Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

2021 ◽  
Author(s):  
David Lessard ◽  
Kim Engler ◽  
Yuanchao Ma ◽  
Adriana Rodriguez Cruz ◽  
Serge Vicente ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Sociodemographic Characteristics ◽  
Patient Portal ◽  
Implementation Outcomes ◽  
Service Outcomes ◽  
Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

scholarly journals A digital health intervention to increase health knowledge related to HIV/AIDS, Tuberculosis and Taenia solium cysticercosis/taeniosis in Iringa, Tanzania: Protocol of a mixed-method study (Preprint)

2020 ◽  
Author(s):  
Christine Holst ◽  
Felix Sukums ◽  
Bernard Ngowi ◽  
Lien My Diep ◽  
Tewodros Aragie Kebede ◽  
...  
Keyword(s):  
Mixed Method ◽  
Health Knowledge ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Taenia Solium ◽  
Intervention Group ◽  
Health Messages ◽  
Mixed Method Study ◽  
The Difference

BACKGROUND Health promotion and health education have traditionally been given to communities in the global south in the form of leaflets or orally by healthcare workers. Digital health interventions (DHIs) such as digital health messages accessed with, for example, smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of the healthcare system. The DHI in this study is focused on disseminating digital health education on three disease complexes of high public health concern, i.e. HIV/AIDS, tuberculosis (TB) and Taenia solium (neuro)cysticercosis/taeniosis (TSCT), a parasitic zoonotic disease that requires a Health One approach to combat. The DHI presents the participants with animated health videos (animations) and provides access to internet hotspots in rural Tanzanian communities, with a freely accessible digital health platform containing messages about health. OBJECTIVE The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. METHODS This is a mixed-method study including a non-randomized, controlled trial and qualitative interviews, conducted in rural Tanzania, in which the DHI is being implemented. A health platform containing digital health messages to the communities was developed prior to the study. The health messages comprise text, pictures, quizzes and animations of everyday stories, aiming at disease prevention and early treatment. The baseline and immediate-after assessment was completed in Iringa, Tanzania in 2019. The participants were interviewed by enumerators and completed questionnaires with questions regarding health knowledge. Participants in the intervention group were exposed to three health animations once, on a tablet device. The participants’ health knowledge was immediately assessed again after exposure. The first follow-up survey was undertaken in August 2019. The internet hotspots with the health platform were thereafter rolled out in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. RESULTS A total of 600 participants have been enrolled in the trial. We will assess 1) the difference in knowledge scores between baseline and immediate-after in the intervention group, 2) the difference in knowledge scores between the groups on the changes from baseline to 3 and 6 months post DHI rollout. As a randomised design was not feasible, potential confounders, e.g. age, gender, education and time from exposure, may be introduced, for which results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, where perspectives and experiences related to use and non-use of the hotspots are being explored. CONCLUSIONS This is an ongoing digital health study, aiming at evaluating the effects of a DHI based on relevant health messages, of which published results can be expected next year. CLINICALTRIAL ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597

scholarly journals The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals―A Qualitative and Quantitative Assessment

Antibiotics ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 11 ◽  
Author(s):  
Sanjeev Singh ◽  
Esmita Charani ◽  
Chand Wattal ◽  
Anita Arora ◽  
Abi Jenkins ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Education And Training ◽  
Healthcare Organizations ◽  
Telephone Interviews ◽  
And Training

Background: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. Methods: Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. Results: 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&T in AMS for staff. Conclusion: No structured provision of E&T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&T for hospital AMS in India.

scholarly journals The effect of a birthplace decision support tool on women’s decision-making and information gathering behaviours during pregnancy: mybirthplace study protocol

2018 ◽  
Vol 25 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Daisy Wiggins ◽  
Vanora A. Hundley ◽  
Carol Wilkins ◽  
Carol Bond ◽  
Gill Walton
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Mixed Method ◽  
Qualitative Interviews ◽  
Decision Support Tool ◽  
Maternity Hospital ◽  
Phase 3 ◽  
Support Tool ◽  
Accessible Information

BackgroundThe Maternity Review for England highlighted the need for more accessible information to support decisions. This study assesses the effect of a decision support tool (DST) on women’s decision-making regarding birthplace.MethodsA mixed method sequential exploratory design involving three phases and 169 women from a large UK maternity hospital. Phase one: A questionnaire survey pre and post-access to the DST examining knowledge level and stages of decision-making scale. Phase 2: Follow-up questionnaire at 28 weeks to enable the usefulness of Mybirthplace to be evaluated. Phase 3: Qualitative interviews with 10 purposely chosen women at 36 weeks gestation. Collection of data on actual birthplace.DiscussionThis study is the first to assess the effect of a DST in supporting women’s choice of place of birth.

scholarly journals Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network

2021 ◽  
Vol 11 (7) ◽  
pp. 647
Author(s):  
Nina R. Sperber ◽  
Olivia M. Dong ◽  
Megan C. Roberts ◽  
Paul Dexter ◽  
Amanda R. Elsey ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Program Implementation ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Implementing Change ◽  
Implementation Outcomes ◽  
Planning Framework

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

scholarly journals Evaluating pictorial support in person-centred care for children (PicPecc): a protocol for a crossover design study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042726
Author(s):  
Stefan Nilsson ◽  
Angelica Wiljén ◽  
Jonas Bergquist ◽  
John Chaplin ◽  
Ensa Johnson ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Research Process ◽  
Crossover Design ◽  
Self Report ◽  
Ethical Review ◽  
High Dose ◽  
Digital Tool ◽  
Legal Guardians ◽  
Ethical Approval

IntroductionThis study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5–17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysisBoth effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child’s perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and disseminationEthical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council’s guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registrationClinicalTrials.gov; NCT04433650.

scholarly journals Endoscopic treatment of suprasellar cysts without hydrocephalus

2016 ◽  
Vol 18 (4) ◽  
pp. 434-441 ◽  
Author(s):  
Song-Bai Gui ◽  
Sheng-Yuan Yu ◽  
Lei Cao ◽  
Ji-wei Bai ◽  
Xin-Sheng Wang ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Patient Outcomes ◽  
Endoscopic Treatment ◽  
Foramen Of Monro ◽  
Image Guided ◽  
Operative Complications ◽  
Appropriate Therapy ◽  
Endoscopic Fenestration

OBJECTIVE At present, endoscopic treatment is advised as the first procedure in cases of suprasellar arachnoid cysts (SSCs) with hydrocephalus. However, the appropriate therapy for SSCs without hydrocephalus has not been fully determined yet because such cases are very rare and because it is usually difficult to perform the neuroendoscopic procedure in patients without ventriculomegaly given difficulties with ventricular cannulation and the narrow foramen of Monro. The purpose of this study was to find out the value of navigation-guided neuroendoscopic ventriculocystocisternostomy (VCC) for SSCs without lateral ventriculomegaly. METHODS Five consecutive patients with SSC without hydrocephalus were surgically treated using endoscopic fenestration (VCC) guided by navigation between March 2014 and November 2015. The surgical technique, success rate, and patient outcomes were assessed and compared with those from hydrocephalic patients managed in a similar fashion. RESULTS The small ventricles were successfully cannulated using navigational tracking, and the VCC was accomplished in all patients. There were no operative complications related to the endoscopic procedure. In all patients the SSC decreased in size and symptoms improved postoperatively (mean follow-up 10.4 months). CONCLUSIONS Endoscopic VCC can be performed as an effective, safe, and simple treatment option by using intraoperative image-based neuronavigation in SSC patients without hydrocephalus. The image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of hydrocephalus in patients with SSC may not be a contraindication to endoscopic treatment.

scholarly journals Interactive, Hands-On Training for Hospital Workers Increases Level of Special Pathogen Preparedness

Sci ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 29
Author(s):  
Syra Madad ◽  
Eleanor Tolf
Keyword(s):  
New York ◽  
New York City ◽  
Mixed Method ◽  
Hospital Workers ◽  
Department Of Health ◽  
Interactive Training ◽  
Hands On ◽  
Before And After ◽  
Question Survey

The purpose of this evaluation was to determine the effect of intensive, interactive training on hospital workers’ preparedness for special pathogen cases by utilizing the Frontline Facility Special Pathogens Training Course created by the Systemwide Special Pathogens Program at New York City Health + Hospitals (NYC H+H). An 8 h course was offered in 2018 and 2019 to healthcare employees throughout the Department of Health and Human Services Region 2, mostly from NYC H+H. Evaluation included multiple-choice pre and post exams, a 26-question survey about level of preparedness before and after the training, and follow-up interviews focused on changes in facility protocols. As a result, 61% of survey respondents indicated that they had never previously attended a hospital-sponsored special pathogen training. After the training, there was a 53.3% report rate of feeling “very prepared,” compared to 14.6% before the training. Additionally, there was an 11% improvement in test scores. Furthermore, 77% of respondents reported that their facility had changed protocols relating to topics of the course after their training date. Survey participants reported general satisfaction with the course, as well as an increased level of preparedness for special pathogen cases. Together, the results of the exams, survey, and interviews suggest that this interactive, mixed-method training increases special pathogen preparedness across different healthcare sectors. With the ongoing threat of special pathogens, the need for continued training and maintaining a state of readiness is paramount in healthcare.

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