Are we sure that Mobile Health is really mobile? An examination of mobile device use during two remotely-delivered weight loss interventions

BackgroundThe “m” in mHealth is often thought of as the ability to receive health information and monitor behaviors on the go. Little is known about how people actually use mobile vs. traditional access methods and if access method affects engagement and health outcomes.MethodsThis study examines the 3-month outcomes of two mobile weight loss interventions (Pounds Off Digitally (POD) and mobile POD (mPOD)) where participants were required to own a mobile device for study entry and received weight loss information via podcast. Only participants in both studies who were randomized to receive the same theory-based podcast (TBP) were used in this analysis. In POD, 41 participants were randomized to the TBP condition (37 to a control not included in this analyses). In mPOD, 49 participants were randomized to the TBP (n = 49) and 47 to the TBP + mobile group (a self-monitoring app and Twitter app for social support). The goal of this study is to examine how participants accessed study components and to examine how type of device impacts engagement and weight loss.ResultsExamining data from both studies in aggregate, despite a mobile delivery method, 58% of participants reported using a non-mobile device to access the majority of the podcasts (desktop computers), 76% accessed the podcasts mostly at their home or work, and 62% were mainly non-mobile (e.g., sitting at work) when listening. Examining objective download data for mPOD, 49% of downloads (2889/5944) originated from non-mobile delivery methods vs. mobile platforms (3055/5944). At 3 months, 55% of Twitter posts originated from the website (n = 665 posts) vs. a mobile app (n = 540; 45%). There was no difference in the number of podcasts participants reported listening to by device. There were more Twitter posts by mobile app users (51 ± 11) than Twitter website users (23 ± 6, p < 0.05). There was a trend (p = 0.055) in greater weight loss among mobile users for podcasts (−3.5 ± 0.5%) as compared to non-mobile users (−2.5 ± 0.5%). Weight loss was significantly greater in Twitter mobile app users (−5.6 ± 0.9%) than website users (−2.2 ± 0.5%, p < 0.01).ConclusionType of device used for podcast listening did not affect engagement but there was a trend toward greater weight loss among mobile users. Method of Twitter posting was associated with engagement and weight loss with mobile app users posting more to Twitter and losing more weight.     

In vitro characteristics of cryopreserved platelet concentrates reconstituted by fresh frozen or lyophilized plasma

Background and objectivesSix percent dimethyl sulfoxide (DMSO) cryopreservation of platelet concentrates (PCs) allow longer storage of PCs but require time-consuming post-thaw washing. An alternative process based on removing supernatant before freezing has been implemented in several centres worldwide. We assessed the in vitro characteristics of cryopreserved PCs (CPPs) prepared according to this latest process using either French lyophilized plasma (FLyP) or fresh frozen plasma (FFP) for reconstitution. FLyP provides additional benefits to the process due to its logistical constraints and quick availability.Materials and methodsApheresis PCs (n = 16) and buffy coat PCs (n = 16) were cryopreserved in 6% DMSO. After storage at ?80 °C, PCs were thawed and reconstituted with FFP or FLyP. Volume, residual leukocytes, total platelet counts (TPCs), post-thaw recovery, biochemical parameters, and DMSO concentration were assessed. Platelet functions were analysed by swirling index, viscoelastometric assay and CD62P quantification.ResultsAfter reconstitution, TPC was above 2.10¹¹/CPs; recovery was 78 ± 14% with no significant difference between FFP and FLyP. Glucose and lactate levels were not different between plasmas, whereas FLyP-CPPs exhibited a significant increase in LDH and significantly lower pH. Residual DMSO was 8 ± 4 G/L. Functional analysis revealed significant differences between FFP and FLyP-CPPs, with lower clot firmness and increased clot initiation. Activation of platelets was not higher in FLyP-CPPs.ConclusionPreparing CPPs according to this “new” process fulfilled the French legal criteria regardless of the type of plasma. Differences highlighted between FFP-CPPs and FLyP-CPPs were unlikely to be of clinical relevance.     

