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Rajagopal S, Sharma S. Comparative Evaluation of Marginal Leakage of Various Bevel Designs Using Direct Composite Restoration in Fractured Anterior Teeth: An In Vitro Study. Cureus 2024; 16:e56860. [PMID: 38659556 PMCID: PMC11040417 DOI: 10.7759/cureus.56860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Background and objective Resin-based restorative materials are the backbone of modern restorative dentistry. But in spite of being an excellent material, there are many shortcomings with direct resin restorative materials such as polymerization shrinkage and microleakage that complicate the rate of clinical success. Hence, the aim of the present study is to compare the microleakage caused by composite restorations using two different bevels, primary and zigzag bevels, while restoring fractured anterior teeth. Materials and methodology Thirty non-carious maxillary central incisors were split into two divisions wherein Group I received the primary bevel and Group II received the zigzag bevel. After receiving the bevel, the samples are restored with direct filling composite material (Neo Spectra ST, Dentsply Sirona, Charlotte, NC, USA). The restored samples underwent thermocycling (Holmarc, Kochi, India) and were assessed for microleakage under a stereomicroscope (Leica M205, Wetzlar, Germany). For the statistical analysis, IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY) was used. Descriptive statistics were expressed in mean and standard deviation. Analytical statistics including the independent Student t-test was used to assess the difference derived from both groups at p<0.05. The normality of the data was assessed using the Shapiro-Wilk test. Results In the primary bevel, 53.3% of the samples showed first-degree microleakage, and 46.7% showed second-degree microleakage, respectively, and in samples restored using the zigzag bevel, 66.7% of the samples had no microleakage, and 33.3% of the samples had first-degree microleakage. The independent t-test revealed that the microleakage of the zigzag bevel showed a significant difference, being superior to the primary bevel at p<0.01. Conclusion Acknowledging the limitations of the study conducted, both bevel designs had a certain degree of microleakage when restored with composite material in anterior fractured teeth. However, the zigzag bevel produced significantly lesser microleakage as compared to the primary bevel restorations.
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Affiliation(s)
- Shruthi Rajagopal
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Subash Sharma
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
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Cleofas J, Andrada-Poa MRJ, Jabal R. The Influence of COVID-19 Program Innovativeness on Occupational Stress Outcomes of Community Health Workers in a Selected City Health Department in the Philippines. Soc Work Public Health 2024; 39:156-168. [PMID: 38380906 DOI: 10.1080/19371918.2024.2320794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The COVID-19 pandemic has caused unprecedented strain on the health sector. Thus, public health organizations have been challenged to design innovative programs that address not only their constituents' needs but also their health workers' work conditions. In one City Health Department in the Philippines, a notable public health program innovation, which harmonizes COVID-19 testing and health risk assessments for other diseases in a single program, has been implemented. This study examined the relationship between the perceived innovativeness of said COVID-19 program and the occupational stress outcomes of community health workers in a selected city health unit in the Philippines. This study used a quantitative, cross-sectional descriptive design with comparative and correlational aspects. A total of 128 purposively selected community health workers involved in the said program participated in this online survey. Findings suggest that age, years of service, gender, and employment status were significantly associated with perceived innovativeness. Reported perceived personal stress level was significantly lower during the implementation of the innovative program compared to the pre-implementation period. Moreover, perceived program innovativeness was found to be significantly negatively correlated with personal stress and significantly positively correlated with occupational support.
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Affiliation(s)
- Jerome Cleofas
- Department of Sociology and Behavioral Sciences Department, De La Salle University, Manila, Philippines
| | | | - Ronaldo Jabal
- Department of Sociology and Behavioral Sciences Department, De La Salle University, Manila, Philippines
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3
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Peralta P. The Statutory Standard of Care in Australia and its Application to Experimental Medical Practice. J Law Med 2023; 30:390-409. [PMID: 38303621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Clinical innovation is essential in the development and improvement of interventions used to treat medical conditions. In Australia, the States and Territories have statutorily reintroduced the Bolam principle in a modified form which provides a defence for medical practitioners who have practised in a manner that, at the time, was widely accepted in Australia by peer professional opinion as competent professional practice. This article explores whether the standard could be successfully pleaded as a defence by experimental practitioners. In doing so, the obstacles to an experimental practitioner's ability to rely on the statutory defence are analysed. It finds that the standard effectively entrenches established practices without sheltering legitimate efforts to advance medicine.
