with the first 5 steps, VAS-Pain during daily weightbearing, and procedural complications. Seventy unique procedures were identified among 62 patients. Follow-up data were obtained from 51 of 62 patients (82%) who responded to surveys or phone calls. This corresponded to 58 of 70 procedures (83%) at a mean postprocedure follow-up of 6.6 ± 1.4 years. Patients had a mean duration of symptoms of 2.1 ± 3.0 years prior to the procedure. Baseline VAS-Pain was 6.8 ± 2.2 and final follow-up VAS-Pain was 0.7 ± 1.1. At the last follow-up, patient-reported VAS-Pain with first 5 steps was 0.9 ± 1.6 and VAS-Pain with weightbearing through the day was 1.3 ± 1.8. Overall, 91% (53/58) of the procedures were considered successful, where patients responded they were "satisfied" or "very satisfied" and 52 of 58 (90%) procedural responses indicated that based on the outcome, they would recommend the procedure to others. Final follow-up VAS-Pain, VAS-first 5 steps, and VAS-weightbearing, were all improved in the success vs failure groups (P ≤ .002). No complications were reported. USPFD was associated with high patient satisfaction and durable pain relief for chronic plantar fasciopathy at an average follow-up of 6.6 ± 1.4 years.

Black and Latino communities are disproportionately affected by HIV, and are often underrepresented in sexual health research. It is crucial to understand their participation in research, and gauge the impact of non-response bias in reported results. A sequential multimodal approach to recruitment could potentially increase the response rates and representativeness of the sample by increasing the likelihood of response from the participants. However, data on the use of various recruitment approaches (i.e. low-barrier strategies) for engaging patients from urban Federally Qualified Health Centers in sexual health research are limited. We analyzed survey recruitment data among patients prescribed PrEP at Federally Qualified Health Centers serving largely black and Latino/a communities to understand the impact of virtual recruitment. We used four sequential attempts over 6months to recruit participants for an incentivized patient feedback survey on sexual health and PrEP services. We also examined demographic differences, including age, sexual identity, gender identity and race/ethnicity, between responders and non-responders. We recruited participants from January to June 2022. The overall response rate was 20.8% (54/259). There was an incremental increase in responses based on the number of strategies used: 66.7% (36/54) of participants were recruited by using one strategy (email only), 22.2% (12/54) were recruited by using two strategies (email and phone calls) and 11.1% (6/54) were recruited using three (email, phone calls and SMS) or four strategies (email, phone calls, SMS and an additional phone call). Responders had received a more recent PrEP prescription compared with non-responders; mean±s.d. months between the most recent PrEP prescription and the first recruitment attempt date of the study was 15±17months for responders and 27±24months for non-responders. We observed no other significant differences in demographic characteristics between responders and non-responders. Response rates to an online sexual health survey among urban Federally Qualified Health Center patients were low using sequential multimodal virtual recruitment approaches, particularly among those without recent healthcare engagement. There were no demographic differences between responders and non-responders. Findings highlight the need for alternative innovative methods for research engagement and to reduce potential bias.

Subspecialty surgical care is limited in low- and middle-income countries (LMICs). Nongovernmental organizations (NGOs) attempt to bridge this gap through short-term medical trips (SMTs), but sustainability remains challenging. This report describes establishing a urology program in El Petén, Guatemala's largest region, as a model for sustainable subspecialty surgical care in LMICs. This retrospective, single-institution review evaluated the Aid Via Action Inc. (AVA) urology program at Hospital Nacional de San Benito (HNSB), a departmental public hospital in El Petén, Guatemala, from June 2024 to June 2025. All AVA cases were reviewed, with a descriptive analysis of program development and implementation. Institutional approval was obtained from the hospital ethics committee and director. Patient selection included medical, anesthesia, and urologic evaluation. Equipment was obtained through donations and partnerships. Sterilization used a 2% glutaraldehyde (Cydex®) protocol. Data were analyzed descriptively in Microsoft Excel, complications categorized by the Clavien-Dindo system, and follow-up conducted through clinic visits, phone calls, and coordination with local physicians. During this period, a total of 37 urologic procedures were performed: 31 TURPs, 2 cystolithotomies, 2 vesicovaginal fistula repairs, 1 cystoscopy, and 1 circumcision. There were three complications-two cases of urinary retention following TURP and one surgical-site infection (all Clavien-Dindo Class II) following a cystolithotomy. The median follow-up was 88days (IQR 73-98days). There were no mortalities. Early outcomes demonstrate the feasibility of implementing a urology program in a resource-limited setting. Long-term success depends on local engagement and sustained urology staffing at HNSB.

