scholarly journals Personalization of Conversational Agent-Patient Interaction Styles for Chronic Disease Management: Results from two studies with COPD patients (Preprint)

2020 ◽  
Author(s):  
Christoph Gross ◽  
Theresa Schachner ◽  
Andrea Hasl ◽  
Dario Kohlbrenner ◽  
Christian F Clarenbach ◽  
...  
Keyword(s):  
Relationship Quality ◽  
Working Alliance ◽  
Chronic Disease Management ◽  
Chronically Ill ◽  
Interaction Style ◽  
Interaction Styles ◽  
Copd Patients ◽  
Chronically Ill Patients ◽  
Copd Diagnosis

BACKGROUND Conversational agents (CAs) for chronic disease management are receiving increasing attention in academia and industry. However, long-term adherence to CAs is still a challenge and to be explored. Personalization of CAs has the potential to improve long-term adherence and, with it, user satisfaction, task efficiency, perceived benefits, and intended behaviour change. Research on personalized CAs has already addressed different aspects, such as personalized recommendations or anthropomorphic cues. However, detailed information on interaction styles between patients and CAs in the role of a medical healthcare professional is scant. Such interaction styles play an essential role for patient satisfaction, treatment adherence and outcome, as has been shown for physician-patient interactions. Currently, it is not clear (i) whether chronically ill patients prefer a CA with either a paternalistic, informative, interpretive, or deliberative interaction style, and (ii) which factors influence these preferences. OBJECTIVE The objective of this paper, comprising of two consecutive studies, is to investigate preferences for CA-delivered interaction styles by chronically ill patients. METHODS The first study was conducted paper-based and explored preferences of COPD-patients for paternalistic, informative, interpretive, and deliberative CA-delivered interaction styles. Based on these results, a second study assessed the effect of the paternalistic and deliberative interaction style on the relationship quality between the CA and patients via hierarchical multiple linear regression analyses in an online experiment with COPD patients. Patients’ socio-demographic and disease-specific characteristics served as moderator variables. RESULTS Study 1 with 117 COPD patients revealed a preference for the deliberative (50 out of 117) and informative (34 out of 117) interaction styles across demographic characteristics. The paternalistic style was preferred by persons with more severe COPD (GOLD 3/4 100%). Study 2 with 123 newly recruited COPD patients showed that younger persons and persons with a less recent COPD diagnosis scored higher on interaction-related outcomes when interacting with a CA that delivered the deliberative interaction style (Age and CA Type: Relationship Quality – b = -0.77 , 95% CI = [-1.37, -0.18]; Intention to Continue Interaction – b = -0.49, 95% CI = [-0.97; -0.01]; Working Alliance Attachment Bond – b = -0.65, 95% CI = [-1.26; -0.04]; Working Alliance Goal Agreement – b = -0.59, 95% CI = [-1.18; -0.01]; Recency of COPD diagnosis and CA Type: Working Alliance Goal Agreement – b = 0.57, 95% CI = [0.01; 1.13]). CONCLUSIONS Our results indicate that age and a patient's personal disease experience inform which interaction style the patient should be paired with to achieve increased interaction related outcomes with the CA. These results allow to design personalized healthcare CAs with the goal to increase long-term adherence to health-promoting behavior.

scholarly journals How healthy are chronically ill patients after eight years of homeopathic treatment? – Results from a long term observational study

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Claudia M Witt ◽  
Rainer Lüdtke ◽  
Nils Mengler ◽  
Stefan N Willich
Keyword(s):  
Observational Study ◽  
Chronically Ill ◽  
Treatment Results ◽  
Homeopathic Treatment ◽  
Chronically Ill Patients

Outbreak of Healthcare-Associated Infection and Colonization With Multidrug-ResistantSalmonella entericaSerovar Senftenberg in Florida

2007 ◽  
Vol 28 (7) ◽  
pp. 805-811 ◽  
Author(s):  
Robyn S. Kay ◽  
Alexander G. Vandevelde ◽  
Paul D. Fiorella ◽  
Rebecca Crouse ◽  
Carina Blackmore ◽  
...  
Keyword(s):  
Infection Control ◽  
Chronically Ill ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Associated Infection ◽  
Healthcare Facilities ◽  
Infection Control Measures ◽  
Healthcare Associated ◽  
Chronically Ill Patients

Background.In July 1999, a rare strain of multidrug-resistantSalmonella entericaserovar Senftenberg was isolated from the sputum of a trauma patient. Over a 6-year period (1999-2005) in northeast Florida, thisSalmonellaserovar spread to 66 other patients in 16 different healthcare facilities as a result of frequent transfers of patients among institutions. To our knowledge, this is the first outbreak of healthcare-associated infection and colonization with a fluoroquinolone-resistant strain of S. Senftenberg in the United States.Objectives.To investigate an outbreak of infection and colonization with an unusual strain of S. Senftenberg and assist with infection control measures.Design.A case series, outbreak investigation, and microbiological study of all samples positive forS.Senftenberg on culture.Setting.Cases ofS.Senftenberg infection and colonization occurred in hospitals and long-term care facilities in 2 counties in northeast Florida.Results.The affected patients were mostly elderly persons with multiple medical conditions. They were frequently transferred between healthcare facilities. ThisSalmonellaserovar was capable of long-term colonization of chronically ill patients. AllS.Senftenberg isolates tested shared a similar pulsed-field gel electrophoresis (PFGE) pattern.Conclusion.A prolonged outbreak of infection and colonization with multidrug-resistantS.Senftenberg was identified in several healthcare facilities throughout the Jacksonville, Florida, area and became established when infection control measures failed. The bacterial agent was capable of long-term colonization in chronically ill patients. Because the dispersal pattern of this strain suggested a breakdown of infection control practices, a multipronged intervention approach was undertaken that included intense education of personnel in the different institutions, interinstitutional cooperation, and transfer paperwork notification.

Perception of Spoken Communication by Elderly Chronically Ill Patients in an Institutional Setting

1981 ◽  
Vol 46 (4) ◽  
pp. 405-412 ◽  
Author(s):  
Rosemary Lubinski ◽  
Eleanor B. Morrison ◽  
Seymour Rigrodsky
Keyword(s):  
Long Term Care ◽  
Chronically Ill ◽  
Institutional Setting ◽  
Communicative Interaction ◽  
Term Care ◽  
Factors Affecting ◽  
Standardized Interview ◽  
Speech Pathologist ◽  
Chronically Ill Patients

The purpose of this research was to investigate the perception of elderly and chronically ill patients regarding the spoken communication that occurs in a long-term care institution. Twenty-four patients were given a focused semi-standardized interview to investigate their perception of how much they talked, their communication partners, where they talked, their topics, their desire and enjoyment in talking, factors affecting communication, and suggestions for improving the communication atmosphere in this setting. Results indicate that communication is limited in quantity and scope, though elderly patients desire communicative interaction. The results of the study are explained from two perspectives—how the patients themselves contribute to the limited communication and how institutional life restricts interaction. Implications for the speech pathologist are given.

Can Life Expectancy and QALYs Be Improved by a Framework for Deciding Whether to Apply Clinical Guidelines to Patients With Severe Comorbid Disease?

2011 ◽  
Vol 31 (4) ◽  
pp. 582-595 ◽  
Author(s):  
R. Scott Braithwaite
Keyword(s):  
Life Expectancy ◽  
Chronically Ill ◽  
Health Impact ◽  
Quality Adjusted Life Years ◽  
Short Term ◽  
Intensive Glucose Control ◽  
Background Mortality ◽  
Life Years ◽  
Chronically Ill Patients

Background: Guidelines with short-term harms and long-term benefits are often applied to chronically ill patients who may not benefit. The payoff time framework has been proposed (i.e., do not apply a guideline if a patient’s life expectancy (LE) is shorter than when a guideline’s cumulative incremental benefits first exceed its cumulative incremental harms), but its health impact is unclear. Objective: To investigate whether the payoff time framework improves LE and/or quality-adjusted life-years (QALY) for chronically ill patients. Methods: I evaluate impact of the payoff time framework on LE and QALYs, assuming (1) high and constant background mortality rate from chronic illness (≥ 10% per year), (2) immediate guideline-related harm with probability < 1, and (3) constant guideline-related benefit that occurs over an extended time. I apply the framework to questions of whether to screen chronically ill 50-year-old women for colorectal cancer using colonoscopy, and whether to advocate intensive glucose control for chronically ill diabetics. Results: If a guideline’s payoff time is greater than a patient’s LE, then withholding that guideline will increase LE and QALYs for that patient. For a 50-year-old chronically ill woman with background mortality > 0.15 per year (corresponding to LE < 6.5 years), withholding CR screening will increase LE. For a diabetic with background mortality > 0.11 per year (corresponding to LE < 9.4 years), withholding CR screening will increase QALYs. Conclusion: The payoff time framework may indicate when withholding a guideline with short-term harms and long-term benefits may increase LE and/or QALY.

scholarly journals Pneumocafé project: an inquiry on current COPD diagnosis and management among General Practitioners in Italy through a novel tool for professional education

2014 ◽  
Vol 9 ◽  
Author(s):  
Claudio M. Sanguinetti ◽  
Fernando De Benedetto ◽  
Claudio F. Donner ◽  
Stefano Nardini ◽  
Alberto Visconti
Keyword(s):  
Early Diagnosis ◽  
General Practitioners ◽  
Professional Education ◽  
Term Treatment ◽  
Diagnosis And Management ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Treatment ◽  
Copd Diagnosis

Background: Symptoms of COPD are frequently disregarded by patients and also by general practitioners (GPs) in early stages of the disease, that consequently is diagnosed when already at an advanced grade of severity. Underdiagnosis and undertreatment of COPD and scarce use of spirometry are widely recurrent, while a better knowledge of the disease and a wider use of spirometry would be critical to diagnose more patients still neglected, do it at an earlier stage and properly treat established COPD. The aim of Pneumocafè project is to improve, through an innovative approach, the diagnosis and management of COPD at primary care level increasing the awareness of issues pertaining to early diagnosis, adequate prevention and correct treatment of the disease. Methods: Pneumocafè is based on informal meetings between GPs of various geographical zones of Italy and their reference respiratory specialist (RS), aimed at discussing the current practice in comparison to suggestions of official guidelines, analyzing the actual problems in diagnosing and managing COPD patients and sharing the possible solution at the community level. In these meetings RSs faced many issues including patho-physiological mechanisms of bronchial obstruction, significance of clinical symptoms, patients’ phenotyping, and clinical approach to diagnosis and long-term treatment, also reinforcing the importance of a timely diagnosis, proper long term treatment and the compliance to treatment. At the end of each meeting GPs had to fill in a questionnaire arranged by the scientific board of the Project that included 18 multiple-choice questions concerning their approach to COPD management. The results of the analysis of these questionnaires are here presented. Results: 1, 964 questionnaires were returned from 49 RSs. 1,864 questionnaires out of those received (94.91% of the total) resulted properly compiled and form the object of the present analysis. The 49 RSs, 37 males and 12 females, were distributed all over the Italian country and practiced their profession both in public and private hospitals and in territorial sanitary facilities. GPs were 1,330 males (71.35%) and 534 females (28.64%), mean age 56,29 years (range 27-70 yrs). Mean duration of general practice was 25.56 years (range: 0,5-40 yrs) with a mean of 1,302.43 patients assisted by each GP and 2,427,741 patients assisted in all. The majority of GPs affirmed that in their patients COPD has a mean-to-great prevalence and a mean/high impact on their practice, preceded only by diabetes and heart failure. Three-quarters of GPs refer to COPD guidelines and most of them believe that a screening on their assisted patients at risk would enhance early diagnosis of COPD. Tobacco smoking is the main recognized cause of COPD but the actions carried out by GPs to help a patient to give up smoking result still insufficient. The majority of GPs recognize spirometry as necessary to early COPD diagnosis, but the main obstacle pointed out to its wider use was the too long time for the spirometry to be performed. GPs’ main reason for prescribing a bronchodilator is dyspnea and bronchodilators preferably prescribed are LABA and LAMA. Control of patient’s adherence to therapy is mainly carried out by GPs checking the number of drugs annually prescribed or asking the patient during a control visit. Finally, about how many COPD patients GPs believe are in their group of assisted patients, a mean range of 25-40 patients was reported, that is consistently below the forecast based on epidemiological data and number of patients assisted by each GP. Conclusions: The results obtained with this project confirm the validity of this informal approach to professional education. Furthermore, this inquiry provided important insights about the general management of COPD and the process of integration between RS and GPs activities on this disease condition in the long run.

scholarly journals Natural Language Processing for Free-Text Classification in Telehealth Services: Differences Between Diabetes and Heart Failure Applications

2021 ◽  
Author(s):  
Fabian Wiesmüller ◽  
Dieter Hayn ◽  
Karl Kreiner ◽  
Bernhard Pfeifer ◽  
Gerhard Pölzl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natural Language Processing ◽  
Language Processing ◽  
Text Classification ◽  
Chronically Ill ◽  
Free Text ◽  
Long Term Monitoring ◽  
Chronically Ill Patients ◽  
Term Monitoring

Telehealth services for long-term monitoring of chronically ill patients are becoming more and more common, leading to huge amounts of data collected by patients and healthcare professionals each day. While most of these data are structured, some information, especially concerning the communication between the stakeholders, is typically stored as unstructured free-texts. This paper outlines the differences in analyzing free-texts from the heart failure telehealth network HerzMobil as compared to the diabetes telehealth network DiabMemory. A total of 3,739 free-text notes from HerzMobil and 228,109 notes from DiabMemory, both written in German, were analyzed. A pre-existing, regular expression based algorithm developed for heart failure free-texts was adapted to cover also the diabetes scenario. The resulting algorithm was validated with a subset of 200 notes that were annotated by three scientists, achieving an accuracy of 92.62%. When applying the algorithm to heart failure and diabetes texts, we found various similarities but also several differences concerning the content. As a consequence, specific requirements for the algorithm were identified.

67. Loving your child to death: Considerations of the care of chronically-ill children and euthanasia in Emil Sher's Mourning Dove and implications for medical educations

2007 ◽  
Vol 30 (4) ◽  
pp. 65
Author(s):  
K. Mukhida
Keyword(s):  
Life Support ◽  
Terminally Ill ◽  
Chronically Ill ◽  
Legal Aspects ◽  
Mourning Dove ◽  
Medical Professionals ◽  
Constant Pain ◽  
Withdraw Life Support ◽  
Wheat Farmer

How do parents cope when their child is ill or dying, when he or she experiences constant pain or suffering? What do parents think of the contributions that medical professionals make to the care of their chronically or terminally ill child? Is it possible for a parent to love a child so much that the child is wished dead? The purpose of this paper is to explore those questions and aspects of the care of chronically or terminally ill children using Mourning Dove’s portrayal of one family’s attempt to care for their ill daughter. A play written by Canadian playwright Emil Sher, Mourning Dove is based on the case of Saskatchewan wheat farmer Robert Latimer who killed his 12 year old daughter Tracy who suffered with cerebral palsy and lived in tremendous pain. Rather than focusing on the medical or legal aspects of the care of a chronically ill child, the play offers a glimpse into how a family copes with the care of such a child and the effects the child’s illness has on a family. Reading and examination of non-medical literature, such as Mourning Dove, therefore serve as a useful means for medical professionals to better understand how illness affects and is responded to by patients and their families. This understanding is a prerequisite for them to be able to provide complete care of children with chronic or terminal illnesses and their families. Nuutila L, Salanterä S. Children with long-term illness: parents’ experiences of care. J Pediatr Nurs 2006; 21(2):153-160. Sharman M, Meert KL, Sarnaik AP. What influences parents’ decisions to limit or withdraw life support? Pediatr Crit Care Med 2005; 6(5):513-518. Steele R. Strategies used by families to navigate uncharted territory when a child is dying. J Palliat Care 2005; 21(2):103-110.

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