Implementation of a Real-Time Medication Intake Monitoring Technology Intervention in Community Pharmacy Settings: A Mixed-Method Pilot Study

Innovative dispensing products offering real-time medication intake monitoring are being developed to address medication non-adherence. However, implementation of these interventions within the workflow of a community pharmacy is unknown. The purpose of this study was to explore factors affecting implementation of a real-time adherence-monitoring, multidose-dispensing system in community pharmacies. A mixed-method study was conducted with pharmacy staff, who packaged and dispensed medications in smart multidose packages and monitored real-time medication intake via web-portal. Pharmacy staff participated in semi-structured interviews. The Technology Acceptance Model, Theory of Planned Behaviour and Capability, Opportunity, Motivation, Behaviour Model informed the interview guide. Interview transcripts were analyzed thematically and findings were mapped back to the frameworks. The usability was assessed by the System Usability Scale (SUS). Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist-perceived patient factors. The mean SUS was found to be 80.63. Products with real-time adherence monitoring capabilities are valued by pharmacists. A careful assessment of infrastructure—including pharmacy workload, manpower and financial resources—is imperative for successful implementation of such interventions in a community pharmacy setting.

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Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access

Pharmacy ◽

10.3390/pharmacy9020095 ◽

2021 ◽

Vol 9 (2) ◽

pp. 95

Author(s):

Sara S. McMillan ◽

Hidy Chan ◽

Laetitia H. Hattingh

Keyword(s):

Community Pharmacy ◽

Healthcare Access ◽

Further Education ◽

Community Pharmacies ◽

Structured Interviews ◽

Pharmacy Staff ◽

Harm Minimisation ◽

Staff Members ◽

Education Support

Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.

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Efficient Use of Clickers: A Mixed-Method Inquiry with University Teachers

Education Sciences ◽

10.3390/educsci8010031 ◽

2018 ◽

Vol 8 (1) ◽

pp. 31 ◽

Cited By ~ 2

Author(s):

◽

Keyword(s):

Focus Group ◽

Pedagogical Content Knowledge ◽

Technology Acceptance ◽

Content Knowledge ◽

Mixed Method ◽

Technological Pedagogical Content Knowledge ◽

Technological Knowledge ◽

Successful Implementation ◽

Pedagogical Content ◽

The Impact

With the advancement of information technology and policies encouraging interactivities in teaching and learning, the use of students’ response system (SRS), commonly known as clickers, has experienced substantial growth in recent years. The reported effectiveness of SRS has varied. Based on the framework of technological-pedagogical-content knowledge (TPACK), the current study attempted to explore the disparity in efficiency of adopting SRS. A concurrent mixed method design was adopted to delineate factors conducive to efficient adoption of SRS through closed-ended survey responses and qualitative data. Participants were purposefully sampled from diverse academic disciplines and backgrounds. Seventeen teachers from various disciplines (i.e., tourism management, business, health sciences, applied sciences, engineering, and social sciences) at the Hong Kong Polytechnic University formed a teacher focus group for the current study. In the facilitated focus group, issues relating to efficient use of clickers, participants explored questions on teachers’ knowledge on various technologies, knowledge relating to their subject matters, methods and processes of teaching, as well as how to integrate all knowledge into their teaching. The TPACK model was adopted to guide the discussions. Emergent themes from the discussions were extracted using NVivo 10 for Windows, and were categorized according to the framework of TPACK. The survey, implemented on an online survey platform, solicited participants on teachers’ knowledge and technology acceptance. The close-ended survey comprised 30 items based on the Technological Pedagogical Content Knowledge (TPACK) framework and 20 items based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Participating teachers concurred with the suggestion that use of clickers is instrumental in engaging students in learning and assessing formative students’ progress. Converging with the survey results, several major themes contributing to the successful implementation of clickers, namely technology, technological-pedagogical, technological-content, technological-pedagogical-content knowledge, were identified from the teacher focus groups. The most and second most frequently cited themes were technological-pedagogical-content Knowledge and the technological knowledge respectively. Findings from the current study triangulated with previous findings on TPACK and use of clickers, particularly, the influence of technological-pedagogical-content Knowledge and technological knowledge on successful integration of innovations in class. Furthermore, the current study highlighted the impact of technological-pedagogical and technological-content knowledge for further research to unfold technology adoption with these featured TPACK configurations, as well as rendering support to frontline academics related to integration of technology and pedagogy.