The objective of this project was to contribute to the understanding of how interruptions impact intravenous (IV) medication processes and identify areas for improvement. The specific aims were to evaluate the type, frequency, and duration of interruptions, including IV smart pump (IVSP) alerts and alarms, that nurses experience during IVSP activities. Real-world observational, exploratory, noninterventional design. Level 1 academic medical center in the Northeast region of the United States. Data on interruptions were documented using an electronic Case Report Form. One hundred IVSP medication administration activities were observed, of which 25% encountered at least one IVSP alert or alarm. The mean duration for each alert/alarm was 17.9 seconds and alerts/alarms occurred every 1.69 minutes during the medication administration activity. Alarms and alerts accounted for 24.5% of the total duration of each IVSP activity, indicating that nurses spent about 25% of their medication administration time responding to alerts/alarms. Regarding other types of interruptions, 44% of the 100 IVSP medication administration activities experienced at least one interruption, averaging 1.23 per activity. The main sources of interruptions were health care professionals (20.4%), medical devices (20.4%), and other nurses (16.7%). Phone calls created the longest interruptions, averaging 48.0 seconds, followed by self-initiated interruptions at 45.7 seconds. Findings reveal that interruptions, including IVSP alerts and alarms, significantly impact IV medication administration, consuming nearly 25% of nurses' activity time. Additional interruptions, often caused by health care professionals and phone calls, further disrupt workflows and extend task durations. Addressing these challenges through streamlined alert systems and improved communication protocols is essential to enhance efficiency and patient safety in clinical settings.

Healthcare systems in Sub-Saharan Africa (SSA) face significant challenges, including limited resources, understaffing, and geographical barriers, which hinder effective healthcare delivery. Phone call follow-ups have emerged as a promising strategy to improve participant retention, enhance data accuracy, and optimize health outcomes in resource-constrained settings. Despite their growing adoption, there is limited synthesized evidence of their effectiveness across various public health contexts in SSA. This systematic review and meta-analysis included 32 studies published between 2000 and 2024, conducted in 11 SSA countries. Studies employing phone call follow-ups in community and facility-based health interventions were evaluated. Participant retention rates, reasons for loss to follow-up, and health outcomes were analyzed. Risk of bias and quality were assessed using validated tools tailored to study designs, including the Hoy et al. checklist for observational studies and the Joanna Briggs Institute (JBI) checklist for experimental studies. Statistical analysis employed a random-effects model to calculate pooled estimates and sensitivity analysis was conducted to assess the robustness of findings. Although the primary focus was on phone call follow-up interventions, a few included studies also utilized text messaging alongside phone calls. The pooled retention rate across studies was 89% (95% CI: 85-91), with substantial variability among countries. Retention rates were highest in Kenya (96%) and Nigeria (87%). In contrast, countries like Cameroon reported a high participant loss rate of 42%. Frequent and consistent follow-up calls were associated with improved retention rates; studies that contacted participants 4-5 times reported retention rates as high as 98%. Barriers to follow-up included network issues, outdated contact information, and participant relocations. Risk of bias assessments showed that 81% of observational studies were rated as low risk. Additionally, 69% of experimental studies were assessed as high quality. Funnel plots assessing publication bias indicated some asymmetry in studies reporting lost rates, suggesting potential bias. Phone call follow-ups have enhanced participant retention and improved SSA health outcomes in regions with robust health infrastructure. However, variability in retention rates underscores the need for tailored strategies to address barriers like network challenges and participant mobility. Integrating innovative platforms like WhatsApp and leveraging consistent follow-up methods can enhance their scalability and impact. Policymakers should consider incorporating phone call follow-ups into routine care to optimize healthcare delivery in resource-constrained settings.

