scholarly journals Challenges and Pitfalls for Implementing Digital Health Solutions in Clinical Studies in Europe

2021 ◽  
Vol 3 ◽  
Author(s):  
Marcel Meyerheim ◽  
Anna Burns-Gebhart ◽  
Kasra Mirzaie ◽  
Tina Garani-Papadatos ◽  
Yvonne Braun ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Studies ◽  
Digital Health ◽  
Ethical Aspects ◽  
Health Care Settings ◽  
Study Implementation ◽  
New Challenges ◽  
Run Up ◽  
Implementation Plans ◽  
Made In

The increasing number of digital solutions developed for use in clinical health care settings is accompanied by new challenges to develop and conduct clinical studies that include eHealth technologies. Clinical study implementation plans often disregard or underestimate the necessity of additional administrative and logistic tasks required at clinical sites as well as ethical aspects to test digital solutions. Experiences made in the run-up of an observational clinical feasibility study at three international clinical sites in the framework of the MyPal project (https://mypal-project.eu/) result in recommendations to avoid delays and barriers in the planning of such prospective studies in clinical and also palliative care for increased efficiency.

scholarly journals Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

2021 ◽  
pp. bmjinnov-2020-000557
Author(s):  
Sharon Rikin ◽  
Eric J Epstein ◽  
Inessa Gendlina
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Qualitative Feedback ◽  
The Usa ◽  
New Challenges ◽  
Science Framework ◽  
Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

scholarly journals Digital health interventions in palliative care: a systematic meta-review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Hannah O’Donnell ◽  
Jean Lugton ◽  
Tilly Gibson-Watt ◽  
Connie Swenson ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Systematic Reviews ◽  
Psychological Symptoms ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Information Provision ◽  
Health Interventions ◽  
Meta Review

AbstractDigital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

scholarly journals Challenges for theories of consciousness: seeing or knowing, the missing ingredient and how to deal with panpsychism

2018 ◽  
Vol 373 (1755) ◽  
pp. 20170344 ◽  
Author(s):  
Victor A. F. Lamme
Keyword(s):  
Conscious Experience ◽  
Complex Phenomenon ◽  
Significant Progress ◽  
Theme Issue ◽  
Perceptual Consciousness ◽  
Knowing That ◽  
Cognitive Access ◽  
Visual Consciousness ◽  
New Challenges ◽  
Made In

Significant progress has been made in the study of consciousness. Promising theories have been developed and a wealth of experimental data has been generated, both guiding us towards a better understanding of this complex phenomenon. However, new challenges have surfaced. Is visual consciousness about the seeing or the knowing that you see? Controversy about whether the conscious experience is better explained by theories that focus on phenomenal (P-consciousness) or cognitive aspects (A-consciousness) remains, and the debate seems to reach a stalemate. Can we ever resolve this? A further challenge is that many theories of consciousness seem to endorse high degrees of panpsychism—the notion that all beings or even lifeless objects have conscious experience. Should we accept this, or does it imply that these theories require further ingredients that would put a lower bound on beings or devices that have conscious experience? If so, what could these ‘missing ingredients’ be? These challenges are discussed, and potential solutions are offered. This article is part of the theme issue ‘Perceptual consciousness and cognitive access’.

scholarly journals Post-event field survey of 28 September 2018 Sulawesi earthquake and tsunami

2019 ◽  
Vol 19 (12) ◽  
pp. 2781-2794 ◽  
Author(s):  
Wahyu Widiyanto ◽  
Purwanto B. Santoso ◽  
Shih-Chun Hsiao ◽  
Rudy T. Imananta
Keyword(s):  
Field Survey ◽  
Severe Damage ◽  
Arrival Times ◽  
Tsunami Waves ◽  
Tsunami Measurements ◽  
Survey Results ◽  
Earthquake Event ◽  
Run Up ◽  
2018 Sulawesi Earthquake ◽  
Made In

Abstract. An earthquake with a magnitude of Mw=7.5 that occurred in Sulawesi, Indonesia, on 28 September 2018 triggered liquefaction and tsunamis that caused severe damage and many casualties. This paper reports the results of a post-tsunami field survey conducted by a team with members from Indonesia and Taiwan that began 13 d after the earthquake. The main purpose of this survey was to measure the run-up of tsunami waves and inundation and observe the damage caused by the tsunami. Measurements were made in 18 selected sites, most in Palu Bay. The survey results show that the run-up height and inundation distance reached 10.7 m in Tondo and 488 m in Layana. Inundation depths of 2 to 4 m were common at most sites and the highest was 8.4 m in Taipa. The arrival times of the tsunami waves were quite short and different for each site, typically about 3–8 min from the time of the main earthquake event. This study also describes the damage to buildings and infrastructure and coastal landslides.

Ethical issues in palliative care research

2015 ◽  
Author(s):  
David Casarett
Keyword(s):  
Palliative Care ◽  
Ethical Issues ◽  
Research Participation ◽  
Ethical Aspects ◽  
Interventional Study ◽  
Care Research ◽  
Qualitative And Quantitative ◽  
Decision Making Capacity ◽  
Potential Benefits ◽  
Study Designs

Recent growth in palliative care research has created a heterogeneous field that encompasses both qualitative and quantitative techniques, and descriptive as well as interventional study designs. Despite the valuable knowledge that has been produced by this research, and the promise of future important advances, its progress has been impeded by a persistent uncertainty about the ethics of these studies. For instance, there have been concerns raised about whether patients near the end of life should ever be asked to participate in research, although others have objected to this extreme position. Nevertheless, the combination of ethical and practical issues can create substantial barriers to palliative care research. This chapter discusses five ethical aspects of palliative care research that investigators and clinicians should consider in designing and conducting palliative care research. These include (1) the study’s potential benefits to future patients, (2) the study’s potential benefits to subjects, (3) the study’s risks to subjects, (4) subjects’ decision-making capacity, and (5) the voluntariness of subjects’ choices about research participation.

Quality of life in terminally ill patients – a challenge for future research

2013 ◽  
Vol 21 (3) ◽  
Author(s):  
Cornelia Meffert ◽  
Gerhild Becker
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Studies ◽  
Palliative Medicine ◽  
Pain Therapy ◽  
Unsolved Problem ◽  
Terminally Ill ◽  
Future Research ◽  
Outcome Criterion

SummaryRecent statistics reveal a substantial and even growing need for palliative care in present-day society. Providing adequate pain therapy remains a largely unsolved problem, mainly because of the small number of clinical studies in palliative medicine. Hence, clinical research is urgently needed – and therefore suitable tools to measure outcomes must be developed. Contrary to typical clinical studies, the usual outcome parameters such as decreased mortality and/or morbidity are unsuitable. Future research should focus on developing an instrument which allows to measure quality of life as the central outcome criterion of clinical studies in palliative medicine.

Seventh Periodic Monitoring Report on the Status of Implementation Plans in Response to Board-Endorsed IEO Recommendations

Policy Papers ◽  
2015 ◽  
Vol 15 (58) ◽  
Author(s):  
Keyword(s):  
Periodic Monitoring ◽  
The Status ◽  
High Level ◽  
Short Time ◽  
Implementation Plans ◽  
Monitoring Report ◽  
Made In

The Seventh PMR includes: (i) a discussion of progress made over the last year on the actions corresponding to four Management Implementation Plans (MIPs) that were classified as still “in progress” in the previous PMR; and (ii) an assessment of the progress made in achieving the high-level objectives in three areas directly related to those MIPs. In addition, an update on substantive issues related to five older MIPs agreed since 2007 is provided at the end of the report. Three new evaluations have been completed by the IEO since March 2014. In July and August 2015, Management issued the MIPs in response to these evaluations. Given that only a short time has passed since their completion, progress in addressing the actions contemplated in those MIPs will be discussed in the next PMR.

Eighth Periodic Monitoring Report on the Status of Implementation Plans in Response to Board-Endorsed IEO Recommendations

Policy Papers ◽  
2017 ◽  
Vol 2017 (32) ◽  
Author(s):  
Keyword(s):  
Institutional Culture ◽  
Self Evaluation ◽  
Management Actions ◽  
Institutional Values ◽  
Periodic Monitoring ◽  
The Status ◽  
Implementation Plans ◽  
Monitoring Report ◽  
Made In

Monitoring Report (PMR) on the Status of Management Implementation Plans (MIPs) in Response to Board-Endorsed IEO Recommendations assesses the progress made over the last year on actions contained in the four MIPs arising from recent IEO evaluations, and another four for which individual management actions were classified as still “in progress” in the Seventh PMR. Overall, 34 of the 77 actions included in the eight MIPs covered in this PMR remain open. Progress on the actions envisaged in the management implementation plans has been somewhat uneven, with more progress being made on the most recent MIPs. Of the 19 actions that have been implemented over the past year, only three relate to the older management actions. Many of the older actions are more broadly worded, and in many instances have no clear timetable. The actions that are progressing more slowly also tend to involve fundamental changes to institutional culture and practices, and therefore require a continuous, long-term effort. In spite of the slower progress on the older actions, significant advances have been made in several key areas. These include: Fund-wide risk analysis and management; the mainstreaming of macro financial surveillance; training on financial sector topics and macro forecasting; acknowledgement, discussion, and dissemination of information on IMF forecasts; the shift towards increasing reliance on quota resources, relative to borrowing; and the approval of the new Statement of Principles and Best Practices in Self-Evaluation. In addition, the 2015 Staff Survey showed significant improvements in several indicators related to the Fund’s internal culture and institutional values. Overall, management and staff appear committed to ensuring that open actions remain on track. Progress on all open actions will be assessed in future PMRs.

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