The Usability, Acceptability, and Functionality of Smart Oral Multidose Dispensing Systems for Medication Adherence: A Scoping Review

Background: Medication non-adherence is a leading cause of non-optimal disease management, resulting in poor health outcomes, poor quality of life, and increased healthcare costs. Smart oral multidose dispensing systems (SOMDS) are being developed to address non-adherence; however, little is known about their integration into daily use by patients. Methods: Using Arksey and O’Malley’s scoping review framework, relevant literature was searched for in electronic databases (PubMed, EMBASE, International Pharmaceutical Abstracts, and Scopus). Observational and interventional studies reporting the integration and impact on adherence from SOMDS in adults ≥18 years and published after 1960 were included. Results: Thirteen articles including one case study, 8 cohort studies, and 4 randomized trials were eligible. SOMDS included smart blister packaging, automated dispensers, and electronic medication trays. The number of medications dispensed per SOMDS was one (n = 3), >1 (n = 2), placebo (n = 1) and not reported (n = 7). Reported outcomes included impact on medication adherence (n = 3), integration (n = 2) and both parameters (n = 8). Conclusion: Although most studies reported that SOMDS appear usable, there was significant variability in the SOMDS types, patient populations, medication adherence definitions, and measurements; impacting the interpretation of results. Future studies should be designed to address effectiveness of SOMDS on medication adherence in patients with multi-drug therapy and the utilization of real-time adherence data for informing clinical decision making.

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An exploration of the role of advanced clinical practitioners in the East of England

British Journal of Nursing ◽

10.12968/bjon.2020.29.15.864 ◽

2020 ◽

Vol 29 (15) ◽

pp. 864-869

Author(s):

Claire Hooks ◽

Susan Walker

Keyword(s):

Clinical Decision Making ◽

Clinical Decision ◽

Self Awareness ◽

The Uk ◽

The Cost ◽

High Degree ◽

Individual Accountability

Medical staff shortages in the UK have provided impetus for the introduction of advanced clinical practitioners (ACPs). This case study explored the views of 22 ACPs, managers and doctors in primary and acute settings in a region of England, to understand how the role is used, and barriers and facilitators to its success. ACP roles improved the quality of service provision, provided clinical career development and enhanced job satisfaction for staff and required autonomous clinical decision-making, with a high degree of self-awareness and individual accountability. Barriers included disparate pay-scales and funding, difficulty accessing continuing education and research, and lack of agreed role definition and title, due to a lack of standardised regulation and governance, and organisational barriers, including limited access to referral systems. Facilitators were supportive colleagues and opportunities for peer networking. Regulation of ACP roles is urgently needed, along with evaluation of the cost-effectiveness and patient experience of such roles.

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Chromosome aneuploidy analysis in embryos derived from in vivo and in vitro matured human oocytes

Journal of Translational Medicine ◽

10.1186/s12967-021-03080-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Jianhua Li ◽

Jing Chen ◽

Tiecheng Sun ◽

Shuiwen Zhang ◽

Tingting Jiao ◽

...

Keyword(s):

In Vitro Fertilization ◽

Clinical Decision Making ◽

Clinical Decision ◽

Poor Quality ◽

Vitro Fertilization ◽

Aneuploidy Rate ◽

Significant Difference

Abstract Background In vitro oocyte maturation (IVM) is being increasingly approached in assisted reproductive technology (ART). This study aimed to evaluate the quality of embryos generated by in-vitro matured immature follicles, as a guideline for further clinical decision-making. Methods A total of 52 couples with normal karyotypes underwent in vitro fertilization, and 162 embryos were donated for genetic screening. Embryos in IVF group were generated by mature follicles retrieved during gonadotrophin-stimulated in vitro fertilization (IVF) cycles. And embryos in IVM group were fertilized from IVM immature oocytes. Results The average age of the women was 30.50 ± 4.55 years (range 21–42 years) with 87 embryos from IVF group and 75 embryos from IVM group. The rate of aneuploid with 28 of the 87 (32.2%) embryos from IVF group and 21 of the 75 (28%) embryos from IVM group, with no significant difference. The frequency of aneuploid embryos was lowest in the youngest age and increased gradually with women’s age, whether in IVF group or IVM group and risen significantly over 35 years old. The embryos with morphological grade 1 have the lowest aneuploidy frequency (16.6%), and increase by the grade, especially in IVF group. In grade 3, embryos in IVM group were more likely to be euploid than IVF group (60% vs 40%, respectively). Conclusions IVM does not affect the quality of embryos and does not increase the aneuploidy rate of embryos. It is clinically recommended that women more than 35 years have a high aneuploidy rate and recommended to test by PGS (strongly recommended to screened by PGS for women more than 40 years). Women aged less than 35 years old for PGS according to their physical and economic conditions. Embryo with poor quality is also recommended to test by PGS, especially for grade III embryos.

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Gait Analysis with Wearables Can Accurately Classify Fallers from Non-Fallers: A Step toward Better Management of Neurological Disorders

Sensors ◽

10.3390/s20236992 ◽

2020 ◽

Vol 20 (23) ◽

pp. 6992

Author(s):

Rana Zia Ur Rehman ◽

Yuhan Zhou ◽

Silvia Del Din ◽

Lisa Alcock ◽

Clint Hansen ◽

...

Keyword(s):

Gait Analysis ◽

Fall Risk ◽

Clinical Decision Making ◽

Principal Component ◽

Clinical Decision ◽

Poor Quality ◽

Neurological Patients ◽

Stride Duration

Falls are the leading cause of mortality, morbidity and poor quality of life in older adults with or without neurological conditions. Applying machine learning (ML) models to gait analysis outcomes offers the opportunity to identify individuals at risk of future falls. The aim of this study was to determine the effect of different data pre-processing methods on the performance of ML models to classify neurological patients who have fallen from those who have not for future fall risk assessment. Gait was assessed using wearables in clinic while walking 20 m at a self-selected comfortable pace in 349 (159 fallers, 190 non-fallers) neurological patients. Six different ML models were trained on data pre-processed with three techniques such as standardisation, principal component analysis (PCA) and path signature method. Fallers walked more slowly, with shorter strides and longer stride duration compared to non-fallers. Overall, model accuracy ranged between 48% and 98% with 43–99% sensitivity and 48–98% specificity. A random forest (RF) classifier trained on data pre-processed with the path signature method gave optimal classification accuracy of 98% with 99% sensitivity and 98% specificity. Data pre-processing directly influences the accuracy of ML models for the accurate classification of fallers. Using gait analysis with trained ML models can act as a tool for the proactive assessment of fall risk and support clinical decision-making.

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Using On-Line Medical Knowledge to Support Evidence-Based Practice

Knowledge Media in Healthcare ◽

10.4018/978-1-930708-13-6.ch011 ◽

2011 ◽

pp. 187-203

Author(s):

Daniel L. Moody ◽

Graeme G. Shanks

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Point Of Care ◽

Medical Knowledge ◽

Clinical Decision ◽

Evidence Based ◽

On Line ◽

Management Project

This paper describes a successful knowledge management project in one of Australia’s state health departments. The objective of the project was to provide medical staff with on-line access to the latest medical knowledge at the point of care in order to improve the quality of clinical decision making. We believe this represents an important case study from both a theoretical and practical viewpoint:

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Promoting Equity When Using the SNOT-22 Score: A Scoping Review and Literature Review

Sinusitis ◽

10.3390/sinusitis6010002 ◽

2022 ◽

Vol 6 (1) ◽

pp. 15-20

Author(s):

Abigail Weaver ◽

Andrew Wood

Keyword(s):

Quality Of Life ◽

Ethnic Differences ◽

Scoping Review ◽

Clinical Decision Making ◽

Local Population ◽

Clinical Decision ◽

White People ◽

Patient Reported ◽

Snot 22

It is established that non-white people experience worse health outcomes than white people within the same population. Equity addresses differences between patient subgroups, allowing needs-based distribution of resources. The use of quality-of-life (QoL) tools to assist clinical decision making such as the SNOT-22 for chronic rhinosinusitis promotes equality, not equity, as quality-of-life (QoL) tools provide the same criteria of symptom scoring across diverse populations. We considered the effects of ethnicity and race on SNOT-22 scores and whether these scores should be adjusted to improve equity. PubMed and MEDLINE provided papers for a scoping review. A combination of the following search terms was used: patient-reported outcome measures (PROM) (OR) quality of life; (AND) race (OR) ethnicity (OR) disparities; (AND) otolaryngology (OR) SNOT-22 (OR) sinusitis. The first study identified no evidence of ethnic variability in SNOT-22 scores. However, the study did not represent the local population, including 86% white people. Other studies identified baseline SNOT-22 disparities with respect to population demographics, gender, and age. Ethnic differences appear to exist in acute sinusitis symptomatology. In other fields both within and outside of otorhinolaryngology, ethnic differences exist with regard to QoL tools. This scoping review identified a paucity of data in rhinology. However, evidence implies some form of correction to QoL scores could help promote equity for non-white patients.

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The Culture of the Patient as a Red Herring in Clinical Decision Making: A Case Study

Medical Anthropology Newsletter ◽

10.1525/maq.1985.17.1.02a00010 ◽

1985 ◽

Vol 17 (1) ◽

pp. 2-5 ◽

Cited By ~ 1

Author(s):

Howard F. Stein

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision

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How to Evaluate Clinically Relevant Literature: Five Simple Rules for the Practicing Clinician in Stroke Neurorehabilitation

10.31234/osf.io/zvx3b ◽

2020 ◽

Author(s):

Jonathan Sanching Tsay ◽

Carolee Winstein

Keyword(s):

Clinical Decision Making ◽

Relevant Literature ◽

Clinical Decision ◽

Balance Sheets ◽

Neural Connections ◽

Recovery Processes ◽

Immediate Recovery ◽

Simple Rules ◽

Busy Clinician ◽

New Generation

Neurorehabilitation relies on core principles of neuroplasticity to activate and engage latent neural connections, promote detour circuits, and reverse impairments. Clinical interventions incorporating these principles have been shown to promote recovery while demoting compensation. However, many clinicians struggle to find evidence for these principles in our growing but nascent body of literature. Regulatory bodies and organizational balance sheets further discourage evidence-based, methodical, time-intensive, and efficacious interventions because practical needs often outweigh and dominate clinical decision making. Modern neurorehabilitation practices that result from these pressures favor strategies that encourage compensation over those that promote recovery. With a focus on helping the busy clinician evaluate the rapidly growing literature, we put forth five simple rules that direct clinicians toward intervention studies that value more enduring but slower biological recovery processes over the more alluring practical and immediate “recovery” mantra. Filtering emerging literature through this critical lens has the potential to change practice and lead to more durable long-term outcomes. This perspective is meant to serve a new generation of mechanistically minded clinicians, students, and trainees poised to not only advance our field but to also erect policy changes that promote recovery-based care of stroke survivors.

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Mind the Gap: Why the Landscape Planning System in Sardinia Does Not Work

Sustainability ◽

10.3390/su13137300 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7300

Author(s):

Anna Maria Colavitti ◽

Alessio Floris ◽

Sergio Serra

Keyword(s):

Landscape Planning ◽

Comparative Method ◽

Poor Quality ◽

Planning System ◽

Local Planning ◽

The Common ◽

Regional Landscape ◽

Landscape Protection

In Italy, after the introduction of the Code of Cultural Heritage and Landscape in 2004, the Regional Landscape Plan (RLP) has acquired a coordination role in the urban planning system, for the implementation of policies for landscape protection and valorisation. The case study of the RLP of Sardinia is a paradigmatic application to the coastal area of the island, which is considered most vulnerable and subject to settlement pressure. The objectives of preservation and valorisation of the territorial resources should be transferred into local planning instruments by adopting strategies aimed at the preservation of the consolidated urban fabric, at the requalification and completion of the existing built-up areas according to the principles of land take limitation and increase in urban quality. The paper investigates the state of implementation and the level of integration of landscape contents in the local plans that have been adapted to the RLP, using a qualitative comparative method. In addition, the results of the plan coherence checks, elaborated by the regional monitoring bodies after the adaptation process, have been analysed to identify the common criticalities and weaknesses. The results highlight the lack of effectiveness of the RLP, after more than a decade since its approval, considering the limited number of adequate local plans and the poor quality of their analytical and regulative contents in terms of landscape protection and valorisation. Conclusions suggest some possible ways to revise the RLP, focusing on the participation of local communities and the development of a new landscape culture.

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A ‘Galilean’ science of language

Journal of Linguistics ◽

10.1017/s0022226714000061 ◽

2014 ◽

Vol 50 (3) ◽

pp. 671-704 ◽

Cited By ~ 11

Author(s):

CHRISTINA BEHME

Keyword(s):

Language Evolution ◽

Relevant Literature ◽

Child Psychology ◽

Scientific Work ◽

Poor Quality ◽

The Poor ◽

Recent Scholarship ◽

Basic Understanding ◽

Sixth Decade

The Science of Language, published in the sixth decade of Noam Chomsky's linguistic career, defends views that are visibly out of touch with recent research in formal linguistics, developmental child psychology, computational modeling of language acquisition, and language evolution. I argue that the poor quality of this volume is representative of the serious shortcomings of Chomsky's recent scholarship, especially of his criticism of and contribution to debates about language evolution. Chomsky creates the impression that he is quoting titbits of a massive body of scientific work he has conducted or is intimately familiar with. Yet his speculations reveal a lack of even basic understanding of biology, and an unwillingness to engage seriously with the relevant literature. At the same time, he ridicules the work of virtually all other theorists, without spelling out the views he disagrees with. A critical analysis of the ‘Galilean method’ demonstrates that Chomsky uses appeal to authority to insulate his own proposals against falsification by empirical counter-evidence. This form of discourse bears no serious relation to the way science proceeds.

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