Abstract Background and Aims CKD management has increasingly incorporated exercise therapy, particularly for patients in non-dialysis-dependent (NDD-) CKD stages. While some studies suggest that exercise may help maintain GFR in the short term, the current evidence remains insufficient to establish its long-term effects. Underlying factors include decreased adherence to exercise interventions, highlighting the need for strategies to sustain behavioral changes. Recent advancements in digital apps and healthcare services are anticipated to enhance adherence, yet studies specifically evaluating their effectiveness in CKD exercise interventions are limited. Method To address this gap, a systematic review was conducted to assess the impact of digital apps and healthcare services on kidney outcomes in CKD patients. The review utilized a search strategy based on the guidelines of the Japanese Society of Renal Rehabilitation published in 2018, covering studies from January 1, 1990, to December 31, 2023. Potential articles matched to the keyword list were extracted from the PubMed database. Two reviewers independently screened titles and abstracts to identify candidates for full-text analysis and data extraction. Meta-analyses were performed if there were a sufficient number of eligible studies (basically three or more). All statistical analyses were performed using Stata 17.0 (StataCorp LLC, TX, USA). Results A total of 395 articles were screened, resulting in nine studies that evaluated clinical outcomes such as GFR, proteinuria, and albuminuria. Among the nine studies, eight assessed changes in GFR, primarily focusing on CKD stages G3 to G4. The interventions varied, including monitoring through pedometers, traditional communication methods (e.g., phone calls, emails), and modern digital devices (e.g., smartphones, tablets). Most studies faced challenges in blinding and had high risks of bias, with few employing intention-to-treat analyses. The GFR evaluation relied on serum creatinine-based estimation formulas, excluding cystatin C analyses. Ultimately, seven studies were included in a meta-analysis, revealing no significant changes in GFR from the interventions (+1.40 [95% confidence interval (CI): −1.87, +4.67] mL/min/1.73 m²), with short-term interventions showing a non-significant increase of +2.79 [95% CI: −1.22, +6.80] mL/min/1.73 m². Additionally, only three studies evaluated proteinuria and albuminuria, with mixed results. One study reported a significant reduction in albuminuria through individualized management using digital tools, while another found no improvement despite a year-long intervention. The inconsistency in outcomes suggests that while healthcare services and digital devices may offer some benefits, their effects on proteinuria and albuminuria remain uncertain. Conclusion In conclusion, the evidence supporting exercise interventions using digital apps and healthcare services in NDD-CKD patients is still inadequate, making it premature to draw definitive conclusions. Although small-scale randomized controlled trials (RCTs) have reported potential benefits in maintaining GFR, there is no evidence of deterioration, suggesting a low risk of clinical harm associated with these interventions. However, the psychological stress and discomfort that such new treatment modalities may impose on patients have not been thoroughly investigated. Therefore, the overall recommendation remains "no recommendation," emphasizing the need for comprehensive evaluations, including patient-reported outcomes, in future research. As digital devices become increasingly integrated into daily life, the anticipated surge in clinical trials utilizing these technologies may significantly enhance the evidence base in the coming years.