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Affiliation(s)
- Perry Peralta
- Senior Associate, Holman, Webb Lawyers, Sydney, Australia
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4
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Kuziemsky CE, Monkman H, Homco J, Liew A, Park H, Wu K, Lesselroth B. Automation vs. Innovation: Unexplored Strategies to Improve Virtual Care. Stud Health Technol Inform 2023; 304:3-7. [PMID: 37347560 DOI: 10.3233/shti230357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
While there is a global desire to increase digital health capacity, digital health should transform health services delivery rather than simply automate - or worse - replicate existing practices. Failing to capitalize on this transformative potential misses an opportunity to engage patients and other users to provide a more person-centered experience. However, digital transformation done recklessly can disrupt workflow, alienate users, and jeopardize patient safety, as we have observed with implementation of many digital health tools. This paper uses a telemedicine example to provide insight into how digital health innovation can be a meaningful enabler of health system transformation. Examining different ways to leverage digital health technologies is crucial to best capitalize on their potential.
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Affiliation(s)
| | - Helen Monkman
- School of Health Information Sciences, University of Victoria, Canada
| | - Juell Homco
- Department of Medical Informatics, University of Oklahoma, USA
| | - Andrew Liew
- Department of Medical Informatics, University of Oklahoma, USA
| | - Hannah Park
- School of Architecture & Design, University of Kansas, USA
| | - Kevin Wu
- Providence Medical Center, Kansas City, Kansas, USA
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5
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Delfino S, Larson A, Haines D, Grell R. World-Class Innovation, but at What Cost? A Brief Examination of the American Healthcare System. Cureus 2023; 15:e39922. [PMID: 37409203 PMCID: PMC10317843 DOI: 10.7759/cureus.39922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
The American healthcare system, often counted among the world's best, offers expedient access to a highly subspecialized network of physicians who work at the forefront of developing and utilizing novel, cutting-edge procedures, and medications. Patients typically have access to large numbers of qualified physicians in every metropolitan area and thus are afforded the luxury of individual choice in hospital, physician, and experience. Unfortunately, the costs of maintaining such a system are quite profound, and the higher investments do not pay dividends in health outcomes. Here, we elaborate on the greatest achievement and worst flaw in the American healthcare system.
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Affiliation(s)
- Spencer Delfino
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Andrew Larson
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Daniel Haines
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Ryan Grell
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
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6
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Nygren JM, Lundgren L, Bäckström I, Svedberg P. Strengthening Digital Transformation and Innovation in the Health Care System: Protocol for the Design and Implementation of a Multidisciplinary National Health Innovation Research School. JMIR Res Protoc 2023; 12:e46595. [PMID: 37256654 DOI: 10.2196/46595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system. OBJECTIVE The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system. METHODS A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process. RESULTS The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results. CONCLUSIONS The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46595.
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Affiliation(s)
- Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lina Lundgren
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Ingela Bäckström
- Department of Communication, Quality Management and Information Systems, Mid Sweden University, Östersund, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Huang M, Vincent Johnson A, Pourafshar N, Malhotra R, Yang J, Shah M, Balogun R, Chopra T. Pathways to improve nephrologist comfort in managing patients on in-center or home self-care dialysis. Hemodial Int 2023. [PMID: 37157127 DOI: 10.1111/hdi.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
In end-stage kidney disease (ESKD), patient engagement and empowerment are associated with improved survival and complications. However, patients lack education and confidence to participate in self-care. The development of in center self-care hemodialysis can enable motivated patients to allocate autonomy, increase satisfaction and engagement, reduce human resource intensiveness, and cultivate a curiosity about home dialysis. In this review, we emphasize the role of education to overcome barriers to home dialysis, strategies of improving home dialysis utilization in the COVID 19 era, the significance of in-center self-care dialysis (e.g., cost containment and empowering patients), and implementation of an in-center self-care dialysis as a bridge to home hemodialysis (HHD).
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Affiliation(s)
- Minghui Huang
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Anita Vincent Johnson
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Negiin Pourafshar
- Division of Nephrology, Department of Medicine, MedStar Georgetown University, Washington, DC, USA
| | - Rakesh Malhotra
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jason Yang
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Monarch Shah
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rasheed Balogun
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tushar Chopra
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Sandhu S, Sendak MP, Ratliff W, Knechtle W, Fulkerson WJ, Balu S. Accelerating health system innovation: principles and practices from the Duke Institute for Health Innovation. Patterns (N Y) 2023; 4:100710. [PMID: 37123436 PMCID: PMC10140606 DOI: 10.1016/j.patter.2023.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The Duke Institute for Health Innovation (DIHI) was launched in 2013. Frontline staff members submit proposals for innovation projects that align with strategic priorities set by organizational leadership. Funded projects receive operational and technical support from institute staff members and a transdisciplinary network of collaborators to develop and implement solutions as part of routine clinical care, ranging from machine learning algorithms to mobile applications. DIHI's operations are shaped by four guiding principles: build to show value, build to integrate, build to scale, and build responsibly. Between 2013 and 2021, more than 600 project proposals have been submitted to DIHI. More than 85 innovation projects, both through the application process and other strategic partnerships, have been supported and implemented. DIHI's funding has incubated 12 companies, engaged more than 300 faculty members, staff members, and students, and contributed to more than 50 peer-reviewed publications. DIHI's practices can serve as a model for other health systems to systematically source, develop, implement, and scale innovations.
