Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population

PurposeTo examine the relationship between cognitive status and the usability of an integrated medication delivery unit (MDU) in older adults who reside in an Assisted Living Facility (ALF).MethodsSubjects were recruited from a single ALF in Pittsburgh, PA. Usability testing sessions required subjects to execute tasks essential to using EMMA^® (Electronic Medication Management Assistant), a Class II Federal Drug Administration (FDA) approved integrated MDU. Video coding allowed for quantification of usability errors observed during the testing sessions. Each subject's cognitive status was assessed using the Mini Mental State Exam (MMSE^®) with scores <24 indicating cognitive impairment. Functional status was assessed using the Lawton Instrumental Activities of Daily Living (IADL) questionnaire, and a global assessment of subjective usability was assessed by completing the System Usability Scale (SUS). Non-parametric statistics and correlation analysis were used to determine whether significant differences existed between cognitively impaired and non-impaired subjects.ResultsNineteen subjects were recruited and completed the protocol. The subject pool was primarily white, female, 80+ and in possession of above average education. There was a significant relationship between MMSE^® scores and the percentage of task success (z = −2.03, p = 0.04). Subjects with MMSE^® scores of 24+ (no cognitive impairment) successfully completed an average of 69.0% of tasks vs. the 34.7% performance for those in the cognitively impaired group (<24). Six of the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct) threshold. No subject with cognitive impairments (<24 MMSE^®) completed more than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the tasks. Three of the MMSE^®’s subsections (Date, Location and Spell ‘world’ backwards) were found to be significantly related (p < 0.05) to the percentage of task success. Tasks success rates were related with IADL scores (z = −3.826, p < 0.0001), and SUS scores (r = 0.467, p = 0.0429).ConclusionsMedication delivery units like EMMA^® have the potential to improve medication management by combining reminder systems with telemedical monitoring and control capabilities. However, subjects judged to be “cognitively impaired” (<24 MMSE^®) scored a significantly smaller percentage of task success than the “unimpaired” (> = 24), suggesting that cognitive screening of patients prior to the use of EMMA^® may be advisable. Further studies are needed to test the use of EMMA^® amongst ALF residents without cognitive impairment to see if this technology can improve medication adherence.     

Perceptions of care coordination in a population-based sample of diverse breast cancer patients

ObjectiveTo identify factors associated with perceptions of care coordination in a diverse sample of breast cancer patients.MethodsBreast cancer patients reported to the metropolitan SEER registries of Detroit or Los Angeles from 6/05 to 2/07 were surveyed after diagnosis (N = 2268, RR = 72.4%). Outcomes were two dichotomous measures reflecting patient appraisal of care coordination during their treatment experience. Primary independent variables were race/ethnicity (white, African American, Latina-high acculturated, Latina-low acculturated) and health literacy (low, moderate, high). Logistic regression was used to evaluate factors associated with both measures of care coordination.Results2148 subjects were included in the analytic dataset. 16.4% of women perceived low care coordination and 12.5% reported low satisfaction. Race/ethnicity was not significantly associated with care coordination. Women with low subjective health literacy were 3–4 times as likely as those with high health literacy to perceive low care coordination and low satisfaction with care coordination (OR = 3.88; 95% CI: 2.78–5.41; OR = 3.19 95% CI: 2.25–4.52, respectively).ConclusionsMany breast cancer patients positively appraised their care coordination, but patients with low health literacy perceived low care coordination.Practice implicationsProviders should be aware of the health literacy deficits that may contribute to their patients’ attitudes towards their breast cancer care coordination.     

Detection and characterization of usability problems in structured data entry interfaces in dentistry