Abstract Background and Aims Tunneled dialysis catheters (TDCs) remain a frequent first-line vascular access for patients with end-stage kidney disease (ESKD) undergoing haemodialysis (HD), who do not have a functioning arteriovenous fistula or graft. TDC dysfunction is a common complication in these patients and thrombolytic therapy is frequently used to restore catheter patency prior to a TDC exchange, which is more invasive and costly, and invariably requiring hospitalization. Urokinase is preferred over recombinant tissue plasminogen activator due to cost and logistic concerns, however, what constitutes the most effective dose remains unsettled. We therefore aimed to study if a higher dose (30,000 unit per catheter lumen) is more effective in restoring catheter patency without a higher risk of adverse effects compared to standard dosing (20,000 unit per lumen) in a multi-ethnic Asian setting. Method Patients who meet eligibility criteria were randomized via block randomization method to standard or high dose groups. A successful final outcome was defined as restoration of catheter patency allowing for uneventful HD and discharge to outpatient dialysis centres (DCs) for chronic dialysis. For successful cases, follow up phone calls to DCs are performed at 1 and 6 months. Post-instillation, patients were also monitored for 12 hours for bleeding events. Clinical and outcome data were collected and statistical analysis was performed using the SPSS program (version 25). Results 44 catheters in 43 patients were studied. 54.5% were male with a mean age of 60.2 ± 13.5 years, 77.3% had diabetes mellitus as cause of ESKD with a median dialysis vintage of 1.2 years (range 0.03–14.5). 95.5% of patients had previously initiated HD via TDC, 40.9% had a previous failed AVF and 79.6% were awaiting AVF creation or maturation. There was no difference in baseline characteristics between standard and high dose groups. Mean dwell time was 9.7 ± 6.0 hours. Overall, a successful outcome was achieved in 65.9% of all catheters; and in 63.6% versus 68.2% for standard and high dose groups respectively (P = 0.750). In those with a successful outcome, 62.1% (18/29) developed recurrent dysfunction at a mean duration of 57.8±45.3 days. This occurred in 57.1% (8/14) versus 66.7% (10/15) in the standard and high dose groups respectively (P = 0.597). TDC was eventually removed in 37.9% of these patients, for reasons not due to TDC dysfunction (6 patients who cannulated AVF successfully, 1 patient who weaned off dialysis and 4 due to sepsis). Recurrence of TDC dysfunction was numerically higher in the standard group at 1 month (30.8% versus 7.7%, P = 0.135) and similar at 6 months in both groups (85.7% versus 90.9%, P = 0.732, in standard and high dose, respectively) after censoring for TDC removal not due to dysfunction. Time to TDC exchange did not differ between standard and high dose groups (mean 55 ± 59.6days versus 60.3 ± 32.6days, respectively, P = 0.857). There were no adverse events throughout the study period. At 6 months, only 6 catheters remained in the study (3 from each group); 25 were exchanged due to dysfunction, 12 were removed for other reasons, and 1 patient died. During TDC exchange, fibrin sheath was present in 66.7% of cases on pullback venogram (63.6% versus 69.2% in standard versus high dose groups, respectively, P = 0.772). Conclusion High dose urokinase may result in a higher catheter patency rate at 1 month, although there is no difference between high and standard doses in restoring or maintaining catheter patency at 6 months in this small study. Urokinase remains an important adjunct treatment to salvage catheters for a quarter of patients who are awaiting AVF creation or recovering from acute kidney injury. Recurrence of TDC dysfunction is high and tends to occur within a mean of 57.8 ± 45.3 days overall, likely due to presence of a fibrin sheath which is demonstrated in about two-thirds of TDCs in both groups. Higher doses are safe and can ease drug preparation and administration for 60,000 unit vials used locally.

The introduction of an innovative system of interaction between the doctor and the secondary medical staff at the State Medical Institution GP No. 35 DZM, which allows the doctor to remotely call the secondary medical staff on demand. The system includes a button at the doctor and a wristband at the nurse, allowing you to remotely call the nurse without interrupting the treatment process. This innovation reduces the need for the number of nurses, optimizes their work and eliminates the need for phone calls or voice calls, which improves patient orientation — the interaction is perceived by patients as intuitively coordinated. The novelty of the solution lies in the simplicity and efficiency of the system, which increases productivity, reduces costs and improves the service atmosphere. Significant results were an increase in the capacity of the polyclinic by 8%, an increase in patient satisfaction by 14%, and a decrease in employee stress by 8%.

