Background:
Outcomes are suboptimal in ulcerative colitis (UC). Telemedicine for UC is feasible and improves outcomes. Our goals were to evaluate a home telemanagement system for UC (UC HAT) on ...disease activity, quality of life (QoL), and adherence compared to best available care (BAC) in a randomized, controlled trial.
Methods:
Adults with UC were randomly assigned to receive UC HAT or BAC for 12 months. UC HAT recruits answered questions regarding disease activity, adherence, side effects, and measured their weight weekly. An educational curriculum was delivered after each session. Alerts and action plans were generated based on the results. BAC underwent routine follow‐up, received written action plans, and were given educational fact sheets. Seo Index scores, Inflammatory Bowel Disease Questionnaire (IBDQ) scores, and adherence rates were compared between UC HAT and BAC at 1 year.
Results:
Twenty‐five patients were randomized to UC HAT and 22 to BAC. After 12 months, 11 withdrew in UC HAT compared to 5 in BAC. Disease activity, QoL, and adherence were not different between groups at any timepoint postbaseline. Adjusted analyses of trial completers using all available data demonstrated decreased Seo Index (11.9 in UC HAT (P = 0.08) versus 1.2 in BAC (P = 0.84) and increased IBDQ scores (12.5 in UC HAT (P = 0.04) versus to −3.8 in BAC (P = 0.47) from baseline in UC HAT compared to BAC.
Conclusions:
UC HAT did not improve disease activity, QoL, or adherence compared to BAC after 1 year. After adjustment for baseline disease knowledge, UC HAT trial completers experienced significant gains in disease‐specific QoL from baseline compared to BAC trial completers. Our results suggest a potential benefit of UC HAT. Further research is indicated to determine if telemedicine improves outcomes in patients with IBD. (Inflamm Bowel Dis 2012;)
One of the major barriers to joining pulmonary rehabilitation (PR) programs is a lack of awareness about its benefits, combined with overall skepticism about regular exercise among COPD patients. ...Empowering COPD patients with foundational knowledge about PR may potentially facilitate their decision to join a PR program. A virtual reality (VR) app may serve as an engaging and interactive means to deliver PR education; however, the feasibility of this approach in COPD patients is unknown. The goal of this project was to assess the feasibility of VR-based PR education in COPD patients. Using mixed methods design, the feasibility of the VR app was assessed by evaluating its usability, patient acceptance, and its impact on patient knowledge about PR. The results of the usability assessment showed high user acceptance of the VR system and the ability to successfully operate the VR appliances. The use of the VR education app resulted in a statistically significant increase in patient understanding of the main concepts of pulmonary rehabilitation. Further development and evaluation of VR-based systems for patient engagement and empowerment are warranted.
Abstract Objective This study was designed to investigate the efficacy and feasibility of a web-based depression stigma education tool for healthcare professionals. Methods A web-based depression ...stigma program utilizing adult learning theories was developed. Forty-two consecutive subjects were enrolled from University of Maryland staff and graduate students. Primary outcomes were Bogardus Social Distance Scale with a vignette on major depression disorder (BSDS-MDD) and the Depression Stigma Scale (DSS) administered before and after the intervention. Results Internet-based education significantly decreased the level of depression stigma (BSDS-MDD 10.6 ± 4.4 versus 7.2 ± 4.4, p < 0.001; DSS-personal 12.7 ± 7.2 versus 7.8 ± 5.3, p < 0.001; DSS-perceived 21.7 ± 5.5 versus 12.4 ± 5.5, p < 0.001). After the educational intervention the subjects’ knowledge about depression significantly improved (pre-test DKS = 18.2 ± 8.2 versus post-test DKS = 20.6 ± 4.1, p < 0.001). The program was very well accepted by participants. For 100% of participants, it was not difficult to operate the program. Conclusions Computer-assisted education was effective in reducing the stigma of depression and increasing knowledge about depressive disorder. A web-based intervention has the potential to be used for educating graduate students and university staff about depression and for reducing depression stigmata. Healthcare professionals interacting with people with stigmatizing conditions can benefit from web-based computer education.
Patient-Centered Medical Home Cyberinfrastructure Finkelstein, Joseph, MD, PhD; Barr, Michael S., MD; Kothari, Pranav P., MD ...
American journal of preventive medicine,
2011, Letnik:
40, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Abstract The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is ...better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.
As the SARS-CoV-2 virus continues to remain a universal threat on a global scale, a large number of COVID-19 clinical trials and observational studies are being conducted and published. Currently, ...9,202 COVID-19 clinical trials have been registered on ClinicalTrials.gov and 293,187 COVID-19 articles were indexed in PubMed. To fully capitalize on the voluminous number of publications reporting COVID-19 interventional and observational studies, their results should be freely accessible via an open-source harmonized shared resource. We introduced ReMeDy (https://remedy.mssm.edu/), an intelligent integrative informatics platform aimed to harmonize and cross-link diverse COVID-19 trial outcomes and observational data. We tested the potential of the platform by uploading 52 COVID-19 clinical trials and 48 COVID-19 observational retrospective studies. ReMeDy was validated based on its capability to store and organize diverse data. The next steps include developing a crowdsourcing functionality coupled with automated outcome extraction using natural language processing.
The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has ...not been systematically assessed.
This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers.
Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change.
After the mobile app use, mean KS increased from 27(3) to 31(3) ( P<0.0001). Proportion of patients who felt they "cannot quit smoking" reduced from 36% (20/55) to 18% (10/55) ( P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level ( P<0.02), employment status ( P<0.05), and high app acceptance ( P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future.
Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.
Personalized exercise interventions comprising aerobic, resistance and corrective therapeutic components were shown to result in endurance and strength improvement and reduction of fatigue and ...spasticity in patients with multiple sclerosis (PwMS). However, telerehabilitation support of multipronged exercise programs in PwMS has received limited attention. The goal of this project was to introduce telerehabilitation support of individualized multipronged exercise programs and to assess feasibility assessment of the initial prototype in PwMS. Feasibility was assessed in 10 PwMS who were asked to perform a standardized set of tasks essential for using the telerehabilitation system independently and score each task. Our results indicated high level of acceptance of the system by these patients. On average, it took about 1-2 minutes for the patients to complete the study tasks essential for system operation. They were able to successfully use the system and follow their individualized exercise prescription. The resulting system will have to undergo a definitive systematic evaluation in a randomized controlled trial to demonstrate its clinical impact.
Hypertension telemanagement in blacks Finkelstein, Joseph; Cha, Eunme
Circulation Cardiovascular quality and outcomes
2, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We propose evaluation of a multi-component home automated telemanagement system providing integrated support to both clinicians and patients in implementing hypertension treatment guidelines. In a ...randomized clinical study, 550 blacks with hypertension are followed for 18 months. The major components of the intervention and control groups are identical and are based on the current standard of care. For the purpose of this study, we define "standard of care" as the expected evidence-based care provided according to the current hypertension treatment guidelines. Although intervention and control groups are similar in terms of their care components, they differ in the mode of care delivery. For the control group the best attempt is made to deliver all components of a guideline-concordant care in a routine clinical environment whereas for the intervention group the routine clinical environment is enhanced with health information technology that assists clinicians and patients in working together in implementing treatment guidelines. The home automated telemanagement system guides patients in following their individualized treatment plans and helps care coordination team in monitoring the patient progress. The study design is aimed at addressing the main question of this trial: whether the addition of the information technology-enhanced care coordination in the routine primary care setting can improve delivery of evidence-based hypertension care in blacks. The outcome parameters include quality of life, medical care use, treatment compliance, psychosocial variables, and improvement in blood pressure control rates. The trial will provide insight on the potential impact of information technology-enhanced care coordination in blacks with poorly controlled hypertension.
The goal of this study was to introduce home blood pressure (BP) telemonitoring in children with hypertension and to assess the feasibility of this approach. Acceptance of the system was assessed by ...attitudinal survey and semi-structured qualitative interview. Qualitative interview results showed consistently positive comments for content, interface and process components. BP measurements obtained by self-testing were as reliable as Dinamap measurements. The home telemonitoring system was positively accepted, easy to use and found to be helpful by participants. Home-based BP telemonitoring has significant potential to improve patient-centered delivery in children with hypertension.
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