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Affiliation(s)
- Sahil Sandhu
- Duke Institute for Health Innovation, Durham, NC, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - William J. Fulkerson
- Duke University School of Medicine, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Suresh Balu
- Duke Institute for Health Innovation, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Corresponding author
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9
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Andrews MR, Long PA, Ahlberg M, Balvert F, Alessandrello R, Lazzari A, Timmermann MM, Nouri Janian M, Rantaniska M, Spence A, Söderman P, Valls-Comamala V, Stamm T. A European arena for joint innovation in healthcare: The Platform for Innovation of Procurement and Procurement of Innovation (PiPPi). Front Public Health 2023; 10:1000590. [PMID: 36711358 PMCID: PMC9877621 DOI: 10.3389/fpubh.2022.1000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
By 2000 the European Union (EU) had recognized that its innovation capacity was underperforming in comparison to similar competitors and trading partners. Although the EU has made an effort to stimulate public research and development (R&D) through policy tools like Pre-Commercial Procurement (PCP) and Public Procurement of Innovation (PPI), starting with the 2000 Lisbon strategy and continuing through the 2021 updated Guidance on Innovation Procurement, there has remained a gap in knowledge of and use of these tools, in particular within healthcare. The past decades have seen an explosion in the number and use of digital technologies across the entire spectrum of healthcare. Demand-driven R&D has lagged here, while new digital health R&D has largely been driven by the supply side in a linear fashion, which can have disappointing results. PCP and PPI could have big impacts on the development and uptake of innovative health technology. The Platform for Innovation of Procurement and Procurement of Innovation (PiPPi) project was a Horizon 2020-funded project that ran from December 2018 to May 2022 with a consortium including seven of Europe's premier research hospitals and the Catalan Agency for Health Information. To promote PCP and PPI, PiPPi established a virtual Community of Practice (CoP) that brings together all stakeholder groups to share and innovate around unmet healthcare needs. This perspective presents a brief history of PCP and PPI in Europe with a focus on digital innovation in healthcare before introducing the PiPPi project and its value proposition.
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Affiliation(s)
- Margaret R. Andrews
- Institute of Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Preston A. Long
- Institute of Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Martina Ahlberg
- Center for Innovation, Karolinska University Hospital, Stockholm, Sweden
| | - Fred Balvert
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rossana Alessandrello
- Innovation Unit, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Agnese Lazzari
- Transformation, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Maarten M. Timmermann
- Procurement, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Mariet Nouri Janian
- Center for Advanced Technology in Health and Wellbeing, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Minerva Rantaniska
- Teaching, Research and Development, Helsinki University Hospital, Helsinki, Finland
| | - Ann Spence
- Transformation, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Söderman
- Center for Innovation, Karolinska University Hospital, Stockholm, Sweden
| | - Victòria Valls-Comamala
- Vall d'Hebron University Hospital, Barcelona, Spain,Health Services Research Group, Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,*Correspondence: Tanja Stamm ✉
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10
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Al-Alawy K, Moonesar IA. Perspective: Telehealth - beyond legislation and regulation. SAGE Open Med 2023; 11:20503121221143223. [PMID: 36643207 PMCID: PMC9834783 DOI: 10.1177/20503121221143223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 01/12/2023] Open
Abstract
The World Health Organization describes health innovation as developing new or improved systems, policies, products, technologies, services or delivery approaches that improve health and well-being, specifically of vulnerable people. The study's objectives were to (a) explore the legislative and regulatory journey of telehealth across the Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries and (b) provide recommendations to strengthen health system performance. We reviewed information sources for Organisation for Economic Co-operation and Development and non-Organisation for Economic Co-operation and Development countries opportunistically, including government and medical board publications, media coverage and peer-reviewed papers, to provide a perspective on the legislative and regulatory telehealth journey. Our review of countries suggests that legislation and regulation remain essential for governance, accountability and assuring that healthcare professionals and technologies are safe and secure. However, there was no uniform approach to telehealth legislation and regulation, and the precautionary approach was observed in some countries. Different strategies appear to have been adopted for telehealth implementation. There is a need to go beyond legislation and regulation to strengthen health system performance and assure the future success of telehealth services. Health system decision makers should work with health system stakeholders to strategise and plan for telehealth services as it will have implications on the future delivery of healthcare services and the health system. Further research is needed to explore how policy frameworks may support innovations in healthcare, such as telehealth.
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Pedersen ERG, Sudzina F. Relationship between citizens' perspective on digital health and underlying health risks. Digit Health 2023; 9:20552076231191045. [PMID: 37529542 PMCID: PMC10387710 DOI: 10.1177/20552076231191045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Digital health has been gaining widespread attention but has not been fully integrated into the existing healthcare system. However, it remains unclear whether the new digital health solutions align with users' needs and wants. This study examines how citizens perceive the functionalities of digital health and how different health risks influence their perception. Methods Using an online survey, data are collected from over 4000 Danish citizens. The data are analysed using linear regression models. Results The results show how users' perceptions of digital health differ significantly. Users are highly interested in data sharing across different healthcare stakeholders but less interested in online health communities. The results also show that the support for digital health is correlated with various health risks, including age, smoking and social network. However, health risks do not have uniform relationship with the perceived value of digital health. Conclusions While developing and implementing new digital health solutions, it is important to consider the perceptions of people who are expected to benefit from such solutions. This study contributes to the literature by deepening the knowledge of how citizens with different risk profiles perceive the multitude of digital health tools being introduced in the healthcare sector.
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12
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Sendak M, Vidal D, Trujillo S, Singh K, Liu X, Balu S. Editorial: Surfacing best practices for AI software development and integration in healthcare. Front Digit Health 2023; 5:1150875. [PMID: 36895323 PMCID: PMC9989472 DOI: 10.3389/fdgth.2023.1150875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Mark Sendak
- Duke Institute for Health Innovation, Durham, NC, United States
| | | | | | - Karandeep Singh
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Suresh Balu
- Duke Institute for Health Innovation, Durham, NC, United States
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13
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Shahid M, Finnegan A, Kilburn K, Udayakumar K, Baumgartner JN. The Health Innovation Impact Checklist: a tool to improve the development and reporting of impact models for global health innovations. Glob Health Action 2022; 15:2056312. [PMID: 35451352 PMCID: PMC9037222 DOI: 10.1080/16549716.2022.2056312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Donor financing is increasingly relying on performance-based measures that demonstrate impact. As new technologies and interventions enter the innovation space to address global health challenges, innovators often need to model their potential impact prior to obtaining solid effectiveness data. Diverse stakeholders rely on impact modeling data to make key funding and scaling decisions. With a lack of standardized methodology to model impact and various stakeholders using different modeling strategies, we propose that a universal innovation impact checklist be used to aid in transparent and aligned modeling efforts. This article describes a new Health Innovation Impact Checklist (HIIC) – a tool developed while evaluating the impact of health innovations funded under the Saving Lives at Birth (SL@B) program. SL@B, a global health Grand Challenge initiative, funded 116 unique maternal and newborn health innovations, four of which were selected for cost-effectiveness analyses (CEAs) within our evaluation. A key data source needed to complete a CEA was the lives saved estimate. HIIC was developed to help validate draft impact models from the SL@B donors and our own team’s additional modeling efforts, to ensure the inclusion of standardized elements and to pressure test assumptions for modeling impact. This article describes the core components of HIIC including its strengths and limitations. It also serves as an open call for further reviewing and tailoring of this checklist for applicability across global efforts to model the impact of health innovations.
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Affiliation(s)
- Minahil Shahid
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Amy Finnegan
- IntraHealth International, Chapel Hill, North Carolina, USA
| | - Kelly Kilburn
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Krishna Udayakumar
- Global Health Innovation Center, Duke University, Durham, North Carolina, USA
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Maddula R, MacLeod J, McLeish T, Painter S, Steward A, Berman G, Hamid A, Abdelrahim M, Whittle J, Brown SA. The role of digital health in the cardiovascular learning healthcare system. Front Cardiovasc Med 2022; 9:1008575. [PMID: 36407438 PMCID: PMC9668874 DOI: 10.3389/fcvm.2022.1008575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Tyson McLeish
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sabrina Painter
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Austin Steward
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | | | - Jeffrey Whittle
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sherry Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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15
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Nass M, Chase T, Buncher N, Gonzalez P, Quino G, Gurnani P, Bair-Merritt M, Kistin C. Pediatric Mobile Health Care Delivery During COVID-19. Acad Pediatr 2022; 22:873-875. [PMID: 35219853 PMCID: PMC8867956 DOI: 10.1016/j.acap.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa Nass
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass.
| | - Tami Chase
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass,Currently at Franciscan Children's Hospital (T Chase), Brighton, Mass
| | - Noah Buncher
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Priscilla Gonzalez
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Gladys Quino
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Priya Gurnani
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Megan Bair-Merritt
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
| | - Caroline Kistin
- Department of Pediatrics (M Nass, T Chase, N Buncher, P Gonzalez, G Quino, P Gurnani, M Bair-Merritt, C Kistin), Boston University School of Medicine/Boston Medical Center, Boston, Mass
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Stewart C, Eckstein L, Nicol D, Nielsen J. Negligence and Health Innovation: Issues with the Standard of Care and the Need to Revisit the Voluntary Assumption of Risk. J Law Med 2022; 29:337-348. [PMID: 35819375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This section examines current debates about the test for standards of care in negligence under the Civil Liability Acts in Australia, and how those debates may impact adversely on innovations in health care. It examines the recent history of attempts to define and regulate health innovation and compares them to judicial determinations from New South Wales that have potential to limit the protections otherwise afforded to competent professional practice. The section argues that, if those protections are eroded, alternative options to protect and encourage innovation should be explored, most especially a resuscitated defence of the voluntary assumption of risk.