BackgroundCoronary heart disease (CHD) continues to be a leading cause of global morbidity and mortality, with patients undergoing percutaneous coronary intervention (PCI) facing a significant risk of recurrent cardiovascular events. While secondary prevention strategies, such as medication adherence and lifestyle modifications, are essential, implementation gaps remain due to limited health care access and inadequate patient engagement. Telemedical interventions offer a promising solution to these challenges by facilitating remote monitoring and providing individualized patient management strategies.ObjectiveThis randomized controlled trial aimed to evaluate the efficacy of a comprehensive web-based telemedical interventional management system in reducing major adverse cardiac and cerebrovascular events (MACCE) and enhancing secondary prevention outcomes among patients with CHD following PCI, compared to usual care alone.MethodsWe conducted a single-center, open-label, randomized controlled trial at a tertiary hospital in China. A total of 2086 patients with post-PCI CHD were randomly assigned in a 1:1 ratio to receive either telemedical management combined with usual care (intervention group; n=1040) or usual care alone (control group; n=1046). The control group received follow-up phone calls from health care providers at 1, 3, 6, and 12 months after discharge. In contrast, the remote patient management group benefited from multicomponent interventions delivered through a telemedicine platform, alongside usual care. This platform provided personalized health education, medication reminders, vital sign monitoring, and artificial intelligence-assisted consultations. The primary outcome was the composite incidence of MACCE, including cardiac death, myocardial infarction, stroke, or target vessel revascularization, at one year. Secondary outcomes included bleeding events, lifestyle changes, blood pressure control, and medication adherence.ResultsAt the one-year follow-up, the intervention group demonstrated a significant reduction in MACCE compared to the control group (36/1040, 3.5% vs 55/1046, 5.3%, P=.04). This was primarily attributed to lower rates of cardiac death (10/1040, 1.0% vs 24/1046, 2.3%, P=.02) and myocardial infarction (8/1040, 0.8% vs 19/1046, 1.8%, P=.03). Additionally, bleeding events classified as BARC 3‐5 were less frequent in the intervention group (6/1040, 0.6% vs 16/1046, 1.6%, P=.03). The intervention group also exhibited improved control over systolic blood pressure (mean 117.74, SD 13.80 mmHg vs mean 121.46, SD 16.85 mmHg, P=.002) and diastolic blood pressure (mean 73.60, SD 10.18 mmHg vs mean 75.72, SD 10.45 mmHg, P=.02), along with higher medication adherence to aspirin (896/1021, 87.8% vs 858/1017, 84.4%, P=.03) and angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors (489/1021, 47.9% vs 442/1017, 43.5%, P=.045). Furthermore, there was a notable reduction in alcohol consumption among participants in the intervention group (119/1021, 11.7% vs 168/1017, 16.5%, P=.002), alongside a trend towards decreased smoking rates (114/1021, 11.2% vs 142/1017, 14.0%, P=.06).ConclusionsTelemedical interventional management significantly enhanced clinical outcomes by reducing MACCE and improving risk factor control among patients with CHD who underwent PCI. These findings underscore the potential of telemedicine to bolster secondary prevention efforts and long-term care strategies. Further multicenter studies are necessary to validate these results and optimize telemedicine frameworks for broader implementation.

A framework for investment scam reporting: Deception and reverse agency in an Australian context.

Greater Resource Utilization for Patient-Reported Outcome Measures Collection in Medicare Inpatient Versus Outpatient Total Knee Arthroplasty: Implications for the New Centers for Medicare and Medicaid Services PRO-PM Policy.

PT Susi Catering is a catering company that provides food services for events such as weddings, offices, and religious celebrations. The manual ordering process, typically handled via WhatsApp or phone calls, often leads to errors and inefficiencies. To address these challenges, this study developed a mobile food ordering application using Android Studio and Firebase. The system was built with the Waterfall method through stages of requirement analysis, system design, implementation, and testing. The application supports two roles: user and admin. Features include user registration, login, food package selection, order forms, pondokan menu options, order history, and real-time chat. Admins can manage orders and communicate with users. Testing demonstrated that the application improved efficiency and accuracy compared to the manual process. The research highlights the effectiveness of mobile applications in enhancing catering service operations.

