Use Of Devices In Healthcare Research Articles

Antifungal susceptibility profile of invasive Candida glabrata isolates (2009-2020) from a tertiary care hospital laboratory in Pakistan.

Introduction. Invasive infections with Candida glabrata are a global concern due to poor clinical outcomes and propensity to acquire resistance to antifungal agents. Hypothesis/Gap Statement. Monitoring emerging resistance and trends in Candida glabrata, an important agent of candidemia in Pakistan, is critical for patient management; data that is missing from Pakistan. Aim. Thus, this study evaluated antifungal resistance and MICs) distribution in invasive C. glabrata isolates from Pakistan. Methods. This cross-sectional and retrospective study was conducted from January 2009 to March 2020 at a clinical laboratory in Pakistan that has a nation-wide network. Antifungal susceptibility data of 277 candidemia, deep organ and soft tissue (invasive) C. glabrata sensu lato isolates against fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, micafungin, caspofungin and amphotericin B was retrieved. Susceptibility testing was performed using colorimetric broth microdilution and interpreted using CLSI criteria. Demographics, clinical history and outcome were studied. Chi-square test was used to demonstrate association between antifungal resistance and clinical characteristics of the patients. Results. We identified 277 patients with invasive C. glabrata infection. Of which 48 (18.4%) isolates were resistant to fluconazole (MIC ≥64 mg l-1), one isolate each was resistant to amphotericin (MIC=2 mg l-1), anidulafungin (MIC=1 mg l-1) and micafungin (MIC=0.5 mg l-1). MIC90 for fluconazole was 64 mg l-1 and other triazoles 2 mg l-1, caspofungin 0.12 mg l-1, anidulafungin 0.06 mg l-1, micafungin 0.03 mg l-1 and amphotericin 0.5 mg l-1. Fluconazole MIC ≥64 mg l-1, caspofungin MIC >0.06 mg l-1 and amphotericin MIC >0.25 mg l-1 (above MIC50) were significantly associated with patient being alive at the time of reporting, no use of healthcare devices, nor infection with other fungi. Fluconazole resistance was significantly associated with prior antifungal use by the patient. Conclusion. Surveillance data of antifungal resistance among common Candida species should be monitored closely for identification of resistant strains.

Touch-free reaching task for Parkinson's disease patients: A motion sensing approach.

The use of motion tracking devices in healthcare is under investigation. Although many motion tracking applications have been proposed to monitor the progress of rehabilitation, using such technology to quantify the progression or improvement of therapies for movement disorders is still scarce. In this study, we introduce a touch-free reaching task which uses a motion sensing device. Our motion tracking system combines a motion tracking device and visual feedback to implement a movement task for the evaluation of the state of motor functions impairment symptoms in Parkinson's disease and other movement disorders.

The use of apps to support Pelvic Floor Muscle Exercise

Introduction: Urinary Incontinence is socially isolating and debilitating condition affecting millions of women worldwide. Pelvic floor muscle exercise (PFME) is the first line of treatment and can prevent or delay the onset of symptoms. However, there is a lack of understanding about motivation and adherence to PFME. The use of mobile devices in ICT has increased exponentially over the last decade; the use of mobile devices in healthcare is referred to as mHealth. Early indications suggest that there are opportunities for mHealth to be effective in resource poor health settings and for health behaviour interventions. Smart phones with apps for PFME have the potential to discreetly support and conveniently remind women to exercise their pelvic floor muscles. Aims and Objectives: Research was undertaken to find out more about motivation and adherence to PFME and the role of smart phone apps. Methods: An exploratory trial was conducted in Moray in the North East of Scotland with twenty eight community dwelling female participants, half of whom were provided with apps for PFME (ten participants received an iPod Touch for the duration of the trial, four used their own device). Data was gathered using questionnaires at the start and the end of the three month trial period and a year later. In addition, participants were asked to complete an adherence chart and to make notes of their experience. A sample of participants was interviewed by telephone at approximately six months in order to gather qualitative data about the experiences of the participants. Of the women who entered the trial, sixteen had incontinence symptoms at the start. At month three, five participants withdrew from the trial and at month twelve a further six participants withdrew. Results: There was broad range in the level of use of apps by participants in the intervention group. Some gave up after a few days saying that the technology was distracting them from exercising. Others had fun using the apps and this helped them to start exercising; they discarded the apps as they developed habitual exercise. A small number of participants heavily relied on their favoured app to help them to exercise and, when they no longer had the app at the end of the trial, their adherence reduced. International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116458– http://www.ijic.org/ As well as usability and the functions of the apps which were useful in prompting and reminding participants to exercise, sensory elements of the apps were found to promote adherence. Conclusions: Although smart phone apps have huge potential for individuals in prevention, selfcare and management of urinary incontinence, there is lack of knowledge about how people engage with the technology in the course of their everyday lives. In this study the technology was found to be a barrier to exercise by some, to support the instigation of exercise by others and to be integral to successful adherence by participants who found an app they liked. “One size does not fit all” and apps should be offered along with other interventions in planning a tailored PFME intervention programme. For the potential of apps to be realised, further research is required on the characteristics of people likely to benefit from apps, the influence of specific elements in the app and how these can be used to engage with individuals to support the desired health behaviour.