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Affiliation(s)
| | | | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania
| | - Jane Nielsen
- Centre for Law and Genetics, University of Tasmania
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17
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Affiliation(s)
| | | | - R. V. Belfin
- Department of Computer Science and Engineering, Karunya Institute of Technology and Sciences, Coimbatore, India
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18
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De Luca V, Lazic V, Birov S, Piesche K, Beyhan O, Pengo MF, Melgara M, Sherman MH, Lilja M, Balenovic A, Parati G, Triassi M, Izzo R, Iaccarino G, Illario M. Digitally Enabled Health Service for the Integrated Management of Hypertension: A Participatory User-Centred Design Process. Int J Environ Res Public Health 2021; 18:12442. [PMID: 34886167 DOI: 10.3390/ijerph182312442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
This article describes a user-centred approach taken by a group of five procurers to set specifications for the procurement of value-based research and development services for IT-supported integrated hypertension management. The approach considered the unmet needs of patients and health systems of the involved regions. The procurers established a framework for requirements and a solution design consisting of nine building blocks, divided into three domains: service delivery, devices and integration, and health care organisation. The approach included the development of questionnaires, capturing patients’ and professionals’ views on possible system functionalities, and a template collecting information about the organisation of healthcare, professionals involved and existing IT systems at the procurers’ premises. A total of 28 patients diagnosed with hypertension and 26 professionals were interviewed. The interviewees identified 98 functional requirements, grouped in the nine building blocks. A total of nine use cases and their corresponding process models were defined by the procurers’ working group. As result, a digitally enabled integrated approach to hypertension has been designed to allow citizens to learn how to prevent the development of hypertension and lead a healthy lifestyle, and to receive comprehensive, individualised treatment in close collaboration with healthcare professionals.
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19
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Alghamdi SM, Alsulayyim AS, Alqahtani JS, Aldhahir AM. Digital Health Platforms in Saudi Arabia: Determinants from the COVID-19 Pandemic Experience. Healthcare (Basel) 2021; 9:1517. [PMID: 34828563 PMCID: PMC8618772 DOI: 10.3390/healthcare9111517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023] Open
Abstract
COVID-19 poses a significant burden to healthcare systems. Healthcare organisations with better health innovation infrastructures have faced a reduced burden and achieved success in curbing COVID-19. In Saudi Arabia, digital technologies have played a vital role in fighting SARS-CoV-2 transmission. In this paper, we aimed to summarise the experience of optimising digital health technologies in Saudi Arabia as well as to discuss capabilities and opportunities during and beyond the COVID-19 pandemic. A literature search was conducted up to September 2021 to document the experience of using DHTPs in Saudi Arabia in response to the COVID-19 outbreak. We also considered any published data, press briefings, and announcements by the MOH in Saudi Arabia. The findings were synthesised in narrative form. Health officials succeeded in optimising and maintaining a strategy to mitigate the spread of the virus via different digital technologies, such as mobile health applications, artificial intelligence, and machine learning. The quick digital response in Saudi Arabia was facilitated by governmental support and by considering users and technology determinants. Future research must concentrate on establishing and updating the guidelines for using DHTPs.
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Affiliation(s)
- Saeed M. Alghamdi
- Respiratory Care Program, Clinical Technology Department, College of Applied Health Science, Umm Al Qura University, Makkah 21955, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK;
| | - Abdullah S. Alsulayyim
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK;
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | - Jaber S. Alqahtani
- UCL Respiratory, University College London, London WC1E 6BT, UK;
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
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20
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Gomes LA, Gregório MJ, Iakovleva TA, Sousa RDD, Bessant J, Oliveira P, Branco JC, Canhão H, Rodrigues AM. A Home-Based eHealth Intervention for an Older Adult Population With Food Insecurity: Feasibility and Acceptability Study. J Med Internet Res 2021; 23:e26871. [PMID: 34463638 PMCID: PMC8459887 DOI: 10.2196/26871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/19/2021] [Accepted: 05/06/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Food insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. OBJECTIVE This study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. METHODS A pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). RESULTS A sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean -3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean -0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean -1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. CONCLUSIONS The home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants' fatigue and physical function. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.6626.