ABSTRACT Retention in birth cohort studies varies globally, with rates of over 80% in high-income countries and 30%–75% in low- and middle-income settings due to socioeconomic vulnerability, geographic dispersion, and infrastructural barriers. Despite the importance of participant retention, evidence on structured tracking systems contextualized to these settings remains limited. This paper describes the design, adaptations, and outcomes of a participant tracking system developed for the Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture, a community-based birth cohort that enrolled 409 pregnant participants in a floriculture-intensive rural area of Ecuador. In this setting, retention was challenged by informal employment, variable phone access, and high mobility. The tracking system was implemented from pregnancy through 18 months postpartum, including two final follow-up waves conducted at 12 and 18 months. It comprised a predefined follow-up schedule, a team with defined roles, a real-time digital planner for recording contact attempts, participation status, and activity completion, and a five-tier participation classification. Tracking was conducted through office visits, phone calls, and home visits. Flexible protocols and targeted outreach addressed pandemic-related disruptions and irregular work schedules. Overall retention was 77%, with 84% and 75% at 12 and 18 months, respectively. Partial refusals (27%) were primarily linked to mobility and work demands, while 94 participants fully discontinued. Home visits enabled completion for 154 participants, with an 88% success rate. This experience illustrates how context-adapted tracking systems can sustain high retention in rural settings, offering a scalable model to inform global health research in underserved populations.

Using a multidisciplinary approach, we sought to develop effective information technology (IT)-driven solutions to reduce both incoming and outgoing telephone communication to minimize errors and complaints while improving efficiency and workplace satisfaction. We built 2 IT-driven workflows, one targeting incoming phone calls and the other outgoing calls. To reduce incoming calls, we implemented a shell test with a monitored dashboard, enabling nursing staff to electronically request blood product release for their patients. To reduce outgoing calls, we developed a web-based application for critical values that sends a secure message with patient information and the critical value, which the provider must acknowledge or refuse. Critical value disposition information is then fed back into the critical value application, and in the event of refusal to acknowledge, the technologist initiates timely escalation via manual workflows. We assessed incoming call volume for blood products, formal complaints, critical value notification turnaround time, and end-user satisfaction. We significantly reduced incoming calls and formal complaints and received positive end-user satisfaction feedback for the critical value application. We did not find a difference in critical value reporting turnaround time after the intervention. We successfully built IT-driven solutions, which reduced incoming and outgoing phone calls in our clinical laboratories. These efforts reduced complaints and created systems well received by end users.

In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, British Journal of Psychiatry, 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study.We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars.Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, p = 0.007) and fewer visits to psychiatrists (9% versus 22%, p = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, p = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD.Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD. · Telephone-based, nurse-delivered IPT is effective in treating PPD.. · We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.. · Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.. · The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.. · Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD..

ABSTRACTPurposePatients diagnosed with advanced cancer are increasingly being offered comprehensive genomic profiling (CGP) to determine whether they are eligible for biomarker‐informed treatment. The communication of CGP results to patients can be suboptimal and associated with patient anxiety. This study explores patient, clinician and public experiences of CGP and preferred methods of communicating results.MethodsFocus groups were held with patients and carers, with the resulting data evaluated by thematic analysis. Concurrently, a questionnaire was designed and distributed to 60 clinicians involved in CGP studies.ResultsTwenty‐four patients with a current/previous cancer diagnosis and 10 carers attended the focus groups. Experience with CGP was minimal and often limited to what participants had read on the internet. Patients/carers felt the delivery of results was very complicated and emphasised emotional facets to communicating CGP results and the wish for delivery to be tailored to them. Questionnaire responses were received from 10 UK sites. 92% of clinicians ensured patients received their CGP results, with the majority (57%) returning all CGP results, but 30% would only report on actionable mutations. Results were delivered face to face by 38% of clinicians, while other methods included letters, phone calls, or a combination of approaches. Many clinicians expressed an interest in receiving training on how to feedback CGP results.ConclusionThere is a need to develop and implement a standardised approach to returning CGP results, as well as increasing healthcare professional education and confidence with interpreting CGP. Due to the increasing access to CGP as part of routine healthcare, it is essential clinicians feel confident to interpret this information and that patients have results returned to them in an understandable format.

Multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in patients with advanced gynecological cancers: A prospective study.