Protective effect of L-carnitine on platelet apoptosis during storage of platelet concentrate

BackgroundPlatelet apoptosis is considered as one of the important factors involved in platelet storage lesion (PSL) and affect the quality of platelets during storage. The beneficial effect of L-carnitine (LC) on platelet apoptosis during platelet concentrates (PCs) storage has not been fully investigated. The aim of this study was to evaluate the effects of LC on platelets of PC regarding their apoptosis markers during storage.MethodsTen PCs from healthy donors were investigated in this study. PCs were prepared by platelet rich plasma (PRP) method and stored at 22 ± 2° C with gentle agitation during storage. The effects of LC (15 mM) on the platelet apoptosis were assessed by analyzing different indicative presence or absence of LC. Sampling was performed to evaluate apoptosis markers during platelet storage.ResultsThe results indicated significantly higher mitochondrial membrane potential for LC-treated platelets than the untreated on the days 2 and 5 of storage (P_day2 = 0.001, P_day5 = 0.001). Phosphatidylserine (PS) exposure significantly increased on the untreated compared with LC-treated platelets on the second and third days of storage (P_day2 = 0.014, P_day3 = 0.012). Also, active caspase 3 was lower in the LC- treated platelets than the control group on the day 5 of storage (P_day5 = 0.004). Cytosolic cytochrome C was so significantly lower in LC-treated compared to the untreated platelets during storage time (P_day2 = 0.002, P_day3 = 0.001, Pday5 = 0.001).ConclusionThe results of this study indicate that the use of LC as an additive solution in platelets may be useful to reduce PSL by decreasing platelet apoptosis via mitochondrial pathway and increase platelet quality during storage.     

The impact of medical informatics on patient satisfaction: A USA-based literature review

PurposePatient satisfaction is increasingly recognized as an important component of quality. The expansion of health information technologies (HIT) might have an impact on patient satisfaction – either positively or negatively. We conducted a literature review to explore the impact of these technologies on patient satisfaction.MethodsThe database of PubMed was searched from inception through May 2010, using the MeSH terms “Medical Informatics” and “Patient Satisfaction”. We included all original interventional studies regardless of their study design that were published in English and were evaluating HIT impact on patient satisfaction. Studies were categorized by technology type according to the American Medical Informatics Association framework and by study design. The major outcome of interest was the HIT impact on patient satisfaction.ResultsOf 1293 citations reviewed, 56 studies met our inclusion criteria. Design of these studies included mostly randomized controlled trials (RCTs) (n = 20, 36%), cross-sectional surveys (n = 17, 30%), and a pre and post studies (n = 14, 25%). Overall, 54% (n = 30) of the studies demonstrated a positive effect of HIT on patient satisfaction, 34% (n = 19) failed to show any effect, 11% (n = 6) had inconclusive results, and 2% (n = 1) revealed a negative effect. Of the 20 RCTs, 40% (n = 8) showed a positive effect of HIT on patient satisfaction, 50% (n = 10) failed to show any effect, and 10% (2) had inconclusive results.ConclusionsAnalysis suggested that while there is some evidence that HIT improves patient satisfaction, studies in this literature review, and in particularly RCTs, were not consistent in their findings. Although HIT may be a promising tool to improve patient satisfaction, more well-designed research studies are needed in order to get a better understanding of this domain and accordingly find new opportunities to improve quality of care.     

An evaluation of clinical performance of FTA cards for HPV 16/18 detection using cobas 4800 HPV Test compared to dry swab and liquid medium

BackgroundsEffective dry storage and transport media as an alternative to conventional liquid-based medium would facilitate the accessibility of women in the low-resource settings to human papillomavirus (HPV)- based cervical cancer screening.ObjectiveTo evaluate analytical and clinical performance of indicating FTA™ Elute Cartridge (FTA card) for the detection of HPV16/18 and cervical precancerous lesions and cancer compared to dry swab and liquid medium.Study designNinety patients with abnormal cytology and/or HPV infection were included for analysis. Three specimens of cervical exfoliated cells from each woman were randomly collected by FTA card, dry swab or liquid-based medium prior to colposcopy examination. The subsequent HPV DNA tests were performed on cobas 4800 HPV platform.Results and conclusionsHigh-risk HPV (hrHPV) positivity rate was 63.3%, 62.2% and 65.6% for samples collected by FTA card, dry swab and liquid medium, respectively. The overall agreements and kappa values for the detection of hrHPV, HPV 16 and HPV 18 between FTA card and liquid-based medium were 88.9% (κ = 0.76), 97.8% (κ = 0.94) and 100% (κ = 1.0),respectively; between FTA card and dry swab were 92.1% (κ = 0.83), 94.5% (κ = 0.87) and 100% (κ = 1.0), respectively. The performances of hrHPV tested by FTA card, dry swab, and liquid-based medium for detecting CIN2+ were comparable in terms of the sensitivity and specificity. The specificity of detection of CIN2+ by HPV16/18 increased by approximately 40% compared to hrHPV for any medium albeit at cost of a moderate loss of sensitivity. Dry medium might offer an alternative to conventional liquid-based medium in the HPV-based cervical cancer screening program especially in low-resource settings but still needs further evaluation.     

