scholarly journals Markovchart: an R package for cost-optimal patient monitoring and treatment using control charts

2021 ◽  
Author(s):  
Balázs Dobi ◽  
András Zempléni
Keyword(s):  
Health Care ◽  
Markov Chain ◽  
Health Care Professionals ◽  
Control Charts ◽  
Patient Monitoring ◽  
R Package ◽  
Diabetic Patients ◽  
Real World Data ◽  
Link Type ◽  
Health Care Applications

AbstractControl charts originate from industrial statistics, but are constantly seeing new areas of application, for example in health care (Thor et al. in BMJ Qual Saf 16(5):387–399, 2007. https://doi.org/10.1136/qshc.2006.022194; Suman and Prajapati in Int J Metrol Qual Eng, 2018. https://doi.org/10.1051/ijmqe/2018003). This paper is about the package, an implementation of generalised Markov chain-based control charts with health care applications in mind and with a focus on cost-effectiveness. The methods are based on Zempléni et al. (Appl Stoch Model Bus Ind 20(3):185–200, 2004. https://doi.org/10.1002/asmb.521), Dobi and Zempléni (Qual Reliab Eng Int 35(5):1379–1395, 2019a. https://doi.org/10.1002/qre.2518, Ann Univ Sci Budapestinensis Rolando Eötvös Nomin Sect Comput 49:129–146, 2019b). The implemented ideas in the package were motivated by problems encountered by health care professionals and biostatisticians when assessing the effects and costs of different monitoring schemes and therapeutic regimens. However, the implemented generalisations may be useful in other (e.g., engineering) applications too, as they mainly revolve around the loosening of assumptions seen in traditional control chart theory. The package is able to model processes with random shift sizes (i.e., the degradation of the patient’s health), random repair (i.e., treatment) and random time between samplings (i.e., visits) as well. The article highlights the flexibility of the methods through the modelling of different disease progression and treatment scenarios and also through an application on real-world data of diabetic patients.

Implementation Strategies for the International Dysphagia Diet Standardisation Initiative (IDDSI), Part I: Quantitative Analysis of IDDSI Performance Among Varied Participants

2020 ◽  
Vol 29 (3) ◽  
pp. 1514-1528 ◽  
Author(s):  
David W. Rule ◽  
Lisa Kelchner ◽  
Ashley Mulkern ◽  
Sarah Couch ◽  
Noah Silbert ◽  
...  
Keyword(s):  
Health Care ◽  
Socioeconomic Factors ◽  
Task Performance ◽  
Health Care Professionals ◽  
Prior Experience ◽  
Classification Task ◽  
Testing Methods ◽  
Link Type ◽  
Self Study ◽  
Predictive Relationships

Purpose The International Dysphagia Diet Standardisation Initiative (IDDSI) is an international standardized framework for texture-modified diets (TMDs). However, user accuracy in conducting IDDSI testing methods are unknown. The aims of this study were threefold: (a) to describe performance on two tasks (an IDDSI knowledge quiz and a TMD sample classification task), (b) to determine interrater and intrarater agreement for classification task performance, and (c) to determine predictive relationships between socioeconomic factors or prior knowledge on task performance. Method Sixty-eight participants were recruited, including health care professionals and non–health care-related individuals. A mixed between-subjects and within-subject design was used. All participants completed a baseline knowledge quiz, 30 min of self-study using the IDDSI.org curriculum, a post self-study knowledge quiz, and a TMD classification task of 21 TMD samples with representation across all IDDSI levels. Data were collected via electronic survey. Results There was a significant increase ( p < .001) between pre and post self-study knowledge quiz scores. On the classification task, unmodified foods and drinks were most accurately classified with thickened liquids (IDDSI Levels 1, 2, 3) most inaccurately classified. At baseline, moderate interrater agreement was found with intrarater agreement ranging from fair to almost perfect among identical samples. No significant predictive relationships were found between classification task performance and socioeconomic status or prior experience. Conclusions Thirty minutes of self-study using the online IDDSI.org curriculum improved baseline IDDSI knowledge check performance. Overall accuracy of TMD classification was low and warrants further evaluation given potential adverse health outcomes secondary to inappropriate TMD presentation. Given no predictive relationships between socioeconomic factors and prior experience on task performance, the IDDSI curriculum and classification task appear accessible to various users, including non–health care-related participants. Future studies should more closely observe testing behavior to further characterize variation in participants' use of the testing methods.