MHealth series: New ideas for mHealth data collection implementation in low– and middle–income countries

The use of mobile devices in healthcare, or mHealth, has the potential to play an important role in low– and middle–income countries in a wide range of areas. A particular area with great potential to improve global health is using mHealth for data collection. We propose three ideas: (i) to validate and conduct household surveys, (ii) to monitor large–scale programs, and (iii) to measure the global burden of disease. We need to know more about mHealth interventions and their validity to maximise their potential.

Increasing sharp safety device use in healthcare: A semi-structured interview study

The use of sharp safety devices in healthcare is considered the most important means of preventing occupational percutaneous injuries and has been mandated for use in most hospitals in industrialized countries including in Canada. However, clinical personnel’s perceptions on the use of safety devices needs further characterization to improve compliance. This study’s objective was to identify healthcare provider perspectives on different aspects of sharp safety device use and on how use could be increased. Using a constant comparison approach, data from semi-structured interviews with 39 nurses, physicians and phlebotomists providing direct patient care, and six nurses acting as the interface between clinical personnel and purchasing departments, were analyzed. Study participants were from three of the six health authorities in British Columbia. The four major categories that emerged from the data were: selection processes; identification and replacement; training; and multi-level barriers and facilitators. Findings highlighted the importance of including personnel regularly using safety devices at each stage of their selection including when they are being considered for replacement with superior devices, as well as the need for appropriate initial and refresher training, and how practices at the hospital, ward and individual level facilitate safety device use.

Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility

This study reports for the first time, to our knowledge, descriptive epidemiological data for 188 invasive Candida isolates from Pakistan, including species identification and antifungal susceptibility against fluconazole, itraconazole, voriconazole, caspofungin, micafungin, anidulafungin and amphotericin. Risk factors for invasive candidiasis (IC) were determined for 96 patients from Karachi, Pakistan. In adults and neonates, Candida tropicalis (38 and 36 %, respectively) was the most common species, followed in adults by Candida parapsilosis (17.8 %), Candida glabrata (15.9 %) and Candida albicans (12.3 %). C. albicans (21 %) was the second most common in neonates. In children, C. albicans (31.9 %), C. tropicalis (26.4 %) and C. parapsilosis (19.4 %) were the most common. C. albicans IC was significantly associated with paediatric age [crude odds ratio (COR) 3.46, 95 % confidence interval (CI) 1.63-7.32]. Rare species made up 17.5 % of the total isolates studied. Resistance to fluconazole was seen in C. glabrata (15 .0%) and Candida krusei (100 .0%). Only one isolate (C. glabrata) was resistant to all three echinocandins. Low MICs of fluconazole for 98 % (184/188) of isolates tested support its continued use as an empiric therapy for IC. Non-C. albicans IC was associated with the use of β-lactam inhibitor combinations (COR 3.16, 95 % CI 1.05-9.57). Use of healthcare devices was documented in 85.4 % of IC patients, whilst 75 .0% had been admitted to special care units. Surprisingly, 66.7 % of patients with IC were not obviously immunosuppressed. The high frequency of modifiable risk factors in this population indicates that candidaemia can be reduced with stringent antibiotic and infection control measures. These data will be useful for empiric selection of antifungals in Karachi, and contribute to global assessments of antifungal resistance.

Tecnología o tecnolatría: ¿a dónde van los cirujanos?

Innovative pressure forms part of the current technical-scientific utopia and equally affects surgeons, patients, communication media, and the health industry. It has brought a new type of technical adventurism with its accompanying iatrogenesis, which involves unnecessary risks. Personal ambitions, industrial persuasion and the promotion of hospital brands, both public and private, have weakened values and professional ethics in an environment in which technology is losing cost/benefit, and the conflict of interests have aroused many suspicions. A critical review of the technolatry culture is presented as well as a sober assessment of the costs of our interventions, not only in the economic sphere, but also as regards the safety of our patients, the environmental sustainability, and the most efficient use of health care devices.