Search

Introduction: Hand hygiene compliance is one of the key performance indicators for infection prevention and control programmes, patient safety and quality of health services. WHO guidelines and the patient centred approach stress the need to increase patient involvement in hand hygiene promotion in healthcare settings. Patients' and health care workers' perspectives are critical for developing interventions to foster patient involvement in promoting hand hygiene. This study explored perceptions of health care workers and patients towards patients' involvement in hand hygiene promotion. Methods: An exploratory qualitative study was conducted in four health facilities: three public, and one private non-profit in central Uganda. We conducted key informant interviews (KIIs) with health care workers and focus group discussions (FGDs) with patients. Respondents were asked their views about a patient reminding a health care worker to practice hand hygiene and how best this can be done. Interviews were audio-recorded, and transcribed. Thematic content analysis was used. Results: We led seven FGDs grouped by sex (6 participants each), with patients from different units of the study health care facilities and 23 KIIs with the in-charges of the health care facilities, wards, and infection control committee members. The majority of the KIIs were in the age category 30 to 45 years (10/23), females (14/23), and 7/23 were nurses by cadre. For the FGD participants, the majority were aged 30 to 45 years (23/42), 24/42 were females, 21/42 had attained secondary education as their highest level of education and 21/42 were Catholics. The health care workers' and patients' views towards patients' participation in promoting hand hygiene among health care workers are presented according to the four themes that emerged: i) Patients reminding health care workers to practice hand hygiene was offensive; ii) Patients fear of negative response from health care workers, including being denied or receiving poor quality services; iii) Role of management in influencing hand hygiene (patient reminding a health care workers to wash hands could be acceptable in private health facilities compared to the public ones); iv) Suggestions on how patients' reminders to health care workers can be done, included empowering patients to do the reminders in a friendly and polite approach to the HCW. Conclusion: Patients are reluctant to remind health workers to practice hand hygiene, because they feel it is confrontational and embarrassing, while health care workers find it offensive. Patient involvement seems to threaten patient-provider relationships. However patient empowerment was reported to be critical in promoting it and this is in-line with the hand hygiene guidelines. [ABSTRACT FROM AUTHOR]

Purpose: To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. Methods: A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit–feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. Results: CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (n = 408 files) to more than 50% over 1.5 years post-implementation (n = 792 files, 52% to 73% offered CIMT, 27%–46% received CIMT). Changes were maintained at 6-month follow-up (n = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (n = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. Conclusions: The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely. IMPLICATIONS FOR REHABILITATION: Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines yet delivery of CIMT in practice remains rare. A multifaceted implementation package including clinician training workshops, a community of practice, drop in support and regular audit and feedback cycles improved delivery of CIMT programs in practice by neurorehabilitation teams. Stroke survivors and people with brain injury who received a CIMT program in usual practice demonstrated clinically important improvements in arm function, dexterity and occupational performance. [ABSTRACT FROM AUTHOR]

Pressure reliefs (PRs) are self-care practices essential for individuals with spinal cord injury (SCI) to prevent life-threatening pressure injuries (PIs). Despite the benefits, individuals often do not do these exercises at home, leading to increased patient morbidity and mortality. To examine how digital technology could improve this population's adherence to PR exercises, we conducted a technology probe study with five individuals with SCI over ten consecutive business days. A chat-based intervention was created to send user-scheduled PR reminders, which were personalized with visual elements and progress trackers. Participants were interviewed before and after interacting with the probe to better understand their experiences with PIs and PR practices. Results shed light on specific factors that may impact individuals with SCI's behaviours towards PRs and four considerations to design a customisable reminder intervention: (1) easy to use and friendly technology, (2) design-your-own- schedule feature, (3) communication style feature, and (4) dialogue support features. Personalisation supported with gamified visual progress tracking and motivational messages emerged as a strong strategy to increase PR adherence. Both sets of findings expand upon the human-computer interaction (HCI) literature for mobile health tools that encourage self-care practices; in particular, to the specific needs of individuals with SCI and the use of visual elements to increase engagement. IMPLICATIONS FOR REHABILITATION: Digital technology, such as chat-based reminders personalized with visual elements and progress trackers, has the potential to improve adherence to pressure reliefs among individuals with spinal cord injury (SCI). Human-centered design is essential for creating effective digital interventions for this population, and four key features of a customizable reminder intervention include easy-to-use technology, a design-your-own schedule feature, communication style options, and dialogue support features. Gamified visual progress trackers and motivational messages may be useful strategies to increase adherence to pressure reliefs and make these exercises more enjoyable for individuals with SCI. This study contributes to the growing body of research on gamification, mHealth, and human-computer interaction, and highlights the potential for digital interventions to improve self-care practices among individuals with disabilities. [ABSTRACT FROM AUTHOR]

Aims: This study was conducted to examine the effect of monthly telephone message reminders after training on women's beliefs and practice behaviours regarding breast self‐examination. Methods: This randomized controlled study was conducted with 83 women aged 20–69 years living in Turkey between September 2021 and July 2022. Women were randomly assigned (1:1) to the intervention (n = 41) or control group (n = 42), both groups received online breast self‐examination training, and the intervention group received monthly reminders on their mobile phones for 3 months. Participants completed the Champion's Health Belief Model Scale and breast self‐examination practice evaluation form at baseline and 3 months after intervention. Results: After the intervention, the mean scores of the benefits and self‐efficacy subscales of Champion's Health Belief Model Scales were significantly higher in the intervention group compared to the control group, and the mean score of barriers was lower. The rate of performing breast self‐exam regularly and at the appropriate time was higher in the intervention group. The rate of forgetting to perform breast self‐examination was higher in control group. Conclusion: A monthly reminder message may be recommended to increase women's belief in breast self‐examination and increase regular practice. Summary statement: What is already known about this topic? Breast cancer is common, it is a type of cancer that progresses slowly and can be treated with early diagnosis and regular application of breast self‐examination is one of the effective non‐invasive screening methods for early diagnosis of breast cancer among women.Studies have found that forgetfulness and neglect, lack of awareness about BSE techniques and lack of knowledge are important obstacles to breast self‐examination. What this paper adds? Breast self‐examination training and then a monthly phone message reminder approach was used in women.It has been observed that the monthly telephone reminder message is an intervention that increases the belief in breast self‐examination in women, along with an increase in the rate of regular and timely examination practice and a decrease in the rate of forgetting to do so. The implications of this paper: The importance of regular phone message reminders about breast self‐examination should be included in the in‐service training given to all health professionals, especially midwives and nurses working in the delivery of primary health care services.A central message system could be developed to remind women of breast self‐examination at the national level. [ABSTRACT FROM AUTHOR]

Background: Adherence to Highly Active Antiretroviral Therapy (HAART) medication is the major predictor of HIV/AIDS treatment success. Poor adherence to HAART creates the risk of transmitting HIV, deteriorating health conditions, treatment failure, increased occurrences of drug-resistant HIV, morbidity and mortality. The objective of the study was to explore and describe factors influencing HAART adherence among HIV-positive women in Southern Ethiopia. Methods: A hospital-based descriptive cross-sectional survey was used among 220 randomly selected respondents. Data was collected with a structured interview guide after each respondent had given consent to take part in the study. The collected data was entered into and analyzed by using the Statistical Package for Social Sciences (SPSS) software program version 27. Results: The level of self-reported adherence (measured by dose) to HAART in the past 30 days was found to be 82.7%. In multivariate analysis, the divorced/separated HIV-positive women had poor adherence to their HAART medication as compared to those who were married [AOR: 2.94, 95% CI: (1.02-8.44)]. Respondents who used reminders in their medication were 75% less likely to be poorly adherent to their HAART medication than those who did not use reminders [AOR: 0.25, 95% CI: (0.06-0.97)]. Those who self-reported depression, perceived stigma, and low perceived susceptibility had poor adherence to their HAART than those who did not report depression, perceived stigma, and low perceived susceptibility [AOR:2.34, 95% CI: (1.01-5.42)], [AOR:2.37, 95% CI: (1.06-5.34)], and [AOR: 4.1, 95% CI: (1.53-11.1)] respectively. HIV-positive women who self-reported low perceived severity were poorly adherent to HAART than those who self-reported high perceived severity [AOR: 2.92, 95% CI: (1.14-7.47)]. Conclusion: Factors including being divorced/separated, not using reminders, depression, perceived stigma, perceived susceptibility, and perceived severity negatively impact HIV-positive women's adherence to HAART. [ABSTRACT FROM AUTHOR]

Mobile populations such as fisherfolk show high HIV incidence and prevalence. We pilot-tested implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake and adherence in the context of healthcare outreach events in two mainland fisherfolk communities on Lake Victoria, Uganda from September 2021 to February 2022. The implementation strategies included PrEP adherence supporters (selected from PrEP users' social networks), community workshops (to address misconceptions and stigma, and empower PrEP advocacy), and check-in calls (including refill reminders). PrEP medical records data were collected from 6-months pre-intervention to 6-months post-intervention. Qualitative interviews with 20 PrEP users (10 who continued, 10 who discontinued), 9 adherence supporters, and 7 key partners (providers, community leaders) explored acceptability. Percentages of PrEP initiators (of those eligible) were significantly higher during the intervention (96.5%) than 6-months before the intervention (84.5%), p < 0.0001; percentages of PrEP users who persisted (i.e., possessed a refill) 6-months post-initiation (47.9% vs. 6.7%) and had at least 80% PrEP coverage (based on their medication possession ratio) from the initiation date to 6-months later (35.9% vs. 0%) were higher during versus pre-intervention, p < 0.0001. A comparison fisherfolk community with better healthcare access had lower uptake (78.3%; p < 0.0001) and persistence at 6-months (34.0%; p < 0.001), but higher coverage during the intervention period (70.4%; p < 0.0001). Qualitative data suggested the strategies promoted PrEP use through reduced stigma and misconceptions. The intervention bundle cost was $223.95, $172.98, and $94.66 for each additional person for PrEP initiation, persistence, and coverage, respectively. Enhanced community-based PrEP implementation that fosters a supportive community environment can improve PrEP use in mobile populations without easy access to healthcare. (NCT05084716). [ABSTRACT FROM AUTHOR]

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the follow-up rates of non-normal cervical screening samples between Denmark and Flanders (Belgium) to illuminate whether organizational differences between the health systems might affect the follow-up rates, e.g. sending of reminders in Denmark since 2012 compared to Flanders with no such system in place. Methods: The study population included 48,082 Danish women and 22,271 Flemish women who received abnormal or inadequate primary screening results from 2014 to 2016. The participants were followed for 24 months, and the timeliness and appropriateness of the recommended follow-up, according to national guidelines, were evaluated. Results: After 18 months over 90% of the Danish women had received some form of follow-up, while in Flanders, this level is achieved only for those who test positive for human papillomavirus. The analysis also revealed that 10–28% of follow-ups were performed too early, with Danish women showing the highest proportions. In both regions, general practitioners (GPs) exhibited better follow-up rates compared to gynaecologists, with gynaecologists displaying a tendency towards earlier re-testing than recommended. Conclusions: An important factor influencing the follow-up rate may be the sending of reminders in Denmark since 2012, as the follow-up rates in general were higher in this period. It is noteworthy that a reminder system is currently being implemented in Flanders and further studies on the potential effects should be studied. Additionally, the organization of the health system might influence the follow-up rate, as engaging the GP for screening in Denmark may have had a positive effect. [ABSTRACT FROM AUTHOR]

This article explores the issue of medication nonadherence in systemic lupus erythematosus (SLE), a serious autoimmune disease. Many patients struggle to commit to long-term treatment, leading to high rates of discontinuation and increased health risks. The article presents a study that tested a clinician-led intervention to improve medication adherence in SLE patients, which proved to be effective. However, the article acknowledges the need for further research and adaptation to make the intervention more widely applicable. The text also emphasizes the importance of individualized treatment goals and addressing barriers to adherence, particularly for patients with language barriers or limited health literacy. Overall, the article provides a promising approach to improving medication adherence in SLE, but more evaluation is needed across diverse populations and clinics. [Extracted from the article]

Elderly individuals face an increased likelihood of developing chronic diseases such as diabetes. Self-care practices and medication adherence play crucial roles in preventing complications and adverse effects of this condition. Therefore, this study aimed to determine self-care behaviors, medication adherence status, and related factors among elderly patients with type 2 diabetes. This descriptive-analytical study was conducted on 374 elderly patients with type 2 diabetes who visited educational healthcare centers in Qazvin, Iran, during 2023 (March–September). Sampling was performed using the convenience method. Data collection instruments included a demographic characteristics checklist, the summary of diabetes self-care activities questionnaire, and the Morisky medication adherence scale. Data analysis was conducted using SPSS-22 software, employing the Kolmogorov–Smirnov test, mean, standard deviation, univariate and multivariate regression analyses. The significance level was set at p ≤ 0.05. The mean age of participants was 67.56 ± 5.93 years. In the self-care questionnaire, the highest score pertained to adherence to the diet recommended by the treating physician (3.16 ± 1.87). In contrast, the lowest scores were related to the frequency of checking inside shoes (0.17 ± 0.93) and foot examination (0.31 ± 1.07), respectively. Furthermore, results in self-care behaviors indicated that with increasing education levels, self-monitoring of blood glucose (SMBG) significantly decreased (P = 0.048). This variable was considerably higher in rural residents than in urban dwellers (P = 0.016). Additionally, the frequency of blood glucose measurements was significantly higher in urban residents than in rural inhabitants (p = 0.006). Based on the results, the mean score for medication adherence among patients was 5.53 ± 1.65. Based on our findings, the level of self-care in physical activity, SMBG, and foot care among the elderly is below average. Furthermore, medication adherence in these patients is poor. We expect that managers and policymakers take steps to reduce complications and improve these two variables by developing educational programs on self-care and emphasizing the importance of treatment adherence for these patients. [ABSTRACT FROM AUTHOR]

Introduction: There is increasing evidence in favor of enhancing adherence to antiretroviral therapy (ART) in people living with HIV (PLHIV) through mobile health (mHealth) assessment and intervention. The study aims to establish the willingness to adopt mobile phone technology to enhance adherence to ART among PLHIV. Methods: The Researchers adopted a cross-sectional survey. Systematic sampling was employed in selecting 237 PLHIV in the HIV clinic for adults at Ido-Ekiti's Federal Teaching Hospital, Nigeria. Data collection was via a 33-item semi-structured questionnaire administered by the interviewer. Information collected via the questionnaire included details on ownership of mobile phone technology, its usage, and willingness to use it to improve adherence to HIV medication. Descriptive statistics coupled with multivariate regression was employed in analyzing data, with the level of significance at 5%. Results: The respondent's had a mean ±SD age of 46.6 ±10 years. Most of the participants were female (77.6%), and have been on ART for over 2years (88.2%). The vast majority of study participants 233 (98.3%) owned a mobile phone. 168 (70.9%) of them were willing to embrace mHealth interventions on medication adherence. Some of the factors influencing the respondent's willingness to receive the intervention were older age (OR = 0.05, 95%Cl:[0.01–0.24]), having formal education (OR = 7.12, 95%Cl:[3.01–16.53]), being diagnosed over 10years ago (OR = 15.63, 95%Cl:[3.02–80.83]) and previous use of phone to send text messages, record video, access the internet, send email and search the internet for health-related information (OR = 2.2, 95%Cl:[1.2–3.9]; OR = 1.8, 95%Cl:[1.0–3.2]; OR = 2.5, 95%Cl:[1.4–4.7]; OR = 2.7, 95%Cl:[1.2–5.5] and OR = 2.0, 95%Cl:[1.0–3.8]) respectively. Conclusion: Many of the PLHIV had a cellphone and expressed willingness on their part to use it in receiving reminders to take their medication. Older age, formal education and internet users were significantly more willing to get reminders to take their medication. [ABSTRACT FROM AUTHOR]

Dyslexia is a specific learning difficulty impacting reading, writing and spelling. Practising nursing requires a unique set of skills that encompass effective communication, critical thinking, and organisational skills. This article focuses on the experiences of nurses with dyslexia, shedding light on the distinct challenges they encounter and the resilient strategies they employ to navigate their roles and excel in the health profession. [ABSTRACT FROM AUTHOR]

The current study examined the effect of a delay on naturalistic time-based prospective memory (PM) tasks. Two experiments were performed to compare PM performance on a texting task with delays of 1 to 6 days after an initial session. In the first experiment, half of the participants were asked to repeat their response with the same delay to test whether requiring a second response (i.e., a repeated PM task, such as taking medication at the same time each day) would affect time-based PM performance. In the second experiment, participants were given an implicit or an explicit reminder several hours before their time to respond to examine the effect of type of reminder on this PM task. The results of both experiments showed a significant decline in PM performance between the 1-day and multi-day delays. Repeating responses (Experiment 1) had no effect on accuracy of the PM task, but in Experiment 2, explicit experimenter-initiated reminders significantly increased time-based PM performance compared with implicit reminders. These results are discussed in the context of previous studies that have tested delay effects on time-based PM and current theoretical descriptions of time-based PM. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE) is a potentially life-threatening infection that affects the inner lining of the heart, particularly the heart valves. Patients with preexisting heart conditions, damaged heart valves, or a history of intravenous drug use are at a higher risk of acquiring IE. Local problem: A rural acute care facility reported that 68.75% of patients who had a methicillin-resistant Staphylococcus aureus infection were diagnosed with IE. Review of medical records showed that 65% of patients with IE did not have antibiotic start/stop dates and 51% were discharged before the 6-week completion date. Methods: The quality-improvement project used a pretest and posttest design. An order set was created based on evidence-based guidelines to assist with the management of patients with IE. The order set included administering intravenous (IV) antibiotics for a minimum of 6 weeks for patients with IE and included a set of recommended weekly follow-up laboratory tests. Interventions: An order set with the standard of care and reminders in the electronic health records (EHRs) were implemented for the management of IE, including antibiotic start and stop dates and weekly follow-up labs. Results: After implementation, there was an improvement in the completion of IV antibiotics, documentation of start/stop dates for IV antibiotics, and completion of recommended laboratory tests. Conclusions: An order set with the standard of care and reminders in the EHR reduced variations in care and improved patient outcomes by ensuring that all providers were following the same evidence-based guidelines for the management of IE. [ABSTRACT FROM AUTHOR]

To present the latest available research assessing the actual impact of reminder and guidance technologies for daily activities in Alzheimer's Disease and Related Dementia's patients, outlining design implications for these technologies. The search was conducted in the ACM Digital Library, IEEExplore, ScienceDirect, PubMed, Cochrane Library, Sage Journal, ResearchGate, and SemanticScholar. An iteratively-developed Boolean search string was built including up to 18 AND/OR terms across Four categories (Memory Aids, Technology, Daily Activities, Memory Impairment). We qualitatively analyzed the findings and discussions of the findings reported in 40 studies in our corpus to determine common barriers to, and facilitators of, effective intervention implementation and adoption. Forty studies fulfilled the inclusion and exclusion criteria. In existing studies, individuals with Alzheimer's Disease and Related Dementias understand the usefulness of different functions that can be provided within an app to assist with everyday tasks. There was a high level of heterogeneity regarding the studies' location, duration, and evaluation methodology. There is a need for assistive reminder and guidance technologies to be tailored towards autonomy, identity and personalization. Future work should include motivating features to aid during mood changes and feelings of insecurity. In existing studies, older adults with cognitive impairment understand the usefulness of different functions that can be provided within an app to assist with everyday tasks. There is a high level of heterogeneity regarding the studies' location, duration, and evaluation methodology. There is ample need for these reminder technologies to be tailored towards autonomy, identity and personalization. Future work should include motivating features to aid during mood changes and feelings of insecurity. [ABSTRACT FROM AUTHOR]

PURPOSE: Several allelic variants of the gene DPYD encoding dihydropyrimidine dehydrogenase (DPD) are associated with impaired metabolism of the systemic fluoropyrimidine fluorouracil (5FU) and its oral prodrug, capecitabine, which elevates the risk for severe toxicity. Following a patient death related to capecitabine toxicity in which DPD deficiency was suspected, a multidisciplinary advisory panel was convened to develop an institution-wide approach to future patients planned for a systemic fluoropyrimidine. METHODS: The panel selected an opt-out testing strategy which focused on developing reliable processes to collect and report test results and targeted education. An electronic health record–based automated reminder was designed to activate when a 5FU- or capecitabine-containing chemotherapy regimen was ordered for a patient without prior exposure to either agent and without a prior DPYD sequencing test result. DPYD testing was standardized across all sites of care, and a closed loop reporting system for abnormal test results was created. Before implementation, targeted education was provided to providers, pharmacists, and nurses, and a failure mode and effects analysis was performed. Program rollout was staged over a 6-month period. RESULTS: At 10 months, the rate of preemptive testing increased from a baseline of 26% to a sustained rate of >90%. In the six network sites, the testing rate increased from 9% to 96%. A total of 1,043 patients have been tested preemptively; allelic variants have been identified in 43 (4.1%). Among 25 evaluable patients, dose reduction or change to a non–fluoropyrimidine-based regimen was accomplished in 96%. CONCLUSION: Preemptive DPYD testing is feasible, and high rates of testing can be achieved using an opt-out, reminder-based program. We provide the details of the implementation and encourage others to emulate it. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic conditions need multiple medications daily to manage their condition. However, most patients have poor compliance, which affects the effectiveness of treatment. To address these challenges, we establish a medication reminder system for the intelligent generation of universal medication schedule (UMS) to remind patients with chronic diseases to take medication accurately and to improve safety of home medication. Methods: To design medication time constraint with one drug (MTCOD) for each drug and medication time constraint with multi-drug (MTCMD) for each two drugs in order to better regulate the interval and time of patients' medication. Establishment of a medication reminder system consisting of a cloud database of drug information, an operator terminal for medical staff and a patient terminal. Results: The cloud database has a total of 153,916 pharmaceutical products, 496,708 drug interaction data, and 153,390 pharmaceutical product-ingredient pairs. The MTCOD data was 153,916, and the MTCMD data was 8,552,712. An intelligent UMS medication reminder system was constructed. The system can read the prescription information of patients and provide personalized medication guidance with medication timeline for chronic patients. At the same time, patients can query medication information and get remote pharmacy guidance in real time. Conclusions: Overall, the medication reminder system provides intelligent medication reminders, automatic drug interaction identification, and monitoring system, which is helpful to monitor the entire process of treatment in patients with chronic diseases. [ABSTRACT FROM AUTHOR]

Introduction: This study in Argentina evaluated the impact of the growzen™ buddy smartphone app on adherence to recombinant human growth hormone (r-hGH) treatment. Methods: The adherence data, invitation dates with a link to the app, app activation dates, and height measurements entered were extracted from the growzen™ digital health ecosystem. Patients with 12 months of adherence data, aged =2 years at treatment start, and aged <19 years were selected both before and after app implementation. Mean adherence was classified as optimal (=85%) versus suboptimal (<85%). Adherence before and after implementation and the pre-post effect on adherence were assessed. Results: Data for 830 patients were available. Prior to app implementation, the proportion of patients with optimal adherence was 68% (n = 348/515). Following the app implementation, out of 315 patients, 302 (96%) received an invitation with a link to the app, 225 (71%) activated their account, and 127 (40%) entered height data in the first year. There was a significant early increase in the proportion of patients with optimal adherence following implementation: 82% (n = 258/315), p < 0.001. After implementation, the proportion of patients with optimal adherence included 80% (n = 78/98) of those with an active account who did not enter height measurements and 89% (n = 113/127) of those who did. There was a significant and positive pre-post app effect on adherence (p < 0.01) in patients with an active account. Discussion: Our results show that using the growzen™ buddy app has a rapid and positive impact on adherence to r-hGH treatment, and patients who were more engaged with the app demonstrated better adherence. [ABSTRACT FROM AUTHOR]

Emerging adults aged 18–29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18–29 to adhere to ART. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A seizure action plan (SAP) is a powerful tool that provides actionable information for caregivers during seizures. Guidelines have expressed the need for individualized SAPs. Our quality improvement team aimed to increase implementation of an SAP within a pediatric tertiary center, initially among epilepsy providers and expanded to all neurology providers. METHODS: Process changes were implemented using Plan-Do-Study-Act cycles and data were evaluated monthly using control charts. The team focused on tracking patients who received SAPs and identified opportunities for improvement, including reminders within the electronic medical record, and standardizing clinic processes. A secondary analysis was performed to trend emergency department (ED) use among our patient population. RESULTS: The SAP utilization rate among epilepsy providers increased from a baseline of 39% to 78% by December 2019 and reached the goal of 85% by June 2020, with a further increase to 92% by February 2022 and maintained. The SAP utilization rate among general neurology providers increased from 43% in 2018 to 85% by July 2020, and further increased to 93% by February 2022 and maintained. ED visits of established patients with epilepsy decreased from a baseline of 10.2 per 1000 to 7.5 per 1000. CONCLUSIONS: Quality improvement methodologies increased the utilization of a standardized SAP within neurology outpatient care centers. The SAP is a simplified tool that allows patients and providers to navigate a complex health care system. The utility of an SAP may potentially extend to minimizing unnecessary ED visits. [ABSTRACT FROM AUTHOR]

Background: Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology. Design: A network meta‐analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies. Methods: Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta‐analysis were performed to identify the overall effects and compare different teletechnologies. Results: Thirty‐four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta‐analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies. Conclusion: Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well‐designed RCTs involving direct comparisons of different teletechnologies are needed in the future. Clinical Relevance: Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that requires multimodal treatment. Adherence remains a significant challenge for many patients due to complex nature of treatment, thus presenting a barrier to management success. This review summarizes the current literature on the factors associated with adherence to medications, and lifestyle behaviors in patients with HS and proposes strategies to improve adherence. In February 2023, a systematic literature search was conducted by two independent authors on PubMed and EMBASE for articles from 2000 to 2023 on hidradenitis suppurativa adherence. A total of 21 articles met inclusion/exclusion criteria for this review. Of the studies, 11 addressed systemic medication adherence, 3 addressed topical medication adherence, 2 addressed both systemic and topical medication adherence, and 5 addressed lifestyle/behavioral modification adherence. The generalizability of results was limited by differences in study design, outcome measures, and sample size. English-only articles with full texts were used. The most reported reasons for non-adherence included presence of side effects, cost of medications, low efficacy, and unclear instructions. Proposed strategies to improve adherence in HS patients include management of side effects, use of reminder systems, improved patient education, patient support groups, aid of family and caregivers, personalization of the medication regimen, and regular follow-ups with patients. PROSPERO Registration Number: CRD42023488549. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Academics / Sağlık Akademisyenleri Dergisi is the property of Journal of Health Academics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Transition to the postanesthesia care unit (PACU) requires timely order placement by anesthesia providers. Computerized ordering enables automated order reminder systems, but their value is not fully understood. We performed a single-center, retrospective cohort study to estimate the association between automated PACU order reminders and primary outcomes (1) on-time order placement and (2) the degree of delay in placement. As a secondary post-hoc analysis, we studied the association between late order placement and PACU outcomes. We included patients with a qualifying postprocedure order from January 1, 2019, to May 31, 2023. We excluded cases transferred directly to the ICU, whose anesthesia provider was involved in the pilot testing of the reminder system, or those with missing covariate data. Order reminder system usage was defined by the primary attending anesthesiologist's receipt of a push notification reminder on the day of surgery. We estimated the association between reminder system usage and timely order placement using a logistic regression. For patients with late orders, we performed a survival analysis of order placement. The significance level was 0.05. Patient (e.g., age, race), procedural (e.g., anesthesia duration), and provider-based (e.g., ordering privileges) variables were used as covariates within the analyses. Reminders were associated with 51% increased odds of order placement prior to PACU admission (Odds Ratio: 1.51; 95% Confidence Interval: 1.43, 1.58; p ≤ 0.001), reducing the incidence of late PACU orders from 17.5% to 12.6% (p ≤ 0.001). In patients with late orders, the reminders were associated with 10% quicker placement (Hazard Ratio: 1.10; 95% CI 1.05, 1.15; p < 0.001). On-time order placement was associated with decreased PACU duration (p < 0.001), decreased odds of peak PACU pain score (p < 0.001), and decreased odds of multiple administration of antiemetics (p = 0.02). An order reminder system was associated with an increase in order placement prior to PACU arrival and a reduction in delay in order placement after arrival. [ABSTRACT FROM AUTHOR]

Technical solutions are being presented for the healthcare and welfare of the aging population. One example is Hyodol, a robot developed for older adults living alone in South Korea. By offering various services such as religious chanting, dementia-prevention quizzes, and daily medication reminders, Hyodol is expected to serve as a companion for lonely older adults. This paper analyzes how the robotic care program for older adults is operating within the Korean public welfare system. Based on our fieldwork at regional welfare institutions and older adults' homes, we show that the robots along with its monitoring system, older adults, institutional managers, caregivers, company staff, and family are forming what we call a "robotic multi-care network." Within this network, the elderly users cultivate their own ways of building relationships with the robot, some perceiving it as a "grandchild" while others view it as a medium to connect with caregivers. The introduction of the care robot at the welfare institutions does not make their elderly care work unmanned, nor does the robot substitute for human caregivers. Instead, it displaces and redistributes the caregivers' tasks and responsibilities, leading to multiple eldercare practices—tactile, digital, proximate, remote. [ABSTRACT FROM AUTHOR]

Background: Intubated preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV neonatal intensive care unit (NICU) faced a high number of ventilator days. Based on 6 weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants 326/7 weeks or less of gestation were intubated for more than 28 days, with an average of 23 days on a ventilator. This NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV NICU. Methods: This project occurred over a 17-week period in 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre-/postimplementation data. Staff education completion, guideline use and compliance, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked. Results: Postimplementation data indicated decreased need for intubation for more than 28 days, ventilator days, and days to first extubation attempt. Implications for Practice and Research: Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants 326/7 weeks or less of gestation. [ABSTRACT FROM AUTHOR]

This paper aims to promote technology usage among older Saudi people by addressing the common problems they encounter around adhering to medication schedules and using mobile health applications. An interactive mobile user interface has been designed based on requirements determined using three inputs: (1) relevant existing research work, (2) interviews with medicine specialists, and (3) a survey of 602 older Saudis. The output from the first input is a set of updated guidelines adapted to the older Saudi population and reconstructed based on cognitive process attributes. The interview output identifies medication adherence issues and proposed solutions. The survey output produced a mobile technology model for older Saudis. The guidelines have been applied to a prototype and then tested in two phases: (1) pilot testing and (2) usability testing. In the testing phase, 50 older Saudi users provided insights into the effectiveness, error safety, and productivity factors of the solution developed, with the results confirming that designing mobile applications based on the model of older users and cognitive attributes improved effectiveness and reduced errors when performing mobile tasks, specifically around adherence to medications. For the productivity factor, the results align with the physical characteristics of the targeted older individuals, who typically require more time than younger people to perform certain tasks. [ABSTRACT FROM AUTHOR]

The reported study compared the impact of four influence strategies (agency assignment, enhanced active choice, deviance regulation marking, and temporal framing) on English- and Spanish-speaking parents' reported intention to vaccinate their children for HPV. An online experiment was conducted to examine the impact of the strategies. In a fractional factorial design, participating parents (N = 1663) were exposed to combinations of influence strategies in text messages presented as reminders they might receive from a healthcare provider about their child's eligibility for the vaccine series. The results indicated small but significant impacts of agency assignment, enhanced active choice, and deviance regulation marking on parents' reported vaccination intentions. The study adds to the research literature on HPV vaccination communication in two important respects. First, it demonstrated how incorporating evidence-based influence strategies into reminder messages can increase parents' vaccination intentions, an important precursor and predictor of actual vaccine uptake. Second, it sets an important precedent by examining the effects of influence strategies on vaccination intentions across different languages. [ABSTRACT FROM AUTHOR]

The Antiretroviral Therapy (ART) management system is a comprehensive software application designed to streamline and enhance the management and monitoring of patients undergoing antiretroviral treatment for HIV/AIDS. The system aims to improve the quality of care provided to ART patients, ensuring accurate treatment initiation, medication dispensing, clinical monitoring, appointment scheduling, adherence monitoring, side effects management, and reporting. By integrating various functionalities, the system enables healthcare providers to efficiently manage patient data, track treatment outcomes, and make informed decisions for optimal patient care. Additionally, the system prioritizes data security and privacy, complying with relevant regulations and employing measures to protect patient confidentiality. Through its integration capabilities, the system fosters interoperability with other healthcare information systems, promoting seamless data exchange and collaboration. Overall, the ART management system serves as a valuable tool in the comprehensive management of ART patients, ultimately contributing to improved health outcomes for individuals living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

The demand for digital platforms in managing heart failure (HF) is expected to increase with promising effects on readmission and health expenditure. The study aims to explore current post-discharge management strategies and identify the need and acceptance of digital platforms, to ensure the development of a user-friendly mobile application for HF patients. Using a cross-sectional analytical research design, 90 consecutive patients diagnosed with HF who were discharged from a Tertiary Care Center were enrolled. Tele-interview was conducted using a self-developed and validated tool. The mean age of participants was 55.54 ± 10.33 years. The participants' adherence to HF management strategies was low in terms of physical exercise and weight monitoring. More than one-third were willing to self-record their measurements and use a mobile application. The common mobile application features requested were medication information/reminder (88.6%), health education (84.3%), chat with nurses (84.3%), physical activity (81.4%), symptoms (78.6%), diet (78.6%) and weight management (72.9%). The findings from this initial phase of mobile development are expected to help leverage better development of digital interventions for HF patients. [ABSTRACT FROM AUTHOR]

Background: Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. Objective: To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. Data sources: We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. Study eligibility criteria: Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. Participants: People with type 2 diabetes in community or health settings. Exposure: Comorbid depression or depressive symptoms in people with type 2 diabetes. Synthesis of results: A narrative review of heterogeneous studies. Risk of bias: The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results: Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. Limitations: There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. Conclusions: Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To present primary care physician (PCP) suggestions for design and implementation of a decision aid (DA) tool to support patient-provider shared decision-making on lung cancer screening (LCS). STUDY DESIGN: Semistructured interviews were conducted with 15 PCPs at an academic medical center. METHODS: The deidentified transcripts were independently coded by 2 study interviewers and jointly reviewed every 5 interviews until we determined that data saturation had been achieved. We then identified themes in the data and selected illustrative quotes. RESULTS: Three main themes were identified: (1) make it brief and familiar (make the tool user-friendly and implement a similar format to other widely used DAs); (2) bring me to automation station (limit busywork; focus on the patient and on the decision); and (3) involve the patient (facilitate patient involvement in the DA with simple language, visual aids, and bullet-point takeaways). CONCLUSIONS: Findings contain concrete suggestions by PCPs to inform usable and acceptable LCS DA tool design and implementation. For an LCS DA to be most successful, PCPs emphasized that the tool must be easy to use and incorporate autopopulation functions to limit redundant patient charting. [ABSTRACT FROM AUTHOR]

Background: Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers. Objective: We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability. Methods: A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing. Results: Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention. Conclusions: Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback. [ABSTRACT FROM AUTHOR]

This article provides a plain language summary of a study on the effects of empagliflozin treatment in patients with chronic kidney disease (CKD). CKD is a progressive condition where the kidneys lose their ability to remove waste products from the blood. The study found that treatment with empagliflozin reduced the risk of kidney disease progression or death from cardiovascular disease compared to a placebo. The treatment also slowed the decline of kidney function and reduced the risk of hospitalization. The results suggest that empagliflozin is effective and safe for a broad range of people with CKD. [Extracted from the article]

Background: People living with HIV (PLWH) are at increased risk of cardiometabolic disorders (CMD). Adequate access to care for both HIV and CMD is crucial to improving health outcomes; however, there is limited research that have examined couples' experiences accessing such care in resource-constrained settings. We aimed to identify barriers to accessing CMD care among PLWH in Malawi and the role of partners in mitigating these barriers. Methods: We conducted a qualitative investigation of barriers to CMD care among 25 couples in Malawi. Couples were eligible if at least one partner was living with HIV and had hypertension or diabetes (i.e., the index patient). Index patients were recruited from HIV care clinics in the Zomba district, and their partners were enrolled thereafter. Interviews were conducted separately with both partners to determine barriers to CMD care access and how partners were involved in care. Results: Participants framed their experiences with CMD care by making comparisons to HIV treatment, which was free and consistently available. The main barriers to accessing CMD care included shortage of medications, cost of tests and treatments, high cost of transportation to health facilities, lengthy wait times at health facilities, faulty or unavailable medical equipment and supplies, inadequate monitoring of patients' health conditions, some cultural beliefs about causes of illness, use of herbal therapies as an alternative to prescribed medicine, and inadequate knowledge about CMD treatments. Partners provided support through decision-making on accessing medical care, assisting partners in navigating the healthcare system, and providing financial assistance with transportation and treatment expenses. Partners also helped manage care for CMD, including communicating health information to their partners, providing appointment reminders, supporting medication adherence, and supporting recommended lifestyle behaviors. Conclusions: Couples identified many barriers to CMD care access, which were perceived as greater challenges than HIV care. Partners provided critical forms of support in navigating these barriers. With the rise of CMD among PLWH, improving access to CMD care should be prioritized, using lessons learned from HIV and integrated care approaches. Partner involvement in CMD care may help mitigate most barriers to CMD care. [ABSTRACT FROM AUTHOR]

This document provides a short summary of the T3MPO-3 study, which was published in Neurogastroenterology and Motility in September 2023. At the end of this summary, there are links to websites where you can find more information about this study. Tenapanor (IBSRELA®) is a newly available medicine in the United States. It is used to treat irritable bowel syndrome with constipation (IBS-C) in people aged 18 years and older. In 2 large clinical trials, tenapanor was shown to improve the symptoms of IBS-C. People with IBS-C often need to take long-term medicines to keep their symptoms under control. As a result, this study, called T3MPO-3, was undertaken to investigate whether there are any possible side effects associated with the long-term use of tenapanor in adults with IBS-C. There were 312 people who had taken part in either of the original 2 trials and took part in this study, with 90 receiving tenapanor for at least 1 year. Loose or watery stool (diarrhea) was the most common side effect, and most cases were mild or moderate. No people died in any of these studies. [ABSTRACT FROM AUTHOR]

Introduction: Patients' adherence to antidepressants is generally reported to be poor. This study examined whether users of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) enhance medication adherence following access to a mobile application (app) tailored for this patient group. The study addresses the implementation phase of medication adherence. Methods: The study was a single group pre-post intervention design. Data were collected using the validated OsloMet Adherence-to-medication Survey tool (OMAS-37) before and after app access. Pre-app access survey (Survey 1) was conducted via social media and online newspapers, encompassing 445 SSRI/SNRI users aged 18 years and above. Post-app access survey (Survey 2) was sent to 103 SSRI/SNRI users from Survey 1. Wilcoxon Signed Rank Test compared preand post-intervention adherence measurements. Pearson's chi-square tests and Fisher's exact tests compared study population categories. Results: Forty-two SSRI/SNRI users, median age 26 (IQR 17), 93% identifying as female, used the app while using the same antidepressant during the 2-month period between gaining access to the app and Survey 2. There was a statistically significant reduction in non-adherence score post-app access (z = 3.57, n = 42, p < 0.001) with medium effect size (r = 0.39), indicating enhanced adherence. Total non-adherence score decreased by 39% from pre-to post-access, and there was a 12% decrease in users scoring equivalent with poor adherence (score <2) post-access. Twenty-nine of 37 non-adherence causes improved, with three showing statistical significance. Of 42 responders, 50% (n = 21) indicated using the app one to two times, while 50% (n = 21) more than three times. Approximately 69% (n = 28) found it useful, and 43% (n = 18) felt safer in their use of antidepressants after access to the app. No significant preference was observed for the app over alternative sources of information. Discussion: Enhanced medication adherence was observed among antidepressant users following access to the tailored app. Further studies are warranted to evaluate the app applicability to a broader range of antidepressants users or other patient groups, encompassing those in the initiation phase of medication adherence. The app is intended as an easily accessible supplement to the information and advice provided by prescribing physicians and dispensing pharmacists. [ABSTRACT FROM AUTHOR]

African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47–4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation. [ABSTRACT FROM AUTHOR]

Cross-sectional surveys have found variations in how prepared medical students feel to prescribe antibiotics responsibly, but insights are lacking on the stability of these outcomes. In a 2015 survey, final-year Swedish medical students reported very high preparedness levels across a comprehensive range of relevant curriculum topics. We repeated this survey in 2021 to assess the stability of previous findings and to capture the potential impacts of the COVID-19 pandemic. Final-year students in 2015 and 2021 at all seven Swedish medical schools were eligible to participate in an online survey covering curricula topics, teaching methods and COVID-19 impacts (2021). Eligible students received email invitations and reminders from local coordinators. Students from six of seven medical schools participated in both surveys, with response rates of 24.1% (309/1281) in 2021 and 21.3% (239/1124) in 2015. The average global preparedness was 77.0% and 83.2%, respectively (p < 0.001), with lower preparedness levels in 24/27 curriculum topics in 2021. Students at certain universities reported COVID-19 impacts on antibiotic prescribing education (format, duration and perceived quality). Self-reported preparedness levels have fallen slightly but remain high compared with 2015 levels in other European countries. Students consistently reported lower preparedness in specific topics; improvement efforts should consider focusing on these areas, particularly in the context of the ongoing implementation of programmes leading to a full licence upon graduation. [ABSTRACT FROM AUTHOR]

Despite a recommendation by PAHO for Tdap vaccination in pregnant women since 2019, uptake remains suboptimal across Latin America. This study evaluated the knowledge and attitudes of women towards maternal Tdap vaccination in Colombia, Peru, and Panama to identify the critical behavioral and social drivers of Tdap vaccine uptake during pregnancy. A cross-sectional online survey was undertaken between December 8, 2022, and January 11, 2023, targeting women in Colombia, Peru, or Panama with a child 12 months or under. We collected data on respondents' demographics, social and behavioral determinants of vaccine acceptance, determinants of vaccine uptake (using the validated 5As taxonomy), and previous vaccination experience. In the 938 respondents who completed the survey (Panama, n = 325; Peru, n = 305; Colombia, n = 308), 73–80 % had received the influenza vaccine, whereas only 30–39 % had received a Tdap vaccine. Significant correlates of Tdap vaccine uptake common to all three countries included a health professional recommendation, knowledge of the vaccine and location of vaccination, perceived vulnerability to pertussis infection, perceived importance of immunization, and receipt of a reminder. In specific countries, nonvaccinated women were more likely to cite issues with ease of access (Panama, Colombia), affordability (opportunity costs; Peru, Colombia), and understanding the rationale for vaccination in pregnancy (Panama, Colombia). To increase maternal Tdap vaccine uptake, health professionals should be encouraged to recommend vaccination consistently, and pregnant women should receive reminders explaining why and where to be vaccinated. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCW) significantly influence older adults' vaccine acceptance. This systematic review aimed to identify effective educational interventions for HCWs that could enhance their ability to engage in a dialogue with older adults on vaccination. Methods: Medline, Scopus, Cochrane library and grey literature were searched for comparative studies investigating educational interventions concerning older adult vaccinations. The search encompassed all languages and publication years. Analysis was performed on the outcomes 'vaccines offered or ordered' and 'vaccination rates'. Whenever feasible, a sub-analysis on publication year was conducted. Methodological limitations were assessed using the RoB 2 for RCTs and the GRADE checklist for non-randomized studies. Study outcomes were categorized according to the four-level Kirkpatrick model (1996) for effectiveness: reaction, learning, behaviour, and results. Results: In total, 48 studies met all inclusion criteria. Most studies included reminder systems signalling HCWs on patients due for vaccination. Other interventions included seminars, academic detailing and peer-comparison feedback. Four articles reporting on the reaction-level indicated that most HCWs had a favourable view of the intervention. Two of the six articles reporting on the learning-level observed positive changes in attitude or knowledge due to the intervention. Seventeen studies reported on the behaviour-level. An analysis on eleven out of seventeen studies focusing on vaccines 'ordered' or 'offered' outcomes suggested that tailored reminders, particularly those implemented before 2000, were the most effective. Out of 34 studies reporting on the result-level, 24 were eligible for analysis on the outcome 'vaccination rate', which showed that compared to usual care, multicomponent interventions were the most effective, followed by tailored reminders, especially those predating 2000. Nonetheless, tailored reminders often fell short compared to other interventions like standing orders or patient reminders. In both the behaviour-level and result-level 'education only' interventions frequently underperformed relative to other interventions. Seventeen out of the 27 RCTs, and seven of the 21 non-randomized studies presented a low-to-medium risk for bias in the studies' findings. Conclusions: Tailored reminders and multicomponent interventions effectively assist HCWs in addressing vaccines with older adults. However, education-only interventions appear to be less effective compared to other interventions rates, attitude, knowledge. [ABSTRACT FROM AUTHOR]

Background It is urgent to implement interventions to increase vaccination rates of influenza/pneumonia vaccines in older adults, yet the effectiveness of different intervention strategies has not been thoroughly evaluated. Objective We aimed to assess the effectiveness of intervention strategies for increasing the coverage of influenza/pneumonia vaccination in older adults. Methods PubMed, Web of Science, Cochrane Library, Embase, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang were searched from 1 January 2000 to 1 October 2022. RCTs that assessed any intervention strategies for increasing influenza/pneumonia vaccination coverage or willingness in older adults were included. A series of random-effects network meta-analysis was conducted by using frequentist frameworks. Results Twenty-two RCTs involving 385,182 older participants were eligible for further analysis. Eight types of intervention strategies were evaluated. Compared with routine notification, health education (odds ratio [OR], 1.85 [95%CI, 1.19 to 2.88]), centralised reminder (OR, 1.63 [95%CI, 1.07 to 2.47]), health education + onsite vaccination (OR, 2.89 [95%CI, 1.30 to 6.39]), and health education + centralised reminder + onsite vaccination (OR, 20.76 [95%CI, 7.33 to 58.74]) could effectively improve the vaccination rate. The evidence grade was low or very low due to the substantial heterogeneity among studies. Conclusions Our findings suggest that health education + centralised reminder + onsite vaccination may potentially be an effective strategy regardless of cost, but the evidence level was low. More rigorous trials are needed to identify the association between strategies and vaccination rates among older adults and to integrate such evidence into clinical care to improve vaccination rates. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) viral load (VL) monitoring was likely interrupted during the Coronavirus disease 2019 (COVID-19) pandemic. We used routine data on repeat VL testing among 667 prevention of vertical HIV transmission (PVT) clients in Ehlanzeni district, to determine compliance to VL testing recommendations and associated factors during different time periods: pre-COVID-19, transition, and COVID-19. Descriptive and multivariable Poisson regression analyses were conducted, with and without including revised PVT-guidelines rolled out in January-2020. Among 405 women with ≥ 2 VL tests, the overall median age was 30 years (interquartile range: 26–35 years). Compliance to recommended VL testing guidelines ranged between 81.5% (172/211) and 92.3% (191/207) at different time periods. Across all three periods and when revised PVT-guidelines were used, being compliant was significantly reduced among those with earliest VL = 50–999 copies/ml (incidence rate ratio (IRR) = 0.71 [95% confidence interval (CI) 0.61–0.82], p value < 0.001) and VL ≥ 1000 copies/ml (IRR = 0.18 [95% CI 0.09–0.36], p value < 0.001). When guideline revisions were excluded, compliance was only significantly reduced among those with VL ≥ 1000 copies/ml (IRR = 0.14 [95% CI 0.06–0.32], p value < 0.001) and increased during the COVID-19 period versus pre-COVID-19 (IRR = 1.10 [95% CI 1.05–1.15], p value < 0.001). Similar significant associations between compliance and VL level were observed when the COVID-19 period was analyzed separately. Significantly increased compliance to VL testing among the 25–34 years age-group versus younger women was also observed across all periods. These results highlight the importance of strengthening strategies such as short message service reminders and educational messaging, reaching all age-groups, to fast-track implementation targets for VL monitoring. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness of the Support-Pro online training platform in increasing the confidence and knowledge of healthcare professionals (HCPs) in treating people living with type 1 diabetes (PWT1D). The platform, which was developed in collaboration with HCPs and PWT1D, provides self-guided education and regular updates to facilitate diabetes self-management. A 12-month trial involving 144 participants showed that HCPs who had access to Support-Pro reported increased confidence and knowledge in treating and supporting PWT1D. The platform was well-received by participants, who found it valuable for continuous professional development in diabetes care. The study highlights the potential of digital health tools like Support-Pro in improving patient outcomes and quality of care in diverse healthcare settings. [Extracted from the article]

Socio-economic deprivation is strongly associated with poor asthma outcomes in England, but this relationship is not primarily due to poor adherence to inhaled corticosteroids (ICS). The study investigated the associations between adverse asthma outcomes, socio-economic deprivation, and ICS adherence at a population level in England. The data showed that areas with greater socio-economic deprivation had worse asthma outcomes, but better levels of ICS adherence. This suggests that while ICS non-adherence may lead to worse asthma outcomes at an individual level, it is not the main factor contributing to the population-level association between socio-economic deprivation and poor asthma outcomes. Further research is needed to explore alternative mechanisms by which socio-economic deprivation may lead to adverse asthma outcomes. [Extracted from the article]

Background: Compared with urban/suburban counterparts, rural communities experience lower rates of physical activity (PA) and higher rates of chronic disease. Promoting PA is important for disease prevention but requires reliable and valid measurement of PA. However, little is known about effectively collecting objective PA data in rural communities. Using data from a cluster randomized trial (Heartland Moves), which aims to increase PA in rural Missouri, this study explored factors associated with successful objective PA data collection and presents lessons learned. Methods: Baseline survey and accelerometry data were collected through Heartland Moves (n = 368) from August 2019 to February 2021, in southeast Missouri. Chi-square and logistic regression analyses were used to explore factors (demographics, subjective PA, and SMS reminders) associated with valid wear of PA devices. Results: Overall, 77% had valid wears. Participants who were not married (odds ratio [OR] 0.48, 95% confidence interval [CI], 0.30–0.79) and those living alone (OR 0.49, 95% CI, 0.30–0.81) were less likely to have valid wears. Participants who met PA guidelines (OR 1.69, 95% CI, 1.03–2.75) or received SMS reminders (OR 3.25; 95% CI, 1.97–5.38) were more likely to have valid wears. Conclusions: Results are supported by lessons learned, including importance of communication (SMS reminders), accessing hard-to-reach groups (living alone), and need to adapt during data collection. [ABSTRACT FROM AUTHOR]

Glaucoma, the leading cause of irreversible blindness worldwide, comprises a group of progressive optic neuropathies requiring early detection and lifelong treatment to preserve vision. Artificial intelligence (AI) technologies are now demonstrating transformative potential across the spectrum of clinical glaucoma care. This review summarizes current capabilities, future outlooks, and practical translation considerations. For enhanced screening, algorithms analyzing retinal photographs and machine learning models synthesizing risk factors can identify high-risk patients needing diagnostic workup and close follow-up. To augment definitive diagnosis, deep learning techniques detect characteristic glaucomatous patterns by interpreting results from optical coherence tomography, visual field testing, fundus photography, and other ocular imaging. AI-powered platforms also enable continuous monitoring, with algorithms that analyze longitudinal data alerting physicians about rapid disease progression. By integrating predictive analytics with patient-specific parameters, AI can also guide precision medicine for individualized glaucoma treatment selections. Advances in robotic surgery and computer-based guidance demonstrate AI's potential to improve surgical outcomes and surgical training. Beyond the clinic, AI chatbots and reminder systems could provide patient education and counseling to promote medication adherence. However, thoughtful approaches to clinical integration, usability, diversity, and ethical implications remain critical to successfully implementing these emerging technologies. This review highlights AI's vast capabilities to transform glaucoma care while summarizing key achievements, future prospects, and practical considerations to progress from bench to bedside. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most patients who sustain a traumatic injury require outpatient follow-up. A common barrier to outpatient postadmission care is patient failure to follow-up. One of the most significant factors resulting in failure to follow-up is age more than 35 years. Recent work has shown that follow-up telephone calls reduce readmission rates. Our aim was to decrease no-show appointments by 10% in 12 months. STUDY DESIGN: The electronic medical records at our level I and II trauma centers were queried for all outpatient appointments for trauma between July 1, 2020, and June 9, 2021, and whether the patient attended their follow-up appointment. Patients with visits scheduled after August 1, 2021, received 24- and 48-hour previsit reminder calls. Patients with visits scheduled between July 1, 2020, and August 1, 2021, did not receive previsit calls. Both groups were compared using multivariable direct logistic regression models. RESULTS: A total of 1,822 follow-up opportunities were included in the study. During the pre-implementation phase, there was a no-show rate of 30.9% (329 of 1,064 visits). Postintervention, a 12.2% reduction in overall no-show rate occurred. A statistically significant 11.2% decrease (p < 0.001) was seen in elderly patients. Multivariate analysis showed standardized calls resulted in significantly decreased odds of failing to keep an appointment (adjusted odds ratio = 0.610, p < 0.001). CONCLUSIONS: Reminder calls led to a 12.2% reduction in no-show rate and were an independent predictor of a patient's likelihood of attending their appointment. Other predictors of attendance included insurance status and abdominal injury. [ABSTRACT FROM AUTHOR]

Radiology departments face challenges in delivering timely and accurate imaging reports, especially in high-volume, subspecialized settings. In this retrospective cohort study at a tertiary cancer center, we assessed the efficacy of an Automatic Assignment System (AAS) in improving radiology workflow efficiency by analyzing 232,022 CT examinations over a 12-month period post-implementation and compared it to a historical control period. The AAS was integrated with the hospital-wide scheduling system and set up to automatically prioritize and distribute unreported CT examinations to available radiologists based on upcoming patient appointments, coupled with an email notification system. Following this AAS implementation, despite a 9% rise in CT volume, coupled with a concurrent 8% increase in the number of available radiologists, the mean daily urgent radiology report requests (URR) significantly decreased by 60% (25 ± 12 to 10 ± 5, t = -17.6, p < 0.001), and URR during peak days (95th quantile) was reduced by 52.2% from 46 to 22 requests. Additionally, the mean turnaround time (TAT) for reporting was significantly reduced by 440 min for patients without immediate appointments and by 86 min for those with same-day appointments. Lastly, patient waiting time sampled in one of the outpatient clinics was not negatively affected. These results demonstrate that AAS can substantially decrease workflow interruptions and improve reporting efficiency. [ABSTRACT FROM AUTHOR]

Background: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. Aim: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. Method: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. Results: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. Conclusion: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education. [ABSTRACT FROM AUTHOR]