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THU0447 HOME-MONITORING GOUT FLARES WITH A SMARTPHONE APP – RESULTS OF A FEASIBILITY STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3643 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 460.1-461

Author(s):

B. Pouls ◽

C. Bekker ◽

B. Van den Bemt ◽

A. Gaffo ◽

M. Flendrie

Keyword(s):

Technology Acceptance ◽

Real Time ◽

Technology Acceptance Model ◽

Home Monitoring ◽

Added Value ◽

Smartphone App ◽

Research Support ◽

Acceptance Model ◽

Gout Flare ◽

Gout Flares

Background:Gout flares are considered a key clinical and research outcome in gout. Early treatment of gout flares increases patient well-being and warrants timely notification of the treating clinician.Objectives:To test the feasibility of a smartphone app to home-monitor gout flares real-time for both patients with a suspicion of and established gout.Methods:Thirty patients were recruited during their visit at the outpatient rheumatology clinic. Inclusion criteria were age ≥ 18 years, smartphone possession, established gout (crystal proven) or a clinical suspicion of gout and at least one flare reported in the last three months.A straight-forward query app was used to incorporate an adapted version of the 2017 four-criteria gout flare definition.[1] For 90 consecutive days the app asked patients to report their current pain score on an 11-points scale as screening question. Scoring pain below 4 terminated the query, otherwise the app posed the remaining criteria: does the patient experience warm and/or swollen joints and are symptoms regarded as a gout flare. Responses were transmitted in real-time to the dashboard and the clinician was alerted via email if predefined conditions were met. End of study evaluation consisted of the number of generated alerts, duration of (possible) flares and actions taken. Patient feasibility was assessed by measuring app attrition and using a questionnaire based on the Technology Acceptance Model. [2] All constructs were analysed using descriptive statistics.Results:All 30 recruited patients finished the trial. Three minor, resolvable technical issues were reported. Seventeen participants never missed a question. In total 110 responses (4.1%) were missed with three participants responsible for 66 missings. 90% of the participants rated app usability good to excellent and 70% would recommend the app to other patients.Twelve out of thirty patients generated a total amount of 174 alerts where four patients with a suspicion of gout were responsible for 148 alerts (85%). These patients scored three out of four criteria as they had warm, swollen and painful joints but, after consultation with the clinician, their symptoms were not regarded as a gout flare.The 174 alerts belonged to 23 (possible) flares with a median duration of 5 days [IQR 3,5 – 7,5]. Twenty-one pro-active telephone calls were made which resulted in four visits to the clinic within 48 hours. Clinical guidance over the phone consisted of checking in on patient’s symptoms, giving advice and ten medication adjustments.Conclusion:This prospective study shows feasibility of a smartphone app for home-monitoring gout flares for patients because of high usability scores and low attrition rates. The app has added value for gout care because it enables clinicians to act on flares as they occur. The next step is to further implement the app whilst perpetuating investigation into the added value for patients and clinical practice alike.References:[1]Gaffo AL, Dalbeth N, Saag KG, et al. Brief Report: Validation of a Definition of Flare in Patients With Established Gout. Arthritis Rheumatol. 2018;70(3):462-467.[2]Davis Jr. FD. A Technology Acceptance Model for empirically testing new end-user information systems: theory and results. MIT PhD thesis. 1985[3]Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS). JMIR Mhealth Uhealth. 2016;4(2):e72.Acknowledgements:This study was funded by AbbVie and Menarini.Disclosure of Interests: :Bart Pouls: None declared, Charlotte Bekker: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Angelo Gaffo Grant/research support from: Received a research grant from AMGEN, Marcel Flendrie Grant/research support from: M. Flendrie has received grants from Menarini and Grunenthal., Consultant of: M. Flendrie has received consultancy fees from Menarini and Grunenthal.

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Loneliness Among the Elderly in Rural Contexts: A Mixed-Method Study Protocol

International Journal of Qualitative Methods ◽

10.1177/1609406921996861 ◽

2021 ◽

Vol 20 ◽

pp. 160940692199686

Author(s):

Borja Rivero Jiménez ◽

David Conde-Caballero ◽

Lorenzo Mariano Juárez

Keyword(s):

Data Collection ◽

Mixed Method ◽

Rural Areas ◽

Population Group ◽

The Elderly ◽

Interaction Patterns ◽

Structured Interviews ◽

Strict Adherence ◽

Data Collection And Analysis ◽

Technological Tools

Loneliness among the elderly has become a pressing issue in Western societies. In the Spanish context, the problem of the so-called “empty” Spain disproportionately affects this population group—elderly individuals living in rural areas with low population density, and therefore at higher risk of social exclusion and isolation. We introduce here a mixed-method, quantitative-qualitative research protocol, triangulated with technological tools, designed to improve both data acquisition and subsequent data analysis and interpretation. This study will take place in a rural locality in the Extremadura region (Spain), chosen according to a particular socio-demographic profile. The De Jong Gierveld Loneliness Scale will be used on a cohort of 80 people over 65 years old. Within this cohort, a smaller sample of 20–30 individuals will be selected for semi-structured interviews about their beliefs and experiences of loneliness. Finally, data gathered from technological tools (smartbands, Bluetooth sensors) will allow us to monitor social interactions and to map daily loneliness/interaction patterns. Data will be triangulated by analyzing and comparing the empirical material gathered through these different methods and tools. Strict adherence to ethical standards for data protection and handling will be essential through data collection and analysis. As well as providing insights into the phenomenon of loneliness in old age, the use of different methods and tools for data collection will provide the basis for an epistemological reflection on the scope and limits of each one of these methods.

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The most used questionnaires for evaluating telemedicine services

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01407-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sadrieh Hajesmaeel-Gohari ◽

Kambiz Bahaadinbeigy

Keyword(s):

Technology Acceptance ◽

User Interaction ◽

End User ◽

Publication Type ◽

Patient Satisfaction Questionnaire ◽

Satisfaction Questionnaire ◽

Implementation Processes ◽

Pubmed Database ◽

System Usability Scale ◽

Acceptance Model

Abstract Background Questionnaires are commonly used tools in telemedicine services that can help to evaluate different aspects. Selecting the ideal questionnaire for this purpose may be challenging for researchers. This study aims to review which questionnaires are used to evaluate telemedicine services in the studies, which are most common, and what aspects of telemedicine evaluation do they capture. Methods The PubMed database was searched in August 2020 to retrieve articles. Data extracted from the final list of articles included author/year of publication, journal of publication, type of evaluation, and evaluation questionnaire. Data were analyzed using descriptive statistics. Results Fifty-three articles were included in this study. The questionnaire was used for evaluating the satisfaction (49%), usability (34%), acceptance (11.5%), and implementation (2%) of telemedicine services. Among telemedicine specific questionnaires, Telehealth Usability Questionnaire (TUQ) (19%), Telemedicine Satisfaction Questionnaire (TSQ) (13%), and Service User Technology Acceptability Questionnaire (SUTAQ) (5.5%), were respectively most frequently used in the collected articles. Other most used questionnaires generally used for evaluating the users’ satisfaction, usability, and acceptance of technology were Client Satisfaction Questionnaire (CSQ) (5.5%), Questionnaire for User Interaction Satisfaction (QUIS) (5.5%), System Usability Scale (SUS) (5.5%), Patient Satisfaction Questionnaire (PSQ) (5.5%), and Technology Acceptance Model (TAM) (3.5%) respectively. Conclusion Employing specifically designed questionnaires or designing a new questionnaire with fewer questions and more comprehensiveness in terms of the issues studied provides a better evaluation. Attention to user needs, end-user acceptance, and implementation processes, along with users' satisfaction and usability evaluation, may optimize telemedicine efforts in the future.

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Gatekeeper training needs of community pharmacy staff

Suicide and Life-Threatening Behavior ◽

10.1111/sltb.12697 ◽

2021 ◽

Vol 51 (2) ◽

pp. 220-228

Author(s):

Delesha M. Carpenter ◽

Courtney A. Roberts ◽

Jill E. Lavigne ◽

Wendi F. Cross

Keyword(s):

Community Pharmacy ◽

Training Needs ◽

Pharmacy Staff ◽

Gatekeeper Training

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A Modified KNN Algorithm for High-Performance Computing on FPGA of Real-Time m-QAM Demodulators

Electronics ◽

10.3390/electronics10050627 ◽

2021 ◽

Vol 10 (5) ◽

pp. 627

Author(s):

David Marquez-Viloria ◽

Luis Castano-Londono ◽

Neil Guerrero-Gonzalez

Keyword(s):

Real Time ◽

High Performance ◽

Interference Mitigation ◽

Parallel Implementation ◽

Computational Time ◽

Successful Implementation ◽

Interchannel Interference ◽

The Difference ◽

High Level ◽

Performance Computing

A methodology for scalable and concurrent real-time implementation of highly recurrent algorithms is presented and experimentally validated using the AWS-FPGA. This paper presents a parallel implementation of a KNN algorithm focused on the m-QAM demodulators using high-level synthesis for fast prototyping, parameterization, and scalability of the design. The proposed design shows the successful implementation of the KNN algorithm for interchannel interference mitigation in a 3 × 16 Gbaud 16-QAM Nyquist WDM system. Additionally, we present a modified version of the KNN algorithm in which comparisons among data symbols are reduced by identifying the closest neighbor using the rule of the 8-connected clusters used for image processing. Real-time implementation of the modified KNN on a Xilinx Virtex UltraScale+ VU9P AWS-FPGA board was compared with the results obtained in previous work using the same data from the same experimental setup but offline DSP using Matlab. The results show that the difference is negligible below FEC limit. Additionally, the modified KNN shows a reduction of operations from 43 percent to 75 percent, depending on the symbol’s position in the constellation, achieving a reduction 47.25% reduction in total computational time for 100 K input symbols processed on 20 parallel cores compared to the KNN algorithm.