BackgroundPoor usability is one of the major barriers for optimally using electronic health records (EHRs). Dentists are increasingly adopting EHRs, and are using structured data entry interfaces to enter data such that the data can be easily retrieved and exchanged. Until recently, dentists have lacked a standardized terminology to consistently represent oral health diagnoses.ObjectivesIn this study we evaluated the usability of a widely used EHR interface that allow the entry of diagnostic terms, using multi-faceted methods to identify problems and work with the vendor to correct them using an iterative design method.MethodsFieldwork was undertaken at two clinical sites, and dental providers as subjects participated in user testing (n = 32), interviews (n = 36) and observations (n = 24).ResultsUser testing revealed that only 22–41% of users were able to successfully complete a simple task of entering one diagnosis, while no user was able to complete a more complex task. We identified and characterized 24 high-level usability problems reducing efficiency and causing user errors. Interface-related problems included unexpected approaches for displaying diagnosis, lack of visibility, and inconsistent use of UI widgets. Terminology related issues included missing and mis-categorized concepts. Work domain issues involved both absent and superfluous functions. In collaboration with the vendor, each usability problem was prioritized and a timeline set to resolve the concerns.DiscussionMixed methods evaluations identified a number of critical usability issues relating to the user interface, underlying terminology of the work domain. The usability challenges were found to prevent most users from successfully completing the tasks. Our further work we will determine if changes to the interface, terminology and work domain do result in improved usability.     

Improving chemotherapy processes with a protocol-based information system: A pre and post-implementation study

BackgroundThe medical application domain has been a great challenge for information technology solutions for decades, especially when the target process has been complex and multidisciplinary such as chemotherapy processes.ObjectiveTo evaluate the impact of a homegrown protocol based information system on the efficiency of chemotherapy workflow processes in an outpatient setting.MethodsA day care unit of the Hematology/Oncology outpatient clinic of Erasmus Medical Center was the setting for this study. The study consisted of comparison of pre- and post-implementation of four workflow efficiency related external indicators: turn-around times of a commonly administered chemotherapy course (Paclitaxel–Carboplatin), chemotherapy course administration postponing rate, the rate of recording course administration time, and patient admission rate of the outpatient clinic. The data was gathered retrospectively from patient charts and information systems’ log files. For the purpose of turn-around-time 109 Paclitaxel–Carboplatin chemotherapy courses of pre-implementation were compared to 118 those of post-implementation. For the other indicators: 247 chemotherapy courses pre-implementation were compared to 324 courses post-implementation. The process maps of pre- and post-implementation were also compared to each other.ResultsThe implementation of the system improved the process by removing repetition and sequencing of the tasks. Following the implementation, chemotherapy postponing decreased by 17.2% (Z = ?4.723, P = .000) and there were 5.7% less records with missing administration time (Z = ?3.047, P = .002). The admission rate increased 1.9 patient per working day (t(94) = ?5.974, P = .000). The overall turn-around-time reduced 18.9 min following the implementation (t(169) = 3.48, P = .001). In a multivariate multiple regression model the reduction in turn-around time was related to the implementation of the system (Pillai's Trace = 0.159, F(4,161) = 7.613, P = .000).ConclusionInformation systems based on treatment protocols can reduce communication and synchronization needs between the stakeholders in a complex workflow process. These systems can help reengineering the process and improve workflow efficiency by removing unnecessary sequencing and repetitions of tasks.     

Are three methods better than one? A comparative assessment of usability evaluation methods in an EHR

ObjectiveTo comparatively evaluate the effectiveness of three different methods involving end-users for detecting usability problems in an EHR: user testing, semi-structured interviews and surveys.Materials and methodsData were collected at two major urban dental schools from faculty, residents and dental students to assess the usability of a dental EHR for developing a treatment plan. These included user testing (N = 32), semi-structured interviews (N = 36), and surveys (N = 35).ResultsThe three methods together identified a total of 187 usability violations: 54% via user testing, 28% via the semi-structured interview and 18% from the survey method, with modest overlap. These usability problems were classified into 24 problem themes in 3 broad categories. User testing covered the broadest range of themes (83%), followed by the interview (63%) and survey (29%) methods.DiscussionMultiple evaluation methods provide a comprehensive approach to identifying EHR usability challenges and specific problems. The three methods were found to be complementary, and thus each can provide unique insights for software enhancement. Interview and survey methods were found not to be sufficient by themselves, but when used in conjunction with the user testing method, they provided a comprehensive evaluation of the EHR.ConclusionWe recommend using a multi-method approach when testing the usability of health information technology because it provides a more comprehensive picture of usability challenges.     