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Affiliation(s)
- Luís Antunes Gomes
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | | | - Rute Dinis de Sousa
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - John Bessant
- University of Exeter Business School, Exeter, United Kingdom
| | - Pedro Oliveira
- Copenhagen Business School, Copenhagen, Denmark.,NOVA School of Business and Economics, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaime C Branco
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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21
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De Luca V, Tramontano G, Riccio L, Trama U, Buono P, Losasso M, Bracale UM, Annuzzi G, Zampetti R, Cacciatore F, Vallefuoco G, Lombardi A, Marro A, Melone MAB, Ponsiglione C, Chiusano ML, Bracale G, Cafiero G, Crudeli A, Vecchione C, Taglialatela M, Tramontano D, Iaccarino G, Triassi M, Roller-Wirnsberger R, Bousquet J, Illario M. "One Health" Approach for Health Innovation and Active Aging in Campania (Italy). Front Public Health 2021; 9:658959. [PMID: 34046390 PMCID: PMC8144456 DOI: 10.3389/fpubh.2021.658959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022] Open
Abstract
This article describes how innovations are exploited in Campania (Italy) to improve health outcomes, quality of life, and sustainability of social and healthcare services. Campania's strategy for digitalization of health and care and for healthy aging is based on a person-centered, life-course, “One Health” approach, where demographic change is considered capable of stimulating a growth dynamic linked to the opportunities of combining the “Silver Economy” with local assets and the specific health needs of the population. The end-users (citizens, patients, and professionals) contribute to the co-creation of products and services, being involved in the identification of unmet needs and test-bed activity. The Campania Reference Site of the European Innovation Partnership on Active and Healthy Aging is a flexible regional ecosystem to address the challenge of an aging population with a life-course approach. The good practices, developed in the context of research and innovation projects and innovative procurements by local stakeholders and collaborations with international networks, have been allowing the transfer of innovative solutions, knowledge, and skills to the stakeholders of such a multi-sectoral ecosystem for health.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli "Federico II, " Naples, Italy
| | - Giovanni Tramontano
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Luigi Riccio
- Direzione Generale per la Tutela della Salute e il Coordinamento del Servizio Sanitario Regionale, Naples, Italy
| | - Ugo Trama
- Direzione Generale per la Tutela della Salute e il Coordinamento del Servizio Sanitario Regionale, Naples, Italy
| | - Pietro Buono
- Direzione Generale per la Tutela della Salute e il Coordinamento del Servizio Sanitario Regionale, Naples, Italy
| | - Mario Losasso
- Dipartimento di Architettura, Università degli Studi di Napoli "Federico II", Naples, Italy
| | | | - Giovanni Annuzzi
- Unità Operativa Semplice Microinfusori e tecnologie innovative, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | | | - Francesco Cacciatore
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II, " Naples, Italy
| | | | | | - Anna Marro
- Azienda Sanitaria Locale Avellino, Avellino, Italy
| | - Mariarosa Anna Beatrice Melone
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate e Centro Interuniversitario di Ricerca in Neuroscienze, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Cristina Ponsiglione
- Dipartimento di Ingegneria Industriale, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Maria Luisa Chiusano
- Dipartimento di Agraria, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Giancarlo Bracale
- Mediterranean Federation for Advancing Vascular Surgery, Naples, Italy
| | | | | | - Carmine Vecchione
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Salerno, Salerno, Italy
| | - Maurizio Taglialatela
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Donatella Tramontano
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli "Federico II, " Naples, Italy
| | | | - Jean Bousquet
- MACVIA-France, Fondation Partenariale FMC VIA-LR, Montpellier, France
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli "Federico II, " Naples, Italy
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22
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Luo L, King AA, Carroll Y, Baumann AA, Brambilla D, Carpenter CR, Colla J, Gibson RW, Gollan S, Hall G, Klesges L, Kutlar A, Lyon M, Melvin CL, Norell S, Mueller M, Potter MB, Richesson R, Richardson LD, Ryan G, Siewny L, Treadwell M, Zun L, Armstrong-Brown J, Cox L, Tanabe P. Electronic Health Record-Embedded Individualized Pain Plans for Emergency Department Treatment of Vaso-occlusive Episodes in Adults With Sickle Cell Disease: Protocol for a Preimplementation and Postimplementation Study. JMIR Res Protoc 2021; 10:e24818. [PMID: 33861209 PMCID: PMC8087964 DOI: 10.2196/24818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals living with sickle cell disease often require aggressive treatment of pain associated with vaso-occlusive episodes in the emergency department. Frequently, pain relief is poor. The 2014 National Heart, Lung, and Blood Institute evidence-based guidelines recommended an individualized treatment and monitoring protocol to improve pain management of vaso-occlusive episodes. Objective This study will implement an electronic health record–embedded individualized pain plan with provider and patient access in the emergency departments of 8 US academic centers to improve pain treatment for adult patients with sickle cell disease. This study will assess the overall effects of electronic health record–embedded individualized pain plans on improving patient and provider outcomes associated with pain treatment in the emergency department setting and explore barriers and facilitators to the implementation process. Methods A preimplementation and postimplementation study is being conducted by all 8 sites that are members of the National Heart, Lung, and Blood Institute–funded Sickle Cell Disease Implementation Consortium. Adults with sickle cell disease aged 18 to 45 years who had a visit to a participating emergency department for vaso-occlusive episodes within 90 