Radiographic outcome of limb-based versus knee-based patient specific guides in total knee arthroplasty

BackgroundPatient specific guides (PSG's) were developed to improve overall component alignment in total knee arthroplasty (TKA). The aim of this study was to undertake a comparative radiographic study of two commonly used PSG and determine whether the radiographic technique used to construct the PSG had a significant effect on overall alignment.MethodsThis prospective cohort study examined the accuracy of limb-based (n = 112) versus knee-based (n = 105) MR PSG in restoring the mechanical axis in three planes according to post-operative Perth CT scan protocol.ResultsLimb-based MR and knee-based MR PSG systems both restored overall hip–knee–ankle angle (HKAA), femoral coronal alignment, tibial coronal alignment, femoral sagittal alignment, tibial sagittal alignment and femoral rotation alignment to within 3° of a neutral mechanical axis with similar precision (91.1% vs. 86.7% p = 0.30, 97.3% vs. 96.2% p = 0.63, 97.3% vs. 97.1% p = 0.94, 94.6% vs. 89.4% p = 0.16, 90.2% vs. 81.0% p = 0.05, 91.1% vs. 86.7% p = 0.30, respectively). However, when the secondary outcome measure of alignment within 2° was assessed, limb-based MR PSG restored HKAA, femoral coronal and tibial sagittal alignment with greater precision than knee-based MR PSG (73.2% vs. 64.8% p = 0.016, 93.8% vs. 80.8% p = 0.004 and 82.1% vs. 62.9% p = 0.001, respectively).ConclusionsThe findings of this study recommend the use of limb-based MR PSG for improved precision in the restoration of neutral mechanical alignment over knee-based MR PSG in TKA.Level of EvidenceTherapeutic level III     

Patient perception of methadone dose adequacy in methadone maintenance treatment: The role of perceived participation in dosage decisions

ObjectiveIn clinical practice, methadone maintenance treatment (MMT) entails tailoring the methadone dose to the patient’s specific needs, thereby individualizing treatment. The aim of this study was to identify the independent factors that may significantly explain methadone dose adequacy from the patient's perspective.MethodSecondary analysis of data collected in a treatment satisfaction survey carried out among a representative sample of MMT patients (n = 122) from the region of La Rioja (Spain). As part of the original study protocol, participants completed a comprehensive battery to assess satisfaction with MMT, psychological distress, opinion of methadone as a medication, participation in dosage decisions, and perception of dose adequacy.ResultsMultivariate binary logistic regression showed that the only variable independently associated with the likelihood of a patient perceiving methadone dose as inadequate was the variable perceived-participation in methadone dosage decisions (OR = 0.538, 95% CI = 0.349–0.828).ConclusionPatient participation in methadone dosage decisions was predictive of perceived adequacy of methadone dose beyond the contribution of other socio-demographic, clinical, and MMT variables.Practice implicationsPatient participation in methadone dosage decision-making is valuable for developing a genuinely patient-centred MMT.     

Tumor detection rates in screening of individuals with SDHx-related hereditary paraganglioma–pheochromocytoma syndrome

PurposeMinimal data exist regarding the efficacy of screening protocols for individuals with SDHx germline pathogenic variants with hereditary paraganglioma–pheochromocytoma syndrome. This study aimed to evaluate the SDHx-related tumor detection rate in individuals undergoing clinical screening protocols.MethodsA multicenter retrospective longitudinal observational study was conducted. Individuals with germline SDHx pathogenic variants underwent clinical whole-body imaging and biochemical testing.ResultsTwo hundred sixty-three individuals with SDHx germline pathogenic variants completed 491 imaging screens. Individuals with SDHB germline pathogenic variants were most common (n = 188/263, 72%), followed by SDHD (n = 35/263, 13%) and SDHC (n = 28/263, 11%). SDHx-related tumors were found in 17% (n = 45/263) of the cohort. Most SDHx-related tumors were identified on baseline imaging screen (n = 39/46, 85%). Individuals with SDHD pathogenic variants had the highest tumor detection rate (n = 14/35, 40%). Of imaging screens identifying SDHx-related paraganglioma/pheochromocytoma, 29% (n = 12/41) had negative biochemical testing. Secondary actionable findings were identified in 15% (n = 75/491) of imaging screens.ConclusionCurrent SDHx screening protocols are effective at identifying SDHx-related tumors. Tumor detection rates vary by SDHx gene and screening has the potential to uncover actionable secondary findings. Imaging is an essential part of the screening process as biochemical testing alone does not detect all disease.     

Norovirus prevalence and estimated viral load in symptomatic and asymptomatic children from rural communities of Vhembe district,South Africa

BackgroundHuman Norovirus (NoV) is recognized as a major etiological agent of sporadic acute gastroenteritis worldwide.ObjectivesThis study describes the clinical features associated with Human NoV occurrence in children and determines the prevalence and estimated viral burden of NoV in symptomatic and asymptomatic children in rural South Africa.Study designBetween July 2014 and April 2015, outpatient children under 5 years of age from rural communities of Vhembe district, South Africa, were enrolled for the study. A total of 303 stool specimens were collected from those with diarrhea (n = 253) and without (n = 50) diarrhea. NoVs were identified using real-time one-step RT-PCR.ResultsOne hundred and four (41.1%) NoVs were detected (62[59.6%] GII, 16[15.4%] GI, and 26[25%] mixed GI/GII) in cases and 18 (36%) including 9(50%) GII, 2(11.1%) GI and 7(38.9%) mixed GI/GII in controls. NoV detection rates in symptomatic and asymptomatic children (OR = 1.24; 95% CI 0.66⿿2.33) were not significantly different. Comparison of the median C_T values for NoV in symptomatic and asymptomatic children revealed significant statistical difference of estimated GII viral load from both groups, with a much higher viral burden in symptomatic children.ConclusionsThough not proven predictive of diarrhea disease in this study, the high detection rate of NoV reflects the substantial exposure of children from rural communities to enteric pathogens possibly due to poor sanitation and hygiene practices. The results suggest that the difference between asymptomatic and symptomatic children with NoV may be at the level of the viral load of NoV genogroups involved.     

A comparison of alignment using patient specific guides,computer navigation and conventional instrumentation in total knee arthroplasty

BackgroundPatient specific guides (PSG) have been introduced as a tool in total knee arthroplasty (TKA) in an attempt to improve limb alignment and reduce operative time compared to other established surgical techniques. The purpose of this study was to compare the post-operative radiographic alignment and operative time in patients who underwent TKA surgery with PSG, conventional instrumentation or computer-assisted navigation surgery using fully cemented components.MethodsA cohort of 260 patients who underwent TKA surgery using PSG (PSG group, n = 115) was compared to patients who underwent TKA using either conventional instrumentation (CON group, n = 92) or computer-assisted navigation (CAS group, n = 53). Post-operative CT imaging using the Perth CT protocol was used to compare alignment between the three groups.ResultsIn the PSG and CAS groups, the post-operative hip–knee angle (HKA) was within 3° of neutral alignment in 91.3% and 90.7% of patients, respectively. This compared to 80.4% of patients in the CON group (p = 0.02). There were no significant differences with respect to alignment when comparing individual component positioning between the PSG and CAS groups apart from tibial slope (Table 3). Total operative time was found to be significantly reduced in the PSG group (80.2 min) compared to both the CON group (86 min, p = 0.002) and the CAS group (110.2 min, p < 0.0001).ConclusionsThe use of PSG resulted in similar alignment accuracy to CAS and superior alignment to CON with significantly shorter operative times.     

Association between DRD2/ANKK1 TaqIA polymorphism and common illicit drug dependence: Evidence from a meta-analysis

BackgroundGrowing evidence indicated conflicting results about the dopamine receptor D2 (DRD2)/kinase domain containing 1 gene (ANKK1) TaqIA single nucleotide polymorphism (rs1800497) and common illicit drug dependence risk including stimulants, opioid and marijuana. We conducted a meta-analysis to evaluate the association between the polymorphism and common illicit drug dependence risk.MethodA total of 25 available studies (26 subgroups) testing the association between the polymorphism and common illicit drug dependence were examined through Oct 2013. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were estimated using fixed- and random-effects models when appropriate. Heterogeneity and publication bias were evaluated.ResultsWe found the DRD2/ANKK1 TaqIA polymorphism was significantly associated with increased risk of opioid dependence under homozygote, dominant, and recessive genetic model, respectively (homozygote: OR = 1.546, 95%CI = 1.279–1.87; dominant: OR = 1.265, 95%CI = 1.055–1.516; recessive: OR = 1.409, 95%CI = 1.182–1.680). Subgroup analyses were similar to the results of the total population by ethnicity and quality score. Besides, we also found that Caucasian and low-quality studies were major sources of heterogeneity for opioid dependence. We failed to find any significant association between the polymorphism and stimulants or marijuana neither in total population nor subgroup analyses under any genetic model.ConclusionsThe current meta-analysis suggested that DRD2/ANKK1 TaqIA polymorphism might be associated with opioid dependence risk, but not associated with stimulants or marijuana dependence.     

Efficacy and safety of paliperidone extended-release in schizophrenia patients with prominent affective symptoms

BackgroundThis post-hoc analysis evaluated the effects of paliperidone extended-release (ER) in patients with schizophrenia and prominent affective symptoms.MethodsPooled data from three 6-week, randomized, double-blind, placebo-controlled studies were analyzed. Subjects received fixed doses of paliperidone ER 3–12 mg/day or placebo. Prominent affective symptoms were defined as depressive (Positive and Negative Syndrome Scale [PANSS] depression item score of ≥ 5 [moderately severe]) and/or manic (PANSS grandiosity score of ≥ 4 [moderate], plus a score of ≥ 4 [moderate] on at least 1 PANSS item for excitement, hostility, uncooperativeness, or poor impulse control). Assessments included PANSS, Clinical Global Impressions-Severity (CGI-S), Personal and Social Performance (PSP) scale, and adverse events (AEs).ResultsAmong 193 patients with prominent affective symptoms, 140 received paliperidone ER and 53 received placebo. Paliperidone ER showed significant mean (SD) improvements vs. placebo in PANSS total (? 20.5 [23.8] vs. ? 6.3 [27.2]; p < 0.001, respectively) and all factor scores (p < 0.01). Significant mean (SD) improvements were observed in PSP (7.2 [15.8] vs. 0.4 [14.6]; p = 0.004) and CGI-S (? 0.9 [1.2] vs. ? 0.3 [1.2]; p < 0.001) scores. Most common AEs with paliperidone ER vs. placebo: headache (16.4% vs. 13.2%), insomnia (7.9% vs. 9.4%), akathisia (7.1% vs. 1.9%), sedation (7.1% vs. 3.8%).LimitationsThese studies were not designed to examine patients with prominent affective symptoms. Authors' clinical judgment was used to define prominent affective symptoms, using relevant PANSS items.ConclusionsPaliperidone ER was well tolerated and associated with significantly greater improvements in symptomatology, functioning, and overall clinical status vs. placebo in patients with schizophrenia and prominent affective symptoms.     

An asthma management system in a pediatric emergency department

IntroductionPediatric asthma exacerbations account for >1.8 million emergency department (ED) visits annually. Asthma guidelines are intended to guide time-dependent treatment decisions that improve clinical outcomes; however, guideline adherence is inadequate. We examined whether an automatic disease detection system increases clinicians’ use of paper-based guidelines and decreases time to a disposition decision.MethodsWe evaluated a computerized asthma detection system that triggered NHLBI-adopted, evidence-based practice to improve care in an urban, tertiary care pediatric ED in a 3-month (7/09–9/09) prospective, randomized controlled trial. A probabilistic system screened all ED patients for acute asthma. For intervention patients, the system generated the asthma protocol at triage for intervention patients to guide early treatment initiation, while clinicians followed standard processes for control patients. The primary outcome measures included time to patient disposition.ResultsThe system identified 1100 patients with asthma exacerbations, of which 704 had a final asthma diagnosis determined by a physician-established reference standard. The positive predictive value for the probabilistic system was 65%. The median time to disposition decision did not differ among the intervention (289 min; IQR = (184, 375)) and control group (288 min; IQR = (185, 375)) (p = 0.21). The hospital admission rate was unchanged between intervention (37%) and control groups (35%) (p = 0.545). ED length of stay did not differ among the intervention (331 min; IQR = (226, 581)) and control group (331 min; IQR = (222, 516)) (p = 0.568).ConclusionDespite a high level of support from the ED leadership and staff, a focused education effort, and implementation of an automated disease detection, the use of the paper-based asthma protocol remained low and time to patient disposition did not change.     

Patient-centered communication and prognosis discussions with cancer patients

ObjectiveTo examine physician communication associated with prognosis discussion with cancer patients.MethodsWe conducted a study of physician–patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk.ResultsActor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (β = .40, C.I. = 0.11–0.68) attentiveness (β = .32, C.I. = 0.06–0.58) and being an oncologist vs. a family physician (β = .33, C.I. = 0.33–1.36) accounted for 46% of the variance in prognosis communication.ConclusionEliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty.Practice implicationsEliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.     