Interface design recommendations for computerised clinical audit and feedback: Hybrid usability evidence from a research-led system

BackgroundAudit and Feedback (A&F) is a widely used quality improvement technique that measures clinicians’ clinical performance and reports it back to them. Computerised A&F (e-A&F) system interfaces may consist of four key components: (1) Summaries of clinical performance; (2) Patient lists; (3) Patient-level data; (4) Recommended actions. There is a lack of evidence regarding how to best design e-A&F interfaces; establishing such evidence is key to maximising usability, and in turn improving patient safety.AimTo evaluate the usability of a novel theoretically-informed and research-led e-A&F system for primary care (the Performance Improvement plaN GeneratoR: PINGR).Objectives(1) Describe PINGR’s design, rationale and theoretical basis; (2) Identify usability issues with PINGR; (3) Understand how these issues may interfere with the cognitive goals of end-users; (4) Translate the issues into recommendations for the user-centred design of e-A&F systems.MethodsEight experienced health system evaluators performed a usability inspection using an innovative hybrid approach consisting of five stages: (1) Development of representative user tasks, Goals, and Actions; (2) Combining Heuristic Evaluation and Cognitive Walkthrough methods into a single protocol to identify usability issues; (3) Consolidation of issues; (4) Severity rating of consolidated issues; (5) Analysis of issues according to usability heuristics, interface components, and Goal-Action structure.ResultsA final list of 47 issues were categorised into 8 heuristic themes. The most error-prone heuristics were ‘Consistency and standards’ (13 usability issues; 28% of the total) and ‘Match between system and real world’ (n = 10, 21%). The recommended actions component of the PINGR interface had the most usability issues (n = 21, 45%), followed by patient-level data (n = 5, 11%), patient lists (n = 4, 9%), and summaries of clinical performance (n = 4, 9%). The most error-prone Actions across all user Goals were: (1) Patient selection from a list; (2) Data identification from a figure (both population-level and patient-level); (3) Disagreement with a system recommendation.ConclusionsBy contextualising our findings within the wider literature on health information system usability, we provide recommendations for the design of e-A&F system interfaces relating to their four key components, in addition to how they may be integrated within a system.     

Current outcomes of chronic active antibody mediated rejection – A large single center retrospective review using the updated BANFF 2013 criteria

BackgroundThe updated BANFF 2013 criteria has enabled a more standardized and complete serologic and histopathologic diagnosis of chronic active antibody mediated rejection (cAMR). Little data exists on the outcomes of cAMR since the initiation of this updated criteria.Methods123 consecutive patients with biopsy proven cAMR (BANFF 2013) between 2006 and 2012 were identified.ResultsPatients identified with cAMR were followed for a median of 9.5 (2.7–20.3) years after transplant and 4.3 (0–8.8) years after cAMR. Ninety-four (76%) recipients lost their grafts with a median survival of 1.9 years after diagnosis with cAMR. Mean C4d and allograft glomerulopathy scores were 2.6 ± 0.7 and 2.2 ± 0.8, respectively. 53.2% had class II DSA, 32.2% had both class I and II, and 14.5% had class I DSA only. Chronicity score >8 (HR 2.9, 95% CI 1–8.4, p = 0.05), DSA >2500 MFI (HR 2.8, 95% CI 1.1–6.8, p = 0.03), Scr >3 mg/dL (HR 3.2, 95% CI 1.6–6.3, p = 0.001) and UPC >1 g/g (HR 2.5, 95% CI 1.4–4.5, p = 0.003) were associated with a higher risk of graft loss.ConclusionscAMR was associated with poor graft survival after diagnosis. Improved therapies and earlier detection strategies are likely needed to improve outcomes of cAMR in kidney transplant recipients.     

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight

ObjectiveTo examine the association of women’s body weight with provider communication during prenatal care.MethodsWe coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication.ResultsCompared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44–0.99, p = 0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32–0.82, p = 0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51–0.91, p = 0.01) and concern statements (IRR 0.68, 95% CI 0.53–0.86, p = 0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19–0.84 p = 0.02).ConclusionLess lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care.Practice implicationsInterventions to increase use of patient-centered communication – especially for women with overweight and obesity – may improve prenatal care quality.     

Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: A randomized controlled trial

ObjectiveTo evaluate the effects of escitalopram 10–20 mg/day on menopause-related quality of life and pain in healthy menopausal women with hot flashes.Study designA double-blind, placebo-controlled randomized trial of escitalopram 10–20 mg/day vs. identical placebo was conducted among 205 women ages 40–62 years with an average of ≥4 daily hot flashes recruited at 4 clinical sites from July 2009 to June 2010.Main outcome measuresThe primary trial outcomes, reported previously, were the frequency and severity of vasomotor symptoms at 8 weeks. Here, we report on the pre-specified secondary endpoints of total and domain scores from the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the pain intensity and interference scale (PEG).ResultsOutcome data were collected on 97% of randomized women and 87% of women took at least 70% of their study medication. Treatment with escitalopram resulted in significantly greater improvement in total MENQOL scores (mean difference at 8 weeks of −0.41; 95% confidence interval (CI) −0.71 to −0.11; p < 0.001), as well as Vasomotor, Psychosocial, and Physical domain scores with the largest difference seen in the Vasomotor domain (mean difference −0.75; 95% CI −1.28 to −0.22; p = 0.02). There was no significant treatment group difference for the Sexual Function domain. Escitalopram treatment resulted in statistically significant improvements in PEG scores compared to placebo (mean treatment group difference at 8 weeks of −0.33; 95% CI −0.81 to 0.15; p = 0.045).ConclusionsTreatment with escitalopram 10–20 mg/day in healthy women with vasomotor symptoms significantly improved menopause-related quality of life and pain.     

Polygenic risk scores and breast and epithelial ovarian cancer risks for carriers of BRCA1 and BRCA2 pathogenic variants

PurposeWe assessed the associations between population-based polygenic risk scores (PRS) for breast (BC) or epithelial ovarian cancer (EOC) with cancer risks for BRCA1 and BRCA2 pathogenic variant carriers.MethodsRetrospective cohort data on 18,935 BRCA1 and 12,339 BRCA2 female pathogenic variant carriers of European ancestry were available. Three versions of a 313 single-nucleotide polymorphism (SNP) BC PRS were evaluated based on whether they predict overall, estrogen receptor (ER)–negative, or ER-positive BC, and two PRS for overall or high-grade serous EOC. Associations were validated in a prospective cohort.ResultsThe ER-negative PRS showed the strongest association with BC risk for BRCA1 carriers (hazard ratio [HR] per standard deviation = 1.29 [95% CI 1.25–1.33], P = 3×10⁻⁷²). For BRCA2, the strongest association was with overall BC PRS (HR = 1.31 [95% CI 1.27–1.36], P = 7×10⁻⁵⁰). HR estimates decreased significantly with age and there was evidence for differences in associations by predicted variant effects on protein expression. The HR estimates were smaller than general population estimates. The high-grade serous PRS yielded the strongest associations with EOC risk for BRCA1 (HR = 1.32 [95% CI 1.25–1.40], P = 3×10⁻²²) and BRCA2 (HR = 1.44 [95% CI 1.30–1.60], P = 4×10⁻¹²) carriers. The associations in the prospective cohort were similar.ConclusionPopulation-based PRS are strongly associated with BC and EOC risks for BRCA1/2 carriers and predict substantial absolute risk differences for women at PRS distribution extremes.     

A usability evaluation of a SNOMED CT based compositional interface terminology for intensive care

ObjectiveTo evaluate the usability of a large compositional interface terminology based on SNOMED CT and the terminology application for registration of the reasons for intensive care admission in a Patient Data Management System.DesignObservational study with user-based usability evaluations before and 3 months after the system was implemented and routinely used.MeasurementsUsability was defined by five aspects: effectiveness, efficiency, learnability, overall user satisfaction, and experienced usability problems. Qualitative (the Think–Aloud user testing method) and quantitative (the System Usability Scale questionnaire and Time-on-Task analyses) methods were used to examine these usability aspects.ResultsThe results of the evaluation study revealed that the usability of the interface terminology fell short (SUS scores before and after implementation of 47.2 out of 100 and 37.5 respectively out of 100). The qualitative measurements revealed a high number (n = 35) of distinct usability problems, leading to ineffective and inefficient registration of reasons for admission. The effectiveness and efficiency of the system did not change over time. About 14% (n = 5) of the revealed usability problems were related to the terminology content based on SNOMED CT, while the remaining 86% (n = 30) was related to the terminology application. The problems related to the terminology content were more severe than the problems related to the terminology application.ConclusionsThis study provides a detailed insight into how clinicians interact with a controlled compositional terminology through a terminology application. The extensiveness, complexity of the hierarchy, and the language usage of an interface terminology are defining for its usability. Carefully crafted domain-specific subsets and a well-designed terminology application are needed to facilitate the use of a complex compositional interface terminology based on SNOMED CT.     