days prior to enrollment will be eligible for inclusion. Patients will be enrolled in the clinic or remotely. The target analytical sample size of this study is 160 patient participants (20 per site) who have had an emergency department visit for vaso-occlusive episode treatment at participating emergency departments during the study period. Each site is expected to enroll approximately 40 participants to reach the analytical sample size. The electronic health record–embedded individualized pain plans will be written by the patient’s sickle cell disease provider, and sites will work with the local informatics team to identify the best method to build the electronic health record–embedded individualized pain plan with patient and provider access. Each site will adopt required patient and provider implementation strategies and can choose to adopt optional strategies to improve the uptake and sustainability of the intervention. The study is informed by the Technology Acceptance Model 2 and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Provider and patient baseline survey, follow-up survey within 96 hours of an emergency department vaso-occlusive episode visit, and selected qualitative interviews within 2 weeks of an emergency department visit will be performed to assess the primary outcome, patient-perceived quality of emergency department pain treatment, and additional implementation and intervention outcomes. Electronic health record data will be used to analyze individualized pain plan adherence and additional secondary outcomes, such as hospital admission and readmission rates. Results The study is currently enrolling study participants. The active implementation period is 18 months. Conclusions This study proposes a structured, framework-informed approach to implement electronic health record–embedded individualized pain plans with both patient and provider access in routine emergency department practice. The results of the study will inform the implementation of electronic health record–embedded individualized pain plans at a larger scale outside of Sickle Cell Disease Implementation Consortium centers. Trial Registration ClinicalTrials.gov NCT04584528; https://clinicaltrials.gov/ct2/show/NCT04584528. International Registered Report Identifier (IRRID) DERR1-10.2196/24818
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Affiliation(s)
- Lingzi Luo
- Washington University School of Medicine, St Louis, MO, United States
| | - Allison A King
- Washington University School of Medicine, St Louis, MO, United States
| | - Yvonne Carroll
- St Jude Children's Research Hospital, Memphis, TN, United States
| | - Ana A Baumann
- Washington University in St. Louis, St Louis, MO, United States
| | | | | | - Joseph Colla
- University of Illinois Chicago, Chicago, IL, United States
| | | | | | - Greg Hall
- Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Klesges
- Washington University School of Medicine, St Louis, MO, United States.,University of Memphis, Memphis, TN, United States
| | | | | | - Cathy L Melvin
- Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Norell
- University of Illinois Chicago, Chicago, IL, United States
| | - Martina Mueller
- Medical University of South Carolina, Charleston, SC, United States
| | - Michael B Potter
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - Gery Ryan
- The RAND Corporation, Santa Monica, CA, United States
| | | | - Marsha Treadwell
- University of California San Francisco, San Francisco, CA, United States
| | - Leslie Zun
- Chicago Medical School, North Chicago, IL, United States
| | | | - Lisa Cox
- RTI International, Durham, NC, United States
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23
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Tam EK, Dong X. Survey of Residency Directors' Views on Entrepreneurship. JMIR Med Educ 2021; 7:e19079. [PMID: 33851929 PMCID: PMC8082379 DOI: 10.2196/19079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/07/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Medical students enter the medicine field with fresh ideas that may make them great entrepreneurs. However, medical students are uncertain about how the program directors of their desired residency would view them if they pursued business opportunities. We surveyed residency directors to obtain their views on medical students' entrepreneurship experiences. This viewpoint article aims to help American medical students who are interested in health innovations understand how their interests and entrepreneurial experiences may affect how they are viewed by residency program directors. Most program directors had favorable views of medical students with experience in entrepreneurship, and they believed that the innovative traits gained from such experiences would add to the program.
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Affiliation(s)
- Emily K Tam
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Boston Medical Center, Boston, MA, United States
| | - Xuezhi Dong
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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24
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Zhao Y, Gjernes T, Hedlund M. Exploring Participation and Interaction in a Bottom-Up Health Promotion Program for Migrant Women in Norway. Qual Health Res 2021; 31:691-702. [PMID: 33349151 PMCID: PMC7882997 DOI: 10.1177/1049732320980397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this article, we examine the participation and interactions of migrant women and experts who attended health parties. Based on data from participation observations and semi-structured interviews from participants of health parties, we examine how health parties may be considered an innovative bottom-up community program that could influence how migrant women focus, learn, and discuss health issues as well as interact with health care. Through a qualitative analysis, the article demonstrates two ways of organizing health parties and different approaches to the health expert role, and how this impacts the social setting and interactions of a health party. In the Norwegian setting, migrant women are considered by health authorities to be the most difficult group to reach due to cultural and language barriers. Health parties may represent an alternative for bridging these barriers and may create a useful context for active participation and learning about health for migrant women.
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25
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Miranda C, Altermatt F, Villagrán I, Goñi J. Developing an Innovative Medical Training Simulation Device for Peripheral Venous Access: A User-Centered Design Approach. Healthcare (Basel) 2020; 8:healthcare8040420. [PMID: 33105754 PMCID: PMC7712721 DOI: 10.3390/healthcare8040420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Nurses and other health students may lack the proper time for training procedural tasks, such as peripheral venous access. There is a need to develop these abilities in novices so that errors can be avoided when treating real patients. Nonetheless, from an experiential point of view, the simulation devices offered in the market do not always make sense for educators and trainees. This could make the adoption of new technology difficult. The purpose of this case study is to describe the development of an innovative simulation device and to propose concrete tactics for the involvement of the educators and trainees. We used a participative design based approach, with an ethnographic basis, where incremental cycles of user testing, development and iteration were involved. The study showcases methods from the field of design and anthropology that can be used to develop future simulation devices that resonate with students and educators to achieve a long term learning experience. Results could shed a light on new ways for the involvement of educators and students to create devices that resonate with them, making learning significant and effective.
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Affiliation(s)
- Constanza Miranda
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Correspondence: ; Tel.: +56-2-23545253
| | - Fernando Altermatt
- Department of Anestesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Ignacio Villagrán
- Health Sciences Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Julián Goñi
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
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26
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Hankins JS, Shah N, DiMartino L, Brambilla D, Fernandez ME, Gibson RW, Gordeuk VR, Lottenberg R, Kutlar A, Melvin C, Simon J, Wun T, Treadwell M, Calhoun C, Baumann A, Potter MB, Klesges L, Bosworth H. Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study. JMIR Res Protoc 2020; 9:e16319. [PMID: 32442144 PMCID: PMC7388044 DOI: 10.2196/16319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hydroxyurea prevents disease complications among patients with sickle cell disease (SCD). Although its efficacy has been endorsed by the National Health Lung and Blood Institute evidence-based guidelines, its adoption is low, both by patients with SCD and providers. Mobile health (mHealth) apps provide benefits in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescription among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE This study aims to increase hydroxyurea utilization through a combined two-level mHealth intervention for both patients with SCD and their providers with the goals of increasing adherence to hydroxyurea among patients and improve hydroxyurea prescribing behavior among providers. METHODS We will test the efficacy of 2 mHealth interventions to increase both patient and provider utilization and knowledge of hydroxyurea in 8 clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that address memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox), addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared with their adherence at baseline. As secondary objectives, we will (1) examine the change in health-related quality of life, acute disease complications, perceived health literacy, and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health and (2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the reach, effectiveness, adoption, implementation, and maintenance framework and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be completed by mid-2021. CONCLUSIONS If this two-level intervention, that is, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future large-scale implementation-effectiveness study. TRIAL REGISTRATION ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16319.
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Affiliation(s)
- Jane S Hankins
- St. Jude Childrens Research Hospital, Memphis, TN, United States
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, United States
| | - Lisa DiMartino
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Donald Brambilla
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Robert W Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Victor R Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Richard Lottenberg
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainsville, FL, United States
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jena Simon
- Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - Ted Wun
- Division of Hematology Oncology, UC Davis School of Medicine, Davis, CA, United States
| | - Marsha Treadwell
- University of California San Francisco Benioff Children Hospital Oakland, Oakland, CA, United States
| | - Cecelia Calhoun
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Ana Baumann
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Michael B Potter
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Lisa Klesges
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Hayden Bosworth
- Department of Medicine, Duke University, Durham, NC, United States
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- Bethesda, MA, United States
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Leal Neto O, Cruz O, Albuquerque J, Nacarato de Sousa M, Smolinski M, Pessoa Cesse EÂ, Libel M, Vieira de Souza W. Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study. JMIR Public Health Surveill 2020; 6:e16119. [PMID: 32254042 PMCID: PMC7175192 DOI: 10.2196/16119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 12/01/2022] Open
Abstract
Background With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens’ participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region. Objective This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics. Methods This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario. Results The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome. Conclusions It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system.
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Affiliation(s)
- Onicio Leal Neto
- University of Zurich, Zurich, Switzerland.,Epitrack, Recife, Brazil
| | - Oswaldo Cruz
- Scientific Computation Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jones Albuquerque
- Epitrack, Recife, Brazil.,Immunopathology