Continuous glucose monitoring: data management and evaluation by patients and health care professionals – current situation and developments

2018 ◽  
Vol 42 (6) ◽  
pp. 225-233
Author(s):  
Guido Freckmann ◽  
Jochen Mende
Keyword(s):  
Health Care ◽  
Continuous Glucose Monitoring ◽  
Health Care Professionals ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Diabetic Patients ◽  
Diabetes Therapy ◽  
Software Applications ◽  
Metabolic States ◽  
Specific Device

Abstract Continuous glucose monitoring (CGM) technology represents a valuable tool for diabetic patients to control and regulate their blood glucose (BG) levels and to reduce adverse metabolic states, for example, by defining glucose alarm thresholds that alert users if the glucose value crosses to an undesired range. Improvement of CGM technology is ongoing, but there are barriers which confine the usefulness of CGM systems. The utility is mainly defined by the operability of the specific device and also by the provided benefit of available CGM software solutions. In order to take best advantage of diabetes therapy, users should be adequately educated in how to use their CGM system and how to interpret the collected data. Different CGM software applications provide partially different CGM reports and statistics. The standardization of this information also would be conducive to the best possible diabetes management.

scholarly journals Diabetic Nephropathy: A Comprehensive Review for Health Care Professionals

2020 ◽  
pp. 1-10
Author(s):  
Sumon Rahman Chowdhur
Keyword(s):  
Health Care ◽  
Diabetic Nephropathy ◽  
Renal Disease ◽  
Health Care Professionals ◽  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Cost Of Health Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

The prevalence of Chronic Kidney Disease (CKD) continues to escalate at an alarming rate and diabetes has become the most common single cause of End-Stage Renal Disease (ESRD) in the world. This is because diabetes, particularly type 2, is increasing in prevalence, and the patients are living longer now. Diabetes is the major cause of end-stage renal disease in the developed world, accounting for 40% to 50% of cases. Diabetic nephropathy contributes significantly to the economic burden of diabetes. In UK, the cost of diabetic complications in 2011/2012 was estimated at £14 billion, by 2035/2036 this is expected to rise to £22 billion. Worldwide, healthcare costs for diabetic patients are much higher than non- diabetic patients. Also, among diabetic patients the cost of health care is much higher in those with complications (Micro < Macro<Micro + Macrovascular complications) than in those without complications, therefore identifying and controlling diabetes and its complications is essential in reducing the burden of the disease. In this review we shall explore the pathophysiology, risk factors, staging, screening, management and prognosis of Diabetic Nephropathy in explicit details to make it easily understandable for the Health Care Professionals. Keywords: Diabetic Nephropathy, Diabetes, Health Care Professionals

Using experiences of mobile application from the perspective of patients with diabetes mellitus: A qualitative meta-synthesis (Preprint)

2018 ◽  
Author(s):  
Xiaoyan Lv ◽  
Yingjuan Cao ◽  
Jinghua Xia ◽  
Ran Tan ◽  
Polun Chang
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Professionals ◽  
Mobile Application ◽  
Management Strategies ◽  
Self Management ◽  
Cochrane Library ◽  
Diabetic Patients ◽  
Negative Effects ◽  
Patients With Diabetes

BACKGROUND Mobile application has become a new tool for management of chronic disease like diabetes mellitus (DM). Up to date, most of the studies related to mobile application focus on the effectiveness of self-management, rarely take perceptions and experiences of users into account. OBJECTIVE To conduct a meta- synthesis of qualitative researches which associated with mobile application using experiences among diabetic patients in order to better understand those factors which facilitate or hinder patients’ embracement, and to provide recommendations for future mobile application design and disease management strategies. METHODS Literatures focused on experiences and perceptions of users in diabetes application were searched in PubMed, Web of Science and Cochrane Library between inception and June 2018. The Jonna Briggs Institute (JBI) Critical Appraisal Tool for qualitative studies was utilized to evaluate the quality of the selected studies. The searching results were synthesized by employing Integrating Methods. RESULTS Four studies were included for analysis, 17 findings were subsequently integrated into 6 categories and finally 2 synthesized results were defined, including the use of mobile application for diabetes can improve patients’ self-management and confidence in disease control, obtain more support from health care professionals, and reduce negative emotions; Problems and negative effects in use. CONCLUSIONS Mobile application is a helpful tool to initiate and maintain self-management among diabetic patients and more improvements are necessary for the sake of easy use and effectiveness. Further high-quality qualitative study is needed to better understand requirements and using experience of diabetics, health care professionals or other stakeholders.

scholarly journals Patients’ and family members’ knowledge and views regarding diabetes mellitus and its treatment

Curationis ◽  
2007 ◽  
Vol 30 (2) ◽  
Author(s):  
H.N. Shilubane ◽  
E. Potgieter
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Professionals ◽  
Family Members ◽  
Health Care Facilities ◽  
Limpopo Province ◽  
Self Management ◽  
Diabetic Patients ◽  
Adequate Knowledge ◽  
Essential Knowledge

Diabetes mellitus affects millions of people worldwide and its related complications continue to be of great concern. The outcome of diabetes depends mainly on the patient’s self-management. Health care professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes towards self-management. A quantitative survey was conducted to identify diabetic patients and family members' knowledge and views about diabetes and its treatment regimen. A convenient sample of 32 diabetics and 32 family members who attended two health care facilities in the Mopani district, Limpopo Province, was drawn. Two similar questionnaires, one for each group respectively, were completed by the subjects. The data was analysed by a computer programme, the Statistical Package for Social Sciences. Findings revealed that the diabetics and family members lack adequate knowledge on diabetes and its treatment. Recommendations regarding the required health education and assistance to be given to these patients and their family members were made.

scholarly journals Black female patients with type 2 diabetes mellitus: knowledge, attitudes and physical activity

2001 ◽  
Vol 57 (3) ◽  
pp. 20-27
Author(s):  
A. J. Van Rooijen ◽  
P. Rheeder ◽  
C. J. Eales ◽  
P. Becker
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Type 2 Diabetes Mellitus ◽  
Health Care Professionals ◽  
Psychosocial Impact ◽  
Diabetic Patients ◽  
Control Of Diabetes

The aim of this study was to obtain baseline data from female Type 2 Diabetes Mellitus (Type 2 DM) patients on their general health status, demographics, their knowledge of and attitudes towards diabetes and exercise, as well as their present physical activity levels.The sample of convenience consisted of 93 patients between the ages of 36 and 70 years, who were attending the Mamelodi Hospital Diabetic Outpatient Clinic.Demographic, clinical, diabetes knowledge, diabetes attitude and physical activity data were captured. Data were summarized with descriptive statistics. Pearson product-moment correlation was employed to assess relationships and Cronbach’s alpha measured reliability.It was found that the sample had a low educational level. (84% schooling up to St 7) Several risk factors for the control of diabetes were identified in the sample. (Class I obesity, HbAI c-levels acceptable to compromised, 75% on treatment for hypertension) They had low scores on knowledge of diabetes ( mean,SD =4.72,2.05 out of 15) and low levels of physical activity. (mean, SD—2.85,2.09) Patients agreed with the attitude in the scale that the health care professionals require skills to educate and counsel diabetic patients, as well as bring about behavioral changes in the patients.( r=0.62) They also agreed that diabetes has a substantial psychosocial impact on their lives. (r=0.41) The highest correlation between to sub-scales was between the need for special training of health care professionals who care for diabetic patients and the psychosocial impact of the disease. (r=0.41) Patients should be educated about the basic physiology of diabetes, insulin action and causes of hypoglycaemia. They should also be motivated to increase physical activity on a continuous basis.Culturally sensitive research is needed to identify health beliefs, motivation for the control of diabetes and environmental and personal barriers to exercise and physical activity in this population.

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