Formative evaluation of a patient-specific clinical knowledge summarization tool

ObjectiveTo iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians’ perceived decision quality compared with standard search of UpToDate and PubMed.Materials and methodsMixed-methods observations of the interactions of 10 physicians with the CKS prototype vs. standard search in an effort to solve clinical problems posed as case vignettes.ResultsThe CKS tool automatically summarizes patient-specific and actionable clinical recommendations from PubMed (high quality randomized controlled trials and systematic reviews) and UpToDate. Two thirds of the study participants completed 15 out of 17 usability tasks. The median time to task completion was less than 10 s for 12 of the 17 tasks. The difference in search time between the CKS and standard search was not significant (median = 4.9 vs. 4.5 min). Physician’s perceived decision quality was significantly higher with the CKS than with manual search (mean = 16.6 vs. 14.4; p = 0.036).ConclusionsThe CKS prototype was well-accepted by physicians both in terms of usability and usefulness. Physicians perceived better decision quality with the CKS prototype compared to standard search of PubMed and UpToDate within a similar search time. Due to the formative nature of this study and a small sample size, conclusions regarding efficiency and efficacy are exploratory.     

Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis

ObjectiveTo evaluate the effect of maternal dengue virus (DENV) infection during pregnancy in premature birth, low birth weight, miscarriage and stillbirth.MethodsSystematic electronic literature searches were conducted including PubMed, Medline, Embase, Web of science, Scopus and the Cochrane Library database, up until July 5, 2017. Effect sizes were estimated by using the relative risk (RR) or odds ratio (OR) with theirs corresponding 95% confidence interval (CI). Subgroup analyses were conducted for study design (prospective or retrospective) and clinical symptom of participants (symptomatic or asymptomatic). Statistical analysis was conducted by STATA 12.0.ResultsThe initial systematic literature searches identified 1048 studies. After screening, fourteen studies were included. The pooled results did not suggest maternal DENV infection might increase the risk of adverse fetal outcomes with a pooled RR of 0.96 (95% CI: 0.85–1.09, I² = 49.6%) for premature birth, RR of 0.99 (95%CI: 0.87–1.12, I² = 35.1%) for low birth weight, OR of 1.77 (95% CI: 0.99–3.15, I² = 17.5%) for miscarriage and RR of 3.42 (95% CI: 0.76–15.49, I² = 54.8%) for stillbirth. Subgroup analysis of studies in symptomatic participants still did not indicate DENV infection appeared to be a risk factor for premature birth, low birth weight and miscarriage with pooled effect size of 0.99 (95% CI: 0.87–1.13, I² = 49.3%), 1.22 (95% CI: 0.827–1.80, I² = 55.1%) and 1.19 (95% CI: 0.56–2.55, I² = 4.7%), respectively.ConclusionsCurrent evidence did not suggest that maternal DENV infection during pregnancy might increase the risk of premature birth, low birth weight, miscarriage and stillbirth.     

A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions

The adverse effects of disease-related malnutrition (DRM) on health care use and costs are well substantiated. However, the impact of managing DRM with nutritional support on health care use, including hospital (re)admissions requires exploration. This systematic review (9 RCT, N = 1190) examined the effects of oral nutritional supplements (ONS) on hospital (re)admissions. Meta-analysis of 6 RCT (N = 852) with data on the proportion of patients (re)admitted to hospital showed significant reductions with ONS vs. routine care (OR 0.59, 95% CI 0.43–0.80, P = 0.001), including 5 RCT (N = 826) that recorded readmissions (OR 0.59, 95% CI 0.43–0.80, P = 0.001). The significant reduction in (re)admissions was found in meta-analyses of ONS trials in various settings and in patients with DRM or of varied nutritional status. A larger meta-analysis (8 RCT, N = 999) that combined other (re)admissions data using standardised differences also showed a significant reduction with ONS (effect size ?0.23, 95% CI ?0.36 to ?0.10, P = 0.001). Most of these trials (75%) were in older people aged ≥65 years (6 RCT, N = 834, effect size ?0.18, 95% CI ?0.31 to ?0.04, P = 0.011). This systematic review shows that ONS significantly reduce hospital (re)admissions, particularly in older patient groups, with economic implications for health care.     

