Ideating Mobile Health Behavioral Support for Compliance to Therapy for Patients with Chronic Disease: A Case Study of Atrial Fibrillation Management

Poor patient compliance to therapy results in a worsening condition that often increases healthcare costs. In the MobiGuide project, we developed an evidence-based clinical decision-support system that delivered personalized reminders and recommendations to patients, helping to achieve higher therapy compliance. Yet compliance could still be improved and therefore building on the MobiGuide project experience, we designed a new component called the Motivational Patient Assistant (MPA) that is integrated within the MobiGuide architecture to further improve compliance. This component draws from psychological theories to provide behavioral support to improve patient engagement and thereby increasing patients’ compliance. Behavior modification interventions are delivered via mobile technology at patients’ home environments. Our approach was inspired by the IDEAS (Integrate, Design, Assess, and Share) framework for developing effective digital interventions to change health behavior; it goes beyond this approach by extending the Ideation phase’ concepts into concrete backend architectural components and graphical user-interface designs that implement behavioral interventions. We describe in detail our ideation approach and how it was applied to design the user interface of MPA for anticoagulation therapy for the atrial fibrillation patients. We report results of a preliminary evaluation involving patients and care providers that shows the potential usefulness of the MPA for improving compliance to anticoagulation therapy.     

Combining Ontologies and Open Standards to Derive a Middle Layer Information Model for Interoperability of Personal and Electronic Health Records

The aim of our study was to enable better interoperability between Personal Health Record (PHR) and Electronic Health Record (EHR) systems and vice versa. A multi-layer architectural model that resides between a PHR and EHR system has been developed. The model consists of an ontology-driven information model and a set of transformation rules that work in conjunction to process data exported from a PHR or EHR system and prepare it accordingly for the receiving system. The model was evaluated by executing a set of case study scenarios containing data from both a PHR and an EHR system. This allowed various challenges to emerge and revealed gaps in current standards in use. The proposed information model offers a number of advantages. Altering only the information model can incorporate modifications to either a PHR or EHR system. The model uses classes and attributes to define how data is captured which allows greater flexibility in how data can be manipulated by receiving systems.     

A survey of general dental practitioners in Merseyside regarding urgent appointments and suspected cancer referrals.

AIMS: The aims of this study were to investigate the current situation regarding unregistered patients in the Mersey region who seek an urgent dental appointment, and to gather information on suspected oral cancer cases seen by dentists in the previous two years and about how such cases are referred. METHODS: The survey took the form of a short questionnaire sent in May 2006 to all general dental practitioners (GDPs) in the Mersey region who were registered with the regional postgraduate dental office. RESULTS: A total of 904 GDPs were identified and 572 (63%) returned completed survey responses. Half (276/572; 48%) reported that they could see new patients urgently under the National Health Service (NHS) and two-thirds (365/571; 64%) that they could see them either under the NHS or privately. Nineteen per cent reported that they would not see any new patients. Those in the most deprived areas were more likely to see a patient on the NHS. The waiting time for an urgent appointment, if it was offered, was over one week for nearly one-third (32%) of the dentists offering NHS care. Most dentists (84%) said that a patient suspected of having oral cancer would be referred the same day as the decision had been made to refer. CONCLUSION: Access to dental care has been a high-profile issue over the past few years. This survey indicated that in Merseyside, just under half of the dentists who responded were willing to see new patients with urgent problems under the NHS. It is suggested that this difficulty in access, together with some reported delays in obtaining appointments and the methods of onward referral, may cause additional barriers to early detection of oral cancer, especially for those in the most at-risk groups, who are also very frequently hard to reach.     

Preceptors’ views of assessing nursing students using a competency based approach

The purpose of this study was to evaluate clinical competence assessment in BSc nursing registration education programmes. This research was undertaken in two phases and incorporated both quantitative and qualitative methodologies. In the first phase, two focus groups were conducted with preceptors working in general, mental health and intellectual disability nursing (n = 16). In the second phase, a survey was undertaken with preceptors (n = 837) in these disciplines.This paper reports on the focus group findings of preceptors’ views and experiences of assessing undergraduate nursing degree students using a competency based approach. A semi-structured interview guide was used to focus the discussions. Three higher order categories that emerged included: attitudes to competencies, being a preceptor and competencies in practice. Competing demands in the clinical environment impacted on preceptors’ experiences of the assessment process. Difficulties such as the wording of competency documentation and incorporation of skills into the assessment were articulated. The importance of a regional and national review of competency assessment systems to find a common language for student assessment as well as promoting greater student skill development within competency frameworks is recommended. These findings; highlight the importance of making assessments more workable within the current environment and aim to inform future development of competence assessment.     

Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis

Objectives

Liver transplantation (LT) in Milan Criteria (MC) hepatocellular carcinoma (HCC) has excellent outcomes. Pre-transplant loco-regional therapy (LRT) has been used to downstage HCC to meet the MC. However, its benefit in patients with a brief waiting time to transplant remains unclear. This study evaluated outcomes in patients with short waitlist times to LT for MC-compliant HCC.

Methods

Patients undergoing LT for MC HCC at either of two transplant centres between 2002 and 2009 were retrospectively evaluated for outcome. Patients for whom post-transplant follow-up amounted to <12 months were excluded.

Results

A total of 225 patients were included, 93 (41.3%) of whom received neoadjuvant LRT. The median waiting time to transplant was 48 days. Mean post-transplant follow-up was 32.2 months. Overall and disease-free survival at 1 year, 3 years and 5 years were 93.1%, 82.4% and 72.6%, and 91.3%, 79.3% and 70.6%, respectively. There was no difference in overall (P = 0.94) and disease-free survival (P = 0.94) between groups who received and did not receive pre-LT LRT. There were also no disparities in survival or tumour recurrence among categories of patients (with single tumours measuring <3 cm, with single tumours measuring 3–5 cm, with multiple tumours).

Conclusions

Loco-regional therapy followed by rapid transplantation in MC HCC appears not to have an impact on post-transplant outcome.     

Comparisons of Body Volumes and Dimensions Using Three-Dimensional Photonic Scanning in Adult Hispanic-Americans and Caucasian-Americans

Background

We studied whether significant differences exist between Hispanic-Americans (H-A) and Caucasian-Americans (C-A) in body dimensions using a newly validated three-dimensional photonic scanner (3DPS).

Methods

We compared two cohorts of 34 adult U.S.-based H-A (19 females) and 40 adult C-A (25 females) of similar age and body mass index (BMI, kg/m²). We measured total body volume (TBV), trunk volume (TV), and other body dimensions, including waist and hip circumferences, estimated percentage body fat (%fat), calculated TV/TBV, and waist-to-hip ratio.

Results

For female cohorts, there were no significant differences in age, weight, height, and 3DPS-measured variables between the two ethnic cohorts. For male cohorts, C-A had greater height (p = 0.014), but there were no significant differences in absolute or proportional volumes or dimensions between the two cohorts.

Conclusions

Results demonstrate that, in these H-A and C-A cohorts of similar age and BMI, total and regional body volumes and dimensions, as well as their proportions, approximate each other very closely in both sexes; these variables also show similar relationships with %fat in each sex. This is in contradistinction to previous study reports using other measurement techniques.     

HLA and cytokine gene polymorphisms in biliary atresia

BACKGROUND/AIMS: Extrahepatic biliary atresia remains one of the major hepatic causes of death in early childhood. Though a number of hypotheses have been developed to account for this disease, its aetiopathogenesis is poorly understood. One possibility is that this is an immune mediated disease which occurs following either toxic or infectious insult in a genetically susceptible host. Earlier studies suggested weak HLA associations but these remain unconfirmed. More recently studies of viral and autoimmune liver disease have begun to investigate non-MHC immunoregulatory gene polymorphisms. METHODS: In the present study we used molecular genotyping to investigate selected HLA A, B, DRB1, DQA1, DQB1 and DPB1 alleles as well as polymorphisms in the interleukin-1 gene family, interleukin-10 promoter sequence and tumour necrosis factor alpha promoter genes in 101 children referred for surgical assessment with extra hepatic biliary atresia. Genotyping data were compared with those of 134 racially and geographically matched healthy adult health care workers. RESULTS AND CONCLUSIONS: Overall there were no statistically significant differences in the distribution of any of the genes tested comparing patients and controls. These data suggest that biliary atresia is not an HLA-associated disease and that polymorphisms in both the interleukin-1 and interleukin-10 genes are not risk factors for this disease.