Démarche diagnostique en auto-immunité : apport de la technologie Multiplex. Exemple de la gamme QUANTA Plex™ (Inova)

The detection of autoantibodies was often useful to diagnose and/or to classify autoimmune diseases.ObjectiveThe aim of this study was to compare the new Luminex^™ technology for anti-ENA, ANCA, anti-TPO and anti-TG antibodies detection with conventional methods.MethodsQUANTA Plex^™ SLE 8, ANCA and Thyroid Profile provided by Inova (Ménarini, France) were used to analyze 815 serum samples sent to the laboratory for the detection of anti-ENA (n = 400), ANCA (n = 161), anti-thyroid antibodies (n = 254).ResultsFor anti-ENA detection, the global concordance was 95.6%. For ANCA detection, the concordance was respectively 78.5 and 91.4% for anti-PR3 and anti-MPO. For thyroid antibodies, the concordance was respectively 90 and 88% for anti-TPO and anti-TG.ConclusionUse of QUANTA Plex^™ Profiles was easy to rapidly and simultaneously detect the most common autoantibodies in autoimmune diseases. These tests appear to be specific and sensitive and will be promute in diagnosis of autoimmune diseases.     

Genetic variation in Micro-RNA genes of host genome affects clinical manifestation of symptomatic Human Cytomegalovirus infection

BackgroundMicro-RNAs are implicated in various physiological and pathologic processes. In this study, we tested whether Micro-RNA gene variants of host-genome affect clinical manifestation of symptomatic HCMV infection.MethodologyHCMV infection was detected by fluorescent PCR and immuno-histochemistry. The detection of genetic variants of four studied Micro-RNA tag-SNPs was done through PCR-RFLP assay and validated with DNA sequencing.ResultsWe observed an increased risk ranged from 3-folds to 5-folds among symptomatic HCMV cases for mutant genotype of rs2910164 (crude OR = 3.11, p = 0.009 and adjusted OR = 3.25, p = 0.007), rs11614913 (crude OR = 3.20, p = 0.006 and adjusted OR = 3.48, p = 0.004) and rs3746444 (crude OR = 4.91, p = 0.002 and adjusted OR = 5.28, p = 0.002) tag-SNPs. Interestingly, all the tag-SNPs that were significant after multiple comparisons at a FDR of 5% in symptomatic HCMV cases remained significant even after bootstrap analysis, providing internal validation to these results. Multifactor Dimensionality Reduction (MDR) analysis revealed 5-folds increased risk for symptomatic HCMV cases under the four-factor model (rs2910164, rs2292832, rs11614913 and rs3746444).ConclusionsThese results suggest that Micro-RNA gene variants of host-genome may affect clinical manifestation of symptomatic HCMV infection.     

Evaluation of an integrated graphical display to promote acute change detection in ICU patients

ObjectiveThe purpose of this study was to evaluate ICU nurses’ ability to detect patient change using an integrated graphical information display (IGID) versus a conventional tabular ICU patient information display (i.e. electronic chart).DesignUsing participants from two different sites, we conducted a repeated measures simulator-based experiment to assess ICU nurses’ ability to detect abnormal patient variables using a novel IGID versus a conventional tabular information display. Patient scenarios and display presentations were fully counterbalanced.MeasurementsWe measured percent correct detection of abnormal patient variables, nurses’ perceived workload (NASA-TLX), and display usability ratings.Results32 ICU nurses (87% female, median age of 29 years, and median ICU experience of 2.5 years) using the IGID detected more abnormal variables compared to the tabular display [F(1, 119) = 13.0, p < 0.05]. There was a significant main effect of site [F(1, 119) = 14.2], with development site participants doing better. There were no significant differences in nurses’ perceived workload. The IGID display was rated as more usable than the conventional display [F(1, 60) = 31.7].ConclusionOverall, nurses reported more important physiological information with the novel IGID than tabular display. Moreover, the finding of site differences may reflect local influences in work practice and involvement in iterative display design methodology. Information displays developed using user-centered design should accommodate the full diversity of the intended user population across use sites.     

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: A randomized clinical trial

ObjectiveThe use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision.MethodsWe performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2–18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision.ResultsThe Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR = (141, 326)) and control group (223 min; IQR = (129, 316)); (p = 0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p = 0.867). ED length of stay did not differ among intervention (262 min; IQR = (165, 410)) and control group (247 min; IQR = (163, 379)); (p = 0.818).ConclusionsThe control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians’ communication.