Computer navigation is a useful intra-operative tool for joint line measurement in total knee arthroplasty

BackgroundRestoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead suboptimal outcomes. The purpose of this study was to analyze the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA).MethodsOne hundred sixty-eight patients (168 knees) underwent CAS TKA by two surgeons at a single institution with 2 years follow-up. The final change in joint line was calculated from the verified tibial resection and distal femoral cuts. Group A patients had joint line changes of less than 4 mm and Group B patients had joint line changes of more than 4 mm. Post-operative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at 6 months and 2 years post TKA.ResultsThere was significant linear correlation between joint line changes and Oxford scores (P = 0.0001), Function scores (P = 0.0001) and Knee scores (P = 0.0001) at 6 months and Oxford scores (P = 0.0001) alone at 2 years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients demonstrated better Oxford scores (P = 0.0001), Function scores (P = 0.0001), Knee scores (P = 0.0001) and total SF-36 scores (P = 0.003) at 6 months as well as better Oxford scores (P = 0.0001) and Knee scores (P = 0.014) at 2 years.ConclusionsCAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.Level of evidence: Prognostic Study, Level II-1.     

The Effects of Focused Nursing Education on 3F Groshong™ PICC Occlusion Rates: The Experience of One Tertiary Pediatric Care Facility

ObjectiveThe primary aim of this project is to reduce the incidence of 3 Fr. Groshong? PICC occlusions through focused nursing education.BackgroundThe use of Peripherally Inserted Central Catheters (PICC) has become an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications. Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs.MethodsA pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/surgical unit at a Southern California Children's Hospital was utilized. Objective measures included a written assessment of nursing knowledge, direct observations of nurses' flushing technique, and retrospective chart review to determine the rate of total catheter occlusion.ResultsMean written test scores improved from 0.78 to 0.93 (p = 0.00) Mean observation scores improved from 0.88 to 0.95, (p = 0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test occlusion rate was 15.49/1000 catheter days (p = 0.057).ConclusionFocused nursing education contributed to reducing 3F Groshong? PICC occlusions and the associated costs due to PICC occlusions.     

Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: A randomized controlled trial

BackgroundThere is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA.MethodPatients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. (Level of evidence: 2.)ResultsTwenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P < 0.001, 95% CI: 1.62–3.25 and 1.58–3.20 respectively). Function improved in each group (paired t test, P = 0.001, 95% CI of 0.94–2.38 in group one and 0.97–2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P = 0.005, CI: − 0.43–0.82 and P = 0.037, CI: − 0.44–0.80 respectively) and two (P = 0.025, CI: − 0.45–0.79 and P = 0.035, CI: − 0.29–0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures.ConclusionBoth lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other.Iranian Registry of Clinical Trials: IRCT201201108235N1.URL: http://irct.ir/searchen.php     

Social networks for improving healthy weight loss behaviors for overweight and obese adults: A randomized clinical trial of the social pounds off digitally (Social POD) mobile app

ObjectiveTo test the efficacy of a weight loss mobile app based on recommender systems and developed by experts in health promotion and computer science to target social support and self-monitoring of diet, physical activity (PA), and weight (Social POD app), compared to a commercially available diet and PA tracking app (standard).Materials and methodsOverweight adults [N = 51] were recruited and randomly assigned to either the experimental group [n = 26; theory-based podcasts (TBP) + Social POD app] or the comparison group (n = 25; TBP + standard app). The Social POD app issued notifications to encourage users to self-monitor and send theory-based messages to support users who had not self-monitored in the previous 48 h. Independent samples t-test were used to examine group differences in kilograms lost and change in BMI. Analysis of covariance was used to analyze secondary outcomes while controlling for baseline values.ResultsParticipant attrition was 12% (n = 3 experimental and n = 3 comparison). Experimental group participants lost significantly more weight (−5.3 kg, CI: −7.5, −3.0) than comparison group (−2.23 kg, CI: −3.6, −1.0; d = 0.8, r = 0.4, p = 0.02) and had a greater reduction in BMI (p = 0.02). While there were significant differences in positive outcome expectations between groups (p = 0.04) other secondary outcomes (e.g., caloric intake and social support) were not significant.DiscussionUse of the Social POD app resulted in significantly greater weight loss than use of a commercially available tracking app. This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity.