Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study

Digital health interventions for spinal surgery patients: A systematic scoping review

Introduction

The potential of digital health interventions to optimize healthcare is promising also in the context of spinal surgery. However, a systematic review assessing the quality of digital health interventions for spinal surgery patients and the potential effects on these patients is lacking.

Method

The objective of the current scoping review was to provide a systematic overview of digital health interventions for spinal surgery patients described in scientific literature. The focus was on describing the current digital health interventions, assessing the quality of these descriptions, reviewing the reported effects and assessing the methodological quality of the included studies.

Results

A total of 14 full-text articles, describing 11 digital health interventions were included in the final analysis. These digital health interventions ranged from a website and app to a mobile phone messaging system and mobile phone interface. Most digital health interventions aim to improve adherence to rehabilitation guidelines and physical health. The included studies were generally of moderate to high quality and showed significant effects on physical health. Vital aspects of digital interventions such as "working mechanism theory" and "prompts and reminders" were often absent in the description of interventions.

Conclusion

The study of digital interventions for spinal surgery patient is emerging and promising. However, there is a scarcity of studies using a rigorous design. A more systematic and comprehensive framework for developing and describing digital interventions for spinal surgery patients is highly recommended.

Managing complications of chronic pancreatitis: a guide for the gastroenterologist

INTRODUCTION

Chronic pancreatitis is a heterogeneous and complex syndrome that, in most cases, causes pain as a cardinal symptom and affects both the morphology and function of the pancreas, leading to several serious complications.

AREAS COVERED

The present review, based on a non-systematic PubMed search updated to June 2023, aims to present the current available evidence on the role of gastroenterologists in the diagnosis and treatment of both local and systemic complications by either endoscopic or medical treatments.

EXPERT OPINION

At diagnosis and during chronic pancreatitis follow-up, particular care is needed to consider not only the clinically manifest signs and symptoms of the disease, such as pain, jaundice, gastrointestinal obstruction, and pseudocysts, which require multidisciplinary discussion to establish the best treatment option (endoscopic or surgical), but also less evident systemic complications. Pancreatic exocrine and endocrine insufficiency, together with chronic inflammation, addiction, and dysbiosis, contribute to malnutrition, sarcopenia, and osteopathy. These complications, in turn, increase the risk of infection, thromboembolic events, and death. Patients with chronic pancreatitis also have an increased risk of psychiatric disorders and pancreatic cancer onset. Overall, patients with chronic pancreatitis should receive a holistic evaluation, considering all these aspects, possibly through multidisciplinary care in dedicated expert centers.

A systematic review on telenursing as a solution in improving the treatment compliance of tuberculosis patients in the COVID-19 pandemic

Introduction: The COVID-19 pandemic had made patients scared of coming to clinics or hospitals, and this could affect the treatment of TB. Therefore, one type of service that can be used by nurses to improve compliance to TB treatment is Telenursing. This article aims to ascertain whether telenursing could be a solution in improving the compliance of TB patients to treatments in the COVID-19 pandemic. Design and Method: This research was conducted using the Randomised Controlled Trial design as well as PRISMA. Furthermore, useful research articles were sourced from the database using the keywords, “Message Reminder and Tuberculosis OR Medication Adherence”. The databases used are Scopus, Science Direct, PubMed, and SAGE, all in English text and from 2015 to 2021, with inclusion criteria. 277 articles were obtained, and then filtered to select 3 articles by reading the main focus of the write-up, with regard to the topic of study. Result: Telenursing can be a solution to reduce the spread of COVID-19, and a substitute for remotely motivating individuals, as social support. Furthermore, it could be used as a reminder to patients to be obedient in carrying out treatments, and as a means of educating and improving good relationships with providers. Conclusions: Telenursing is a fairly effective solution in helping TB patients improve treatment compliance, reduce drug dropout rates and missed doses, as well as, raise awareness about the importance of health in the COVID-19 pandemic.  

New clinic workflow improves compliance for routine PCN exchanges

PURPOSE

To examine the effect of a clinic workflow intervention on follow-up for routine ercutaneous nephrostomy tube (PCN) exchanges.

METHODS

An intervention consisting of automated electronic tracking for all PCN placements and exchanges followed by phone call reminders to schedule a follow-up exchange 60 days post-procedure was introduced on March 19, 2019. All PCN exchanges performed from March 19, 2018 to September 18, 2019 were identified through a local electronic database search to assess the impact of intervention as a quality improvement project. Basic demographic information and procedure details were collected. Routine follow-up at our institution is recommended every 90 days. The exchange rates within 90 days were compared between groups using a Chi-squared test.

RESULTS

A total of 160 PCN placements or exchanges were performed pre-intervention and 69 PCN exchanges were performed post-intervention. Pre-intervention, 75/160 (46.3%) were exchanged within 90 days compared to 47/69 (68.1%) exchanged within 90 days post-intervention. The remainder had delayed follow-up due to loss to follow-up or scheduling delays. Post-intervention, there was a significantly improved rate of compliance for PCN exchanges within the recommended 90 days at our institution (p-value = 0.002).

CONCLUSION

Automated tracking and phone call follow-up at 60 days post-procedure is a simple and effective intervention that can improve compliance for routine PCN exchanges and reduce the number of patients that are lost to follow-up.

Institution-initiated text messaging can reduce unplanned emergency department visits after appendectomy

BACKGROUND/PURPOSE

The purpose of this study was to reduce unplanned Emergency Department (ED) visits for minor complaints in children after appendectomy through proactive institution-driven communication and utilization of telehealth resources.

METHODS

We developed a text messaging system to initiate communication with parents of postappendectomy patients and connect them with a telehealth visit or a phone call with a surgical provider as needed. Using descriptive statistics, chi square, and statistical process control analytics, we compared rates of postoperative ED visits for the 8 months pre- and post-implementation of the messaging system and summarized the feedback we received from patients.

RESULTS

A total of 791 laparoscopic appendectomies were performed in two institutions (preintervention = 382, post-intervention = 409). The postoperative ED visit rate decreased from 5.8% preimplementation to 2.4% post-implementation (p = 0.02). Over one-fifth of families messaged (21.6%) had questions in the postoperative period. The majority expressed interest in a video visit (52.5%), while some preferred to speak with the surgeon's office (25%). Over 90% of respondents found the system helpful, and 4.9% opted out.

CONCLUSION

Implementation of a hospital-initiated text messaging system has the potential to reduce ED visits in the immediate postoperative period after appendectomy. This system can be scaled to include different surgeries across multiple disciplines.

LEVEL OF EVIDENCE

III.

TYPE OF STUDY

Clinical Retrospective Pre/Post Intervention Study.

mHealth Apps for Enhanced Management of Spinal Surgery Patients: A Review

mHealth (mobile health) refers to mobile technologies that aid medical and public health practices. As of February 2019, 81% of Americans own a smartphone, and mHealth applications (apps) have become increasingly common with more than 400,000 mHealth applications currently available. Advancements in mobile technology now allow us to provide personalized up-to-date information, track personal health data, remind and engage patients, and communicate in a cost-effective way. There are new opportunities for healthcare providers to integrate mHealth into clinical practice. We discuss the current scientific evidence, and research into mHealth technology.

Retained biliary plastic stents - lest we forget

Prolonged indwelling of endoscopically placed biliary plastic stents may lead to complications. We conducted a retrospective analysis of patients who underwent endoscopic retrograde cholangio-pancreaticography (ERCP) at our centre in 2017 and were noted to have retained biliary plastic stents ( > 3 months after an index ERCP). A total of 127 patients had previously placed biliary plastic stents, out of which 45 (35.4%) were retained. The median age of the latter was 52 years (range = 22-79 years) with 27 (60%) patients being men. The median duration of the retained stents was 144 days (range = 94-3292 days). The majority of the patients were asymptomatic. However, 9 (20%) patients had cholangitis, 2 (4.4%) had choledocholithiasis, 2 (4.4%) had cholangitic abscess and 1 (2.2%) developed septicaemia. Fortunately, all these complications could be managed medically and endoscopically. Retention of biliary plastic stents is a problem often overlooked and underestimated in clinical practice. Various measures need to be instituted to create awareness of this entity to prevent undesirable outcomes.

Radiology, Mobile Devices, and Internet of Things (IoT)

Radiology by its nature is intricately connected to the Internet and is at the forefront of technology in medicine. The past few years have seen a dramatic rise in Internet-based technology in healthcare, with imaging as a core application. Numerous Internet-based applications and technologies have made forays into medicine, and for radiology it is more seamless than in other clinical specialties. Many applications in the practice of radiology are Internet based and more applications are being added every day. Introduction of mobile devices and their integration into imaging workflow has reinforced the role played by the Internet in radiology. Due to the rapid proliferation of wearable devices and smartphones, IoT-enabled technology is evolving healthcare from conventional hub-based systems to more personalized healthcare systems. This article briefly discusses how the IoT plays a useful role in daily imaging workflow and current and potential future applications, how mobile devices can be integrated into radiology workflows, and the impact of the IoT on resident and medical student education, research, and patient engagement in radiology.

Long-term outcomes after temporary placement of a self-expanding fully covered metal stent for benign biliary strictures secondary to chronic pancreatitis

BACKGROUND AND AIMS

Temporary single, fully covered self-expanding metal stent (FCSEMS) placement for benign biliary strictures (BBSs) associated with chronic pancreatitis (CP) may require fewer interventions than endotherapy with multiple plastic stents and may carry less morbidity than biliary diversion surgery. This study aimed to assess long-term outcomes in CP-associated BBSs after FCSEMS placement and removal.

METHODS

In this open-label, multinational, prospective study, subjects with CP and a BBS treated with FCSEMS placement with scheduled removal at 10 to 12 months were followed for 5 years after FCSEMS indwell. Kaplan-Meier analyses assessed BBS resolution and cumulative probability of freedom from recurrent stent placement to 5 years after FCSEMS indwell.

RESULTS

One hundred eighteen patients were eligible for FCSEMS removal. At a median of 58 months (interquartile range, 44-64) post-FCSEMS indwell, the probability of remaining stent-free was 61.6% (95% confidence interval [CI], 52.5%-70.7%). In 94 patients whose BBSs resolved at the end of FCSEMS indwell, the probability of remaining stent-free 5 years later was 77.4% (95% CI, 68.4%-86.4%). Serious stent-related adverse events occurred in 27 of 118 patients (22.9%); all resolved with medical therapy or repeated endoscopy. Multivariate analysis identified severe CP (hazard ratio, 2.4; 95% CI, 1.0-5.6; P = .046) and longer stricture length (hazard ratio, 1.2; 95% CI, 1.0-1.4; P = .022) as predictors of stricture recurrence.

CONCLUSION

In patients with symptomatic BBSs secondary to CP, 5 years after placement of a single FCSEMS intended for 10 to 12 months indwell, more than 60% remained asymptomatic and stent-free with an acceptable safety profile. Temporary placement of a single FCSEMS may be considered as first-line treatment for patients with CP and BBSs. (Clinical trial registration number: NCT01014390.).

Mobile messaging and smartphone apps for patient communication and engagement in spine surgery

Mobile health (mHealth) applications are rapidly becoming increasingly available to patients. These interventions utilize simple mobile messaging (SMS) and software applications on mobile devices for a variety of purposes. In the surgical population mHealth applications have shown promise in increasing medication and protocol adherence, monitoring patients after surgery, and helping modify behaviors associated with poor surgical outcomes. There is a paucity of spine specific applications at this time. Further development and study of efficacy of spine specific mHealth applications is needed.

A systematic review of mobile health interventions in China: Identifying gaps in care

INTRODUCTION

Mobile health has a promising future in the healthcare system in most developed countries. China's rapidly developing mobile technology infrastructure offers an unprecedented opportunity for wide adoption of mobile health interventions in the delivery of effective and timely healthcare services. However, there is little data on the current extent of the mobile health landscape in China. The aim of this study was to systematically review the existing mobile health initiatives in China, characterise the technology used, disease categories targeted, location of the end user (urban versus rural), and examine the potential effects of mobile health on health system strengthening in China. Furthermore, we identified gaps in development and evaluation of the effectiveness of mobile health interventions.

METHODS

A systematic review of the literature published from 18 December 2015 - 3 April 2019 was conducted and yielded 2863 articles from English and Chinese retrieval database and trial registries, including PubMed, EMBASE, China National Knowledge of Infrastructure and World Health Organization International Clinical Trials Registry Platform. Studies were included if they used mobile health to support patient healthcare outcomes.

RESULTS

A total of 1129 full-text articles were assessed and 338 were included in this study. The review found that most studies targeted client education and behaviour change via applications (apps) (65.4%), including WeChat, and text messaging (short text messages) (19.8%) to improve patient medical treatment outcomes such as compliance and appointment reminders. The most common disease-specific mobile health interventions focused primarily on chronic disease management and behaviour change in cardiology (13.3%), endocrinology/diabetes (12.1%), behavioural health (11.8%), oncology (11.2%) and neurology (6.8%). The mobile health interventions related to nutrition (0.6%) and chronic respiratory diseases (1.6%) are underrepresented in mobile health in comparison to the burden of disease in China. The majority (90.0%) of the mobile health interventions were conducted exclusively in urban areas, with few opportunities reaching rural populations.

CONCLUSIONS

Overall, mobile health has a promising future in China, with recent rapid growth in initiatives. The majority are focused on education and behaviour change in the realm of chronic diseases and target patients in urban areas. The imbalance in mobile health between the urban and rural areas, as well as between population disease spectrum and health service delivery, pose substantial dilemmas. However, mobile health may be redirected to correct this imbalance, possibly improving access to healthcare services, and filling the gaps in order to improve health equity for the underserved populations in China.

Using text message reminders in health care services: A narrative literature review

INTRODUCTION

Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes.

METHODS

A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews.

RESULTS

Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable.

DISCUSSION

Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.

Predictors and outcomes of delayed plastic biliary stent removal following endoscopic retrograde cholangiopancreatography

OBJECTIVE

Plastic biliary stents are commonly placed during endoscopic retrograde cholangiopancreatography (ERCP) and should be removed or replaced within 3 months to reduce the risk of stent obstruction. The aim of the study was to identify predictors and outcomes of patients who had delayed plastic biliary stent removal following ERCP.

MATERIALS AND METHODS

Consecutive patients who received ERCP with plastic biliary stent placement at Loma Linda University Medical Center (10/2004-6/2013) were identified. Delayed removal was defined as presence of stent >3 months after index ERCP. Multivariable regression analysis to identify baseline characteristics associated with delayed removal was performed. Clinical outcomes of stent obstruction (e.g., cholangitis, hospitalization, intensive care) were also collected for those with delayed removal.

RESULTS

Among 374 patients undergoing ERCP with plastic biliary stent, 71 (19%) had delayed stent removal. Patients who had anesthesia assistance (AOR = 3.8, 95%CI 1.2-11.4), non-English primary language (AOR = 3.0, 95%CI 1.5-6.2), and outpatient ERCP (AOR = 2.0, 95%CI 1.1-3.4) had increased while choledocholithiasis (AOR = 0.5, 95%CI 0.3-0.99) had lower odds of delayed stent removal. Among those with delayed removal, 13 (18%) were hospitalized for stent obstruction (5 (7%) had cholangitis, 8 (11%) were hospitalized for more than a week, and 3 (4%) required intensive care).

CONCLUSIONS

Almost one-fifth of patients who underwent ERCP with plastic biliary stent placement had delayed removal with nearly one-fifth of these patients requiring hospitalization for stent obstruction. Targeting patients at risk by improving communication and ease of scheduling an ERCP may reduce preventable adverse events associated with delayed biliary stent removal.

Effect of Short Message Service on Management of Pulmonary Tuberculosis Patients in Anhui Province, China: A Prospective, Randomized, Controlled Study

Background

To explore the significance of short message service (SMS) on the management of pulmonary tuberculosis (TB) patients in reinforcing the treatment adherence and health awareness, and provide scientific evidences for popularizing this model and formulating related polices and measures.

Material/Methods

Six counties (districts) were selected by stratified cluster sampling method, and randomly divided into control group and intervention group. Pulmonary TB patients eligible to the study criteria were included in the study. SMS management and regular education of core knowledge about pulmonary TB were carried out in SMS group patients. The conventional directly observed therapy (DOT) was carried out in control group. Data was collected by questionnaire method.

Results

A total of 350 patients were included in the study, including 160 cases in the SMS group and 190 cases in the control group. There were 270 males (77.1%) and 80 females (22.9%). The treatment completion rate in SMS group (96.25%) was significantly higher than that in the control group (86.84%) (χ²=9.52, P=0.002). Both the interrupted treatment rate and the missed dose rate in the SMS group were significantly lower than those in the control group (χ²=10.41, P=0.001; χ²=28.54, P<0.001). After a period of treatment, the reexamination rate of SMS group patients was significantly higher than that in control group (except the reexamination rate after 5 months treatment).

Conclusions

The management of pulmonary TB patients by SMS can effectively reinforce the completed treatment rate of pulmonary TB patients and reduce their missed dose rate and interrupted treatment rate, and further enhance their reexamination awareness. Therefore, SMS on the management of patients may be a new promising therapeutic strategy for pulmonary TB.