Regular Phone Calls Research Articles

Caregiver Wellness after Traumatic Brain Injury (CG-Well): Protocol for a randomized clinical trial

IntroductionAfter injury, survivors of moderate to severe traumatic brain injury (msTBI) depend on informal family caregivers. Upwards of 77% of family caregivers experience poor outcomes, such as adverse life changes, poor health-related quality of life, and increased depressive symptoms. Caregivers frequently report minimal support or training to prepare them for their new role. The majority of previously developed caregiver and caregiver/survivor dyad interventions after msTBI focus on providing information to either survivors only, or to long-term caregivers, rather than to the new caregiver. This manuscript describes the protocol of an ongoing randomized control trial, Caregiver Wellness after TBI (CG-Well), developed to provide education, support, and skill-building to caregivers of adults with msTBI, beginning when the survivor is early in the clinical course. MethodsWithin two weeks of admission to the ICU, participants are randomized to CG-Well online modules (intervention group, n = 50 dyads) or information, support, and referral (ISR) e-bulletins that exist in the public domain (control group, n = 50 dyads) over the first six months after their family member’s msTBI. Both groups receive regular phone calls. The primary outcome is intervention satisfaction at six months. ResultsEnrollment began in March, 2022 and is projected to complete October 2024. We have enrolled approximately 70% of participants at this time. Primary analysis completion is anticipated April, 2025. DiscussionThis RCT is designed to evaluate caregiver satisfaction by addressing the need for tailored supportive care for caregivers of msTBI beginning during the ICU admission. Trial RegistrationClinicaltrials.gov Registration Number: NCT05307640

Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies.

Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

Increasing access to mental health supports for 12–17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial

BackgroundIndigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12–17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app’s broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs.MethodsA pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks.DiscussionThis trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways.Trial registrationhttps://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

Home care models dedicated to COVID-19 patients: the experience of a Local Health District of Veneto Region (Italy).

During COVID-19 pandemic, health professionals have been working in an extreme uncertainty context. Affected patients needed to be cared at home as long as possible to avoid virus spreading and hospital resources saturation. The Veneto Regional Administration (North-east of Italy) released Regional guidelines about it. The Western Healthcare District of the Local Health Authority of the city of Vicenza (180,000 inhabitants) implemented a healthcare pathway following them. Aim of the study is to describe the results and outcomes of such implementation. In the implemented health care pathway, a new service called "Special Unit of continuity of care" (USCA) with physicians and nurses has been dedicated to the prise en charge at home of patients suffering from Sars-CoV-2. They were referred to the USCA by general practitioners or by hospital specialists, and managed through a daily clinical monitoring by regular home visits and phone calls, specialist consultations and therapy management. In order to prevent hospital admission, an oxygen concentrator when possible has been employed and managed at home by the members of the USCA when the oxygen saturation was below 93%. An observational retrospective study has been conducted using anonymized data from different databases: the USCA activity database (from 12/01/20 to 21/31/21), the hospital and Emergency Department discharge databases, and the "healthcare co-payments exemptions database". The latter database refers to the people excluded - because of their chronicity - from the co-payment of a list of medical exams and services. Descriptive and multivariate logistic regression analyses have been implemented. 1,419 patients suffering from Sars-CoV-2 have been cared and managed by the USCA in the considered period of time (mean 11.4 days), of whom 787 (55.5%) with at least one chronic condition (described in the above quoted "healthcare co-payments exemption database") and 261 provided with oxygen concentrator. 275 (19.4%) needed a hospital admission, 39 (2.8%) in intensive unit; 53 died during hospitalization (3.8%). Out of the 261 patients utilizing oxygen concentrator, 103 have been admitted to hospital (39.5%), 7.3% in intensive unit and 8.0% died. In implemented multivariate analyses, the use of oxygen concentrator, proxy measure of the severity of the condition, is the major determinant for the risk of hospital admission (adj OR: 3.2, CI 2.3-4.3) and of dying within 30 days (adj OR: 2.8 CI 1.5-5.1). Among the 261 patients provided with oxygen concentrator, 158 (60,5%) have been managed at home without any admission to emergency department and/or hospitalization. In an uncertain context such as COVID-19 pandemic, the already-implemented home care model has been modified by integrating the USCA physicians and nurses and specialist care networks to prevent hospitalization and the sense of isolation and abandonment of people as much as possible. Almost 1,500 patients suffering from COVID-19 have been cared for at home over 13 months by such new service with complex and multidisciplinary activities. The risk of hospitalization and death appears determined by the severity of the pathology with high and significant OR 60% of patients with oxygen concentrators who, despite an initial high hyposaturation were not hospitalized, represent, partly, the group of patients who would have been requiring hospital care in the absence of a home care pathway in a standard situation.

Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective.

Despite expanded and successful antiretroviral therapy program coverage, a large proportion of people drop out at different stages along their treatment course. As a result, treatment gains do not reach a large proportion of these groups. It has been demonstrated that around half of the patients who test Human immunodeficiency virus (HIV) positive in Sub-Saharan Africa are lost between testing and being considered for eligibility for therapy. The purpose of this study was to determine the factors that influence patients on antiretroviral therapy who lost to follow up in HIV treatment clinics in Asunafo South District, Ahafo Region. We used phenomenological qualitative research approach in conducting this study. Purposive sampling was used to select respondents, while key informant interview was used to collect the data. The major identified challenges in carrying out follow-up visits of patients on antiretroviral therapy were wrong addresses and phone numbers of clients, coupled with poor telecommunication networks, geographical relocation of clients, poor documentation of patients' information, and non-availability of means of transport. The preferred reengagement strategies identified in this study were: supply of drugs through home visits, intensive education, engaging the services of community-based surveillance officers, enhanced regular phone calls visits, adoption and use of an integrated antiretroviral therapy clinic, intensified education on HIV, and involvement of religious leaders. In conclusion, all clinicians and stakeholders should consider the identified challenges and reengagement strategies when providing antiretroviral services.

SOCIALLY ACTIVE OR ISOLATED? OLDER COMMUNITY-DWELLING ITALIANS’ EXPERIENCES DURING THE COVID-19 PANDEMIC

Abstract Media coverage of older adults during the COVID-19 pandemic emphasized their experiences of social isolation – a risk that pre-dated the pandemic but was magnified by it. A focus on older adults’ pandemic-induced isolation also is evident in gerontological research. This depiction, however, may not capture the complexity of older adults’ experiences during the pandemic. Our study examined this topic using semi-structured interviews that were conducted with participants in a senior center in a mid-sized northern Italian city in May 2022 (n=23). Our analysis revealed that the pandemic had some negative effects on older adults’ social relationships; however, it also identified strategies that older adults used to maintain and even enhance their connections with others. Participants described reduced in-person interaction with family and friends, stemming from less daily interaction and the cancellation of family gatherings. They compensated for these losses, to some degree, with regular phone and video calls. Participants also described permanently strained relationships with family members and friends, often the result of differing views of COVID-19 vaccines. The pandemic’s challenges, however, enhanced other social relationships through exchanges of moral and practical support. In contrast with the frequent depiction of older adults’ isolation during the COVID-19 pandemic, our data reveal strategies that allowed them to remain socially engaged and active in their communities.

Favipiravir does not appear to be a major teratogen: Case series from Türkiye

IntroductionFavipiravir has gained attention during the Coronavirus Disease-2019 pandemic due to its potential antiviral effect against Severe Acute Respiratory Syndrome Coronavirus-2. Favipiravir has been identified as a teratogen in animal studies, but there is limited human data. We aimed to evaluate the pregnancy outcomes of women exposed to favipiravir during the pandemic. Material and methodsPregnant women who were exposed to favipiravir and applied to Marmara University School of Medicine Medical Pharmacology Outpatient Clinic Teratology Information Service between December 2020-September 2021 are included in the study. The demographic information, medical and obstetric histories of patients were acquired during admission, the outcomes of the pregnancies and the characteristics of the infants were gathered by regular phone calls. The infants whose parents consented were evaluated by a pediatrician for general well-being and congenital anomalies. Results22 pregnant women were included in this study. 81.8 % received the recommended favipiravir dose (8000 mg in 5 days), in the first trimester. Two patients were lost to follow-up, there was one elective termination and 19 live births. Congenital anomalies were found in 2 infants, one of whom had 9q34 duplication syndrome. Except for these, all newborns examined by the pediatrician were healthy. DiscussionWithin a limited case series, a subset of the infants exposed to favipiravir prenatally were followed up to 1 year of age. Two infants exhibited congenital malformations that cannot be directly linked to favipiravir due to confounding variables. Considering the limited data published, favipiravir does not appear to be a major teratogen.

Connecting Older Adults with Students Through Interprofessional Telecare (COAST-IT)

By 2030, it is projected that one in five people in the United States will be 65 years old and older. It is critical that future health care professionals are prepared to care for older adults. Students’ communication skills and attitudes toward older adults have been shown to benefit from a geriatric specific curriculum. Connecting Older Adults with Students Through Interprofessional Telecare (COAST-IT), a longitudinal program begun in 2020, pairs student partners (SPs) with older adult partners (OAPs) who have regular phone calls. This was implemented across various graduate health profession schools and aims to provide students the opportunity to learn and practice effective communication skills with older adults, while also decreasing social isolation and loneliness experienced by the older adult partner. This paper focuses on our initial results looking at the impact on students who participated. Students were surveyed pre- and post-participation in the COAST-IT program through a combination of open-ended questions and questions taken from the University of California, Los Angeles (UCLA) Geriatrics Attitude Scale. Students reported an improvement in their ability to communicate with older adults, increased confidence in their communication skills, and an improved understanding of ageism.Initially, OAPs were recruited from a variety of local facilities including the geriatric clinic associated with the University and the community of assisted living and long-term care facilities, senior living communities, and various community organizations that focus on serving older adults. The Director of Outreach Programs in the Multidisciplinary Center on Aging at the University of Colorado presented to civic organizations and older adults began volunteering. Word of mouth spread among OAPs, and they began recruiting their friends; there are now OAPs from nine states participating. The program received a Social Innovation Award from the National Area of Agencies in Washington D.C., which supported our university's Age Friendly University designation.Students are oriented to the program and process of conducting weekly phone calls by their faculty coordinator in each program. The COAST-IT mission, process information, and examples of communication techniques are provided to students through a student handbook and Learning Management System module. Students participate in an interdisciplinary formal orientation prior to engaging in their OAP encounters. Monthly synchronous online educational presentations are provided to all students. Topics include a variety of issues on aging with breakout sessions for discussion and networking among disciplines.

Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic: A Secondary Analysis of the COVISIT International Survey.

During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic. A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy. Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy). Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.

Adherence With Oral Anticancer Therapies: Clinical Trial versus Real-World Experiences with a Focus on Prostate Cancer.

In this review, we address adherence rates in clinical settings, barriers to compliance with dosing schedules, and potential strategies to overcome challenges in maintaining high levels of adherence. Four studies reporting real-world adherence to prostate cancer medications, 52 studies describing barriers to adherence, and 16 studies on methods to minimize poor adherence were reviewed. Mean nonadherence rates of 25 to 51% have been identified in prostate cancer patients prescribed oral therapies, with higher rates in older patients. An extensive review of prostate cancer patients receiving gonadotropin hormone-releasing hormone agonist injections found an overall nonadherence rate of over 27%. Patients may encounter barriers to complying with dosing instructions related to the medication (eg, complex dosing schedules, the total burden of medication management, fasting or dietary requirements, high medication costs, adverse effects, and drug-drug interactions). Barriers may also be related to patient-specific factors (eg, suboptimal education regarding the importance of adherence, physical limitations and cognitive decline associated with advancing age, living alone without a care partner, high symptom burden, needle phobia, and comorbid mental disorders). Interventions to improve dosing adherence may include automated reminders, treatment diaries, educational materials, and the involvement of patients, family members, care partners, and healthcare teams. Many oral anticancer medications improve survival in men with prostate cancer and therefore it is vital to establish good adherence by understanding the pitfalls that patients may encounter. In situations where both oral and injectable drugs are interchangeable, injections of long-acting drugs lead to fewer opportunities for dosing nonadherence than oral therapies. In contrast, oral medicines do not require scheduling for injections and travel for injection appointments. Therefore, maximizing adherence to all treatment regimens will reduce the chance of efficacy failures and likely lead to improved clinical outcomes.

Independent risk factors of asthma exacerbations: 3-year follow-up in a single-center prospective cohort study.

Because minimizing future risk is the goal of asthma chronic asthma management, it is particularly important to identify risk factors. We conducted this 3-year single-center prospective cohort study to determine the independent risk factors of asthma exacerbations (AEs). We performed this prospective, longitudinal, observational study with a 3-year follow-up on 257 patients aged 18-81 years with at least a 1-year history of asthma. Follow-up visits are conducted through regular annual phone calls, and the primary endpoints were AE. The uncontrolled group was more likely to develop AE than the well-controlled group [odds ratio (OR): 6.34, 95% confidence interval (CI): 1.14-35.21, P<0.05]. Patients with low Asthma Quality of Life Questionnaire (AQLQ) scores were more likely to develop AE than these with high AQLQ scores (OR: 0.59, 95% CI: 0.35-0.99, P<0.05). AQLQ and Asthma Control Questionnaires (ACQ) were both strong independent risk factors within 3 years of enrollment; the cut-off values (COV) of the AQLQ and the ACQ (uncontrolled) that better evaluated the risk with the AE were ≤5.4 and >1, respectively. The AQLQ scores had a sensitivity of 79.07% and a specificity of 59.09% [area under curve (AUC): 0.70, P<0.0001], and the ACQ (uncontrolled) had a sensitivity of 81.4% and a specificity of 52.29% (AUC 0.68, P<0.0001). The findings of this study suggest that patients with uncontrolled asthma and a diminished health-related quality of life had an increased risk of exacerbations in the future. Defining these risk factors associated with AE is important as it will identify these at the highest risk to patients and may guide future interventions.

Facilitators and Barriers to Donor Detection Based on Hospital Staff Opinions in Different Hospitals

ackground: Donor detection is the first step of organ procurement for transplantation, and about 50% of all potential donors are not detected. Objectives: The present study aimed to evaluate the facilitators and barriers to donor detection based on hospital characteristics and staff opinions. Methods: In this cross-sectional study, a 16-item questionnaire was prepared to clarify medical staff opinions about facilitators (10 items) and barriers (6 items) to potential donor detection. The questionnaire was distributed on social networks, and all medical staff members were invited to participate in the study. Results: A total of 230 medical staff participated in this study. From their point of view, the main facilitator was active detection via regular daily phone calls (150, 65.2%), which had the most advocators among medical staff of public (64.1%) and private hospitals (74.5%). Detection by donor coordinators or inspectors tanked the second (103, 44.8%). Moreover, private hospitals highly agreed with detection by donor coordinators and inspectors in 66.7% and 60.8% of cases, respectively. Donor detection by an in-hospital-coordinator was recommended by 42.6% of all 230 participants, with most advocators among those affiliated with an organization (65.4%). Staff opinions about donor selection and care to donor families were important barriers according to 53.5% and 46.1% of subjects, respectively. Conclusion: To identify all potential donors, different strategies are necessary according to hospital characteristics. In public hospitals, daily calls; in private ones, active visits; and in an-organization-related hospitals, in-hospital coordinators could be effective.

Psychosocial Factors as Predictors of Suicidal Ideation among undergraduates of University of Ibadan

This research was aimed at investigating the psychosocial factors predicting suicidal ideation among the undergraduate of University of Ibadan, Nigeria. Descriptive correlational design survey was adopted for this research. A sample size of 220 respondents was randomly selected for the purpose of this research. Valid and reliable instruments were used for data collection. Data collected were analysed using the Multiple Regression Analysis and Pearson Product Moment Correlation at 0.05 level of significance. The results revealed that self-esteem (r=0.337, p&lt;.01), family support (r=0.366, p&lt;.01), hopelessness (r=0.417, p&lt;.01) and religion (r=0.402, p&lt;.01) had a positive significant relationship with suicidal ideation, while emotional intelligence (r = -.414, p&lt;.01) had a negative relationship with suicidal ideation. Also, the joint contribution of the independent variables (Self-Esteem, Hopelessness, Emotional Intelligence, Family Support and Religion) on suicidal ideation was significant. Finally, it was revealed that the independent variables contributed to the dependent variable relatively as expressed below. Self-esteem (β = .774, t = 16.350 P&lt;.01), emotional intelligence (β = -.318, t = -7.938 P&lt;.01), family support (β = .301, t = 5.760, P &lt;.01), hopelessness (β = .498, t = 10.388, P &lt;.01), religion (β = .309, t = 7.531, P &lt;.01) respectively. The study recommends that the school administrators should establish counselling units in each faculty to bring counselling psychologists closer to the student for any assistance where necessary. The religious bodies such as Churches and Mosques should do everything to preach hopeful messages to their congregation. This is to enliven the students attending such programmes thereby giving them hope irrespective of their situation. Families should also provide the needed support that would boost the students’ self- esteem and worth. This may be in form of more affection, support for their aspirations and dreams etc. This is achievable through regular phone calls, visitations and other kinds of support where necessary by the family members and significant others. Keywords: Hopelessness, Religion, Self-Esteem, Emotional Intelligence, Suicidal Ideation DOI: 10.7176/JHMN/101-07 Publication date: August 30 th 2022

21st Century Good Neighbor Program: An Easily Generalizable Program to Reduce Social Isolation in Older Adults.

Aim: In this once-in-a-lifetime humanitarian crisis, what does it mean to be a good neighbor? It means that as a community, we must address loneliness and barriers to care faced by vulnerable populations such as older adults. We share an inexpensive longitudinal experiential service-learning program implemented by health professions and undergraduate student volunteers that aims to help alleviate loneliness in older adults while imparting meaningful experiences to volunteers.Intervention Design and Setting: The 21st Century Good Neighbor Program is an observational cohort study of an experiential service-learning program started in May 2020, and this article shares the results collected after 1 year. This longitudinal, weekly phone call program was conducted in a single community setting in the Midwestern part of the United States. Older adults over the age of 60 served by a local community service agency (CSA) were invited to participate. Volunteers consisted of students 18 or older. Student volunteers made regular phone calls to a pair of older adults throughout the course of 1 year following standardized call scripts. The loneliness of the older adults was measured by volunteers using the 3-item UCLA Loneliness Assessment.Results: 261 older adults were engaged in conversations with a volunteer. A total of 1,391 calls were accepted by older adults and the median length of a welcomed call was 11 min. The average baseline loneliness score was 4.156 ± 1.41 and the prevalence of social isolation was 19.5%. There was no significant change in the UCLA loneliness score in the first year of follow up. However, a majority of volunteers (88%) agreed or strongly agreed that the program had a positive impact on them. In addition, the program identified 257 issues older adults faced that required follow-up. The most prevalent concerns referred to the community service agency by volunteers were issues related to utilities, food and transportation access.Conclusion: The 21st Century Good Neighbor Program is a unique intervention in which student volunteers and older adults paired by a community service agency forge relationships though a longitudinal phone call-based program. This easy-to-implement program provides another layer of support to identify and refer issues that impact social determinants of health. The added benefit of volunteer satisfaction in the setting of COVID 19 pandemic is heartening. We hope to continue to study the impact of this intervention on social isolation in this vulnerable population.

254 OPTIMISING COMMUNICATION WITH FAMILIES OF PATIENTS ON ACUTE STROKE AND GERIATRIC MEDICINE WARDS IN A LARGE TERTIARY HOSPITAL

Abstract Background Good communication with patients and families is important for older adults admitted to acute stroke or geriatric medicine wards, particularly with COVID19-related restricted visiting. These patients often have communication difficulties including aphasia, delirium, cognitive or hearing impairment, limiting their own communication with relatives. Using the Plan, Do, Study, Act (PDSA) approach we undertook a quality improvement project to optimise communication with families of patients on above wards in a large tertiary hospital. Methods PDSA cycle 1: Staff were surveyed to identify satisfaction level with communication and ways to optimise communication. Inpatients on study wards were identified, we recorded demographic and clinical details and prevalence of communication difficulties. We created a designated folder with individual ‘communication sheets’ in conjunction with ward doctors and the nurse manager. PDSA cycle 2: We performed a rapid interval audit of the communication folder use. ‘Outlier’ patients were excluded as their teams did not receive education about folder use. Results PDSA cycle 1: A total of 90 inpatients on three wards were included, mean age 78y (SD ±14.4y), 47% were male. Three-quarters (73%) had a communication difficulty noted, reported by nursing staff. Two patients were intubated and six had stroke-related aphasia. Half of surveyed staff reported communication with families was suboptimal. Most (86%) suggested a centrally-located communication logbook would be helpful. PDSA cycle 2: Over two weeks, communication sheets were reviewed for all included patients. Median frequency of calls to families was 4 days (range 0–14). Most (79%) had the name of the primary contact clearly documented. Many (52%) included no contact number. Only 9% had secondary contact information documented. Conclusion Communication with families of patients on acute stroke and geriatric medicine wards was suboptimal. Over a short interval this improved with regular phone calls using specific centrally-located communication folders. Further optimisation of their use is needed.

Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis.

The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.

The effect of nurse-led telephone support on adherence to blood pressure control and drug treatment in individuals with primary hypertension: A randomized controlled study.

The aim of this study was to evaluate the effect of telephone monitoring, in combination with texts, on medication adherence and blood pressure (BP) control in primary hypertension. Data were collected from August to December 2016. Seventy-seven adults were randomized to the intervention and control groups. A 12-week intervention consisted of regular text messages and phone calls. The control group received usual hypertension care. The outcomes were evaluated with blood pressure measurement and medication adherence self-efficacy scale short form. Medication adherence in Week 12 was found to be significantly higher in the intervention group than in the control group. Mean systolic and diastolic BP levels in Weeks 4, 8 and 12 were statistically significantly lower in the intervention group than in the control group (p < 0.05). Using text messaging and nurse-led telephone monitoring improved adherence and BP control in adults with hypertensive in primary care.

CT Image Examination Based on Virtual Reality Analysis in Clinical Diagnosis of Gastrointestinal Stromal Tumors.

With the advancement and development of medical equipment, CT images have become a common lung examination tool. This article mainly studies the application of CT imaging examination based on virtual reality analysis in the clinical diagnosis of gastrointestinal stromal tumors. Before extracting suspected lymph nodes from a CT image of the stomach, the CT image sequence is preprocessed first, which can reduce the cumbersomeness of subsequent extraction of suspected lymph nodes and speed up the subsequent processing. According to medical knowledge, CT images of the stomach show that lymph nodes mainly exist in the adipose tissue around the gastric wall, but there are no lymph nodes in the subcutaneous fat outside the chest. The most basic gray value in the image and the neighborhood average difference feature related to gray level are used as the primary features of visual attention detection. When extracting the neighborhood average difference feature, we use a 3∗3 sliding window method to traverse each point of the pixel matrix in the image, thereby calculating the feature value of each pixel in the image. After the feature extraction is completed, it is necessary to calibrate the data and make a training data set. The SP immunohistochemical staining method was used. The specimens were fixed with 10% formaldehyde, routinely embedded in paraffin, sectioned, and stained with HE. The tumor tissue was determined by immunohistochemistry, and the reagents were products of Maixin Company. All patients were followed up by regular outpatient review, letters, and visits or phone calls. The data showed that immunohistochemical tumor cells showed positive staining for CD117 (14/15, 93.3%) and CD34 (10/15, 66.7%). The results show that the application of virtual reality technology to CT imaging examination can significantly improve the diagnostic accuracy of gastrointestinal stromal tumors.

Don't forget the trauma patient: lessons from a major trauma and major COVID centre.

Don't forget the trauma patient: lessons from a major trauma and major COVID centre.

Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.