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Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study

BMC Psychiatry ◽

10.1186/s12888-021-03152-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yen-Ching Chang ◽

Ling-Hui Chang ◽

Su-Ting Hsu ◽

Meng-Wen Huang

Keyword(s):

Mental Health Professionals ◽

Organizational Support ◽

Psychiatric Rehabilitation ◽

Successful Implementation ◽

Policy Changes ◽

Structured Interviews ◽

Team Collaboration ◽

Self Confidence ◽

Professional Perspectives ◽

Implementation Problems

Abstract Background The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals’ experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. Methods Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. Results The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals’ self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients’ lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. Conclusions To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.

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What matters to patients? A mixed method study of the importance and consideration of oncology patient demands

BMC Health Services Research ◽

10.1186/s12913-021-06247-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mathias WAELLI ◽

Etienne Minvielle ◽

Maria Ximena Acero ◽

Khouloud Ba ◽

Benoit Lalloué

Keyword(s):

Cancer Patients ◽

Mixed Method ◽

New Technologies ◽

Care Pathway ◽

Scale Up ◽

Healthcare Delivery ◽

Delivery Systems ◽

Breast Cancer Patients ◽

Structured Interviews ◽

Oncology Patient

Abstract Background A patient-centred approach is increasingly the mandate for healthcare delivery, especially with the growing emergence of chronic conditions. A relevant but often overlooked obstacle to delivering person-centred care is the identification and consideration of all demands based on individual experience, not only disease-based requirements. Mindful of this approach, there is a need to explore how patient demands are expressed and considered in healthcare delivery systems. This study aims to: (i) understand how different types of demands expressed by patients are taken into account in the current delivery systems operated by Health Care Organisations (HCOs); (ii) explore the often overlooked content of specific non-clinical demands (i.e. demands related to interactions between disease treatments and everyday life). Method We adopted a mixed method in two cancer centres, representing exemplary cases of organisational transformation: (i) circulation of a questionnaire to assess the importance that breast cancer patients attach to every clinical (C) and non-clinical (NC) demand identified in an exploratory inquiry, and the extent to which each demand has been taken into account based on individual experiences; (ii) a qualitative analysis based on semi-structured interviews exploring the content of specific NC demands. Results Further to the way in which the questionnaires were answered (573 answers/680 questionnaires printed) and the semi-structured interviews (36) with cancer patients, results show that NC demands are deemed by patients to be almost as important as C demands (C = 6.53/7 VS. NC = 6.13), but are perceived to be considered to a lesser extent in terms of pathway management (NC = 4.02 VS C = 5.65), with a significant variation depending on the type of non-clinical demands expressed. Five types of NC demands can be identified: demands relating to daily life, alternative medicine, structure of the treatment pathway, administrative and logistic assistance and demands relating to new technologies. Conclusions This study shows that HCOs should be able to consider non-clinical demands in addition to those referring to clinical needs. These demands require revision of the healthcare professionals’ mandate and transition from a supply-orientated system towards a demand-driven approach throughout the care pathway. Other sectors have developed hospitality management, mass customisation and personalisation to scale up approaches that could serve as inspiring examples.

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A sample cell for the study of enzyme-induced carbonate precipitation at the grain-scale and its implications for biocementation

Scientific Reports ◽

10.1038/s41598-021-92235-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jennifer Zehner ◽

Anja Røyne ◽

Pawel Sikorski

Keyword(s):

Real Time ◽

Laser Scanning Microscopy ◽

In Situ Monitoring ◽

Confocal Laser ◽

Precipitation Process ◽

Successful Implementation ◽

Detailed Knowledge ◽

Carbonate Precipitation ◽

Sample Cell

AbstractBiocementation is commonly based on microbial-induced carbonate precipitation (MICP) or enzyme-induced carbonate precipitation (EICP), where biomineralization of $$\text {CaCO}_{3}$$ CaCO 3 in a granular medium is used to produce a sustainable, consolidated porous material. The successful implementation of biocementation in large-scale applications requires detailed knowledge about the micro-scale processes of $$\text {CaCO}_{3}$$ CaCO 3 precipitation and grain consolidation. For this purpose, we present a microscopy sample cell that enables real time and in situ observations of the precipitation of $$\text {CaCO}_{3}$$ CaCO 3 in the presence of sand grains and calcite seeds. In this study, the sample cell is used in combination with confocal laser scanning microscopy (CLSM) which allows the monitoring in situ of local pH during the reaction. The sample cell can be disassembled at the end of the experiment, so that the precipitated crystals can be characterized with Raman microspectroscopy and scanning electron microscopy (SEM) without disturbing the sample. The combination of the real time and in situ monitoring of the precipitation process with the possibility to characterize the precipitated crystals without further sample processing, offers a powerful tool for knowledge-based improvements of biocementation.

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