Evaluation of myCOPD, a digital self-management technology, in a remote and rural population. (Preprint)

2021 ◽  
Author(s):  
Beth Sage ◽  
Rowena Cooper ◽  
Adam Giangreco ◽  
Michelle Duffy ◽  
Elaine Finlayson ◽  
...  
Keyword(s):  
Rural Communities ◽  
Hospital Admissions ◽  
Self Management ◽  
Service Needs ◽  
Management Technology ◽  
Lower Health ◽  
Bed Days ◽  
One Year ◽  
Very High ◽  
Improve Health

UNSTRUCTURED Digital self-management technologies are increasingly common given their potential to improve health outcomes and mitigate demands on clinical services. This study evaluated myCOPD in 113 participants from predominantly remote and rural communities for up to one year. Although popular, myCOPD was not associated with reduced hospital admissions, inpatient bed days or lower health service needs. Further subgroup analysis did however suggest that very high myCOPD usage may benefit some individuals.

Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting

2019 ◽  
Vol 26 (6) ◽  
pp. 332-340
Author(s):  
Wai Leng Chow ◽  
Chaw Yu K Aung ◽  
Shao Chuen Tong ◽  
Geraldine SL Goh ◽  
Sheldon Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Healthcare Utilization ◽  
Patient Activation ◽  
Cost Of Care ◽  
Self Management ◽  
Telephone Support ◽  
Total Cost ◽  
Bed Days ◽  
One Year ◽  
The One

Aims Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. Methods This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. Results Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower ( p = 0.07) in telemonitoring. Conclusion In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

scholarly journals One Year of the COVID-19 Pandemic in Galicia: A Global View of Age-Group Statistics during Three Waves

2021 ◽  
Vol 18 (10) ◽  
pp. 5104
Author(s):  
Iván Area ◽  
Henrique Lorenzo ◽  
Pedro J. Marcos ◽  
Juan J. Nieto
Keyword(s):  
Intensive Care Unit ◽  
Hospital Admissions ◽  
Age Groups ◽  
Age Group ◽  
Nw Spain ◽  
The Past ◽  
Global View ◽  
Time Period ◽  
Key Variables ◽  
One Year

In this work we look at the past in order to analyze four key variables after one year of the COVID-19 pandemic in Galicia (NW Spain): new infected, hospital admissions, intensive care unit admissions and deceased. The analysis is presented by age group, comparing at each stage the percentage of the corresponding group with its representation in the society. The time period analyzed covers 1 March 2020 to 1 April 2021, and includes the influence of the B.1.1.7 lineage of COVID-19 which in April 2021 was behind 90% of new cases in Galicia. It is numerically shown how the pandemic affects the age groups 80+, 70+ and 60+, and therefore we give information about how the vaccination process could be scheduled and hints at why the pandemic had different effects in different territories.

Treatment of Polydipsia Using a Contingency Management Procedure Incorporating a Self-Management Approach: A Single Case Study

1993 ◽  
Vol 21 (3) ◽  
pp. 275-279 ◽  
Author(s):  
John Turnbull
Keyword(s):  
Single Case ◽  
Contingency Management ◽  
Research Literature ◽  
Self Management ◽  
Pharmacological Intervention ◽  
Management Approach ◽  
Management Procedure ◽  
Management Techniques ◽  
One Year

Polydipsia is a disorder that has received little attention in the research literature. Treatment has been mainly confined to medical or pharmacological intervention. Few studies have reported the use of contingency management techniques and none have sought to encourage self-management. This study shows how such a procedure brought about a significant change in rates of water drinking in a thirty-one year old man with a mild learning disability.

scholarly journals Peer support program (P-SUP) to strengthen self-management in patients with chronic conditions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Giesen ◽  
H Könnecke ◽  
M Redaèlli ◽  
D Simic ◽  
M Heßbrügge ◽  
...  
Keyword(s):  
Peer Support ◽  
Support Groups ◽  
Chronic Conditions ◽  
Primary Outcome ◽  
Hospital Admissions ◽  
Self Management ◽  
Artery Disease ◽  
Telephone Coaching

Abstract Background Chronic care programmes (CCPs) ensure a standardised, evidence based and structured patient care. In Germany, CCPs are successful in improving quality of care and making care more patient-centred. Regarding self-management support, however, the programs only feature patient education and shared decisions on treatment goals. Peer support has proven to be a successful component in outpatient care to enhance self-management. The aim of this study is to support patients with type 2 diabetes and coronary artery disease in conducting successful self-management through a multimodal program. Methods This randomized controlled trial (RCT) is set up for 27 months and will include a study population of approximately 1800 patients, beginning in summer 2020. The primary outcome (PO) is the reduction of hospital admissions. In addition to the PO, secondary outcomes include motivational and knowledge-based aspects. Furthermore, health-competitive and health-economic data will be collected. The formative evaluation will review the processes for implementation. The central element of the intervention will be peer support groups, in which the group will participate in physical activities and educational lectures on nutrition, exercise or disease related knowledge. Additionally, a specially designed online platform, personalized feedback for patients on medical outcomes from their family doctors, and regular telephone coaching to increase intrinsic motivation and activation will be provided. Results In addition to the primary outcome (reduction of hospital admissions), increased motivation levels, improved quality of life and increased health literacy are expected. Conclusions This project, funded by the Federal Joint Committee (establishment of statutory health insurance funds and medical providers in Germany), can serve as a blueprint for future implementations of public health approaches and accessible care models for patients with chronic conditions. Key messages Peer support as a successful method to enhance self-management in patients with type 2 diabetes and coronary artery disease. A multimodal program, consisting of peer support groups, an online platform, personalized medical feedback and telephone coaching, aiming to improve quality of life in patients with chronic conditions.

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

scholarly journals The internet‐based arthritis self‐management program: A one‐year randomized trial for patients with arthritis or fibromyalgia

2008 ◽  
Vol 59 (7) ◽  
pp. 1009-1017 ◽  
Author(s):  
Kate R. Lorig ◽  
Philip L. Ritter ◽  
Diana D. Laurent ◽  
Kathryn Plant
Keyword(s):  
Randomized Trial ◽  
Management Program ◽  
Self Management ◽  
The Internet ◽  
One Year

scholarly journals Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

2010 ◽  
Vol 18 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Cibele Grothe ◽  
Angélica Gonçalves da Silva Belasco ◽  
Ana Rita de Cássia Bittencourt ◽  
Lucila Amaral Carneiro Vianna ◽  
Ricardo de Castro Cintra Sesso ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Severe Infection ◽  
Venous Catheter ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Double Lumen ◽  
One Year ◽  
Very High

This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo - UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Decision Support System Based on Fuzzy Logic for Assessment of Expected Corporate Income Performance

2021 ◽  
pp. 2150009
Author(s):  
Arthur Yosef ◽  
Eli Shnaider ◽  
Rimona Palas ◽  
Amos Baranes
Keyword(s):  
Fuzzy Logic ◽  
Decision Support ◽  
Operating Income ◽  
Explanatory Variables ◽  
Section Model ◽  
Evaluation Mechanism ◽  
One Year ◽  
High Degree ◽  
Decision Support Method ◽  
Very High

This study presents a decision-support method to estimate the next year performance of corporate Operating Income Margin (OIM). It is based on a unique combination of cross-section model and the rules-based evaluation mechanism. The estimate is done in terms of broad categories, and not precise numerical values. The model is constructed as follows: its dependent variable (OIM) is one year ahead vs. the corresponding explanatory variables. This structure of the model allows us to view explanatory variables as reflecting financial potential of corporations. The evaluation component consists of a set of rules designed to identify the companies whose “potential” clearly points to an opportunity to invest. For the method presented here to succeed, it is necessary to utilize a highly reliable modeling method, even if it is “Fuzzy”. We apply Soft Regression (SR), which is a Soft Computing modeling tool based on Fuzzy Logic, and utilize all available proxy variables by creating intervals of values. Advantages of utilizing SR, and the intervals’-based modeling are extensively discussed. Modeling results for five consecutive years are consistent and stable, thus indicating high degree of reliability. Testing indicates very high success rate for the stock market related domain, the lowest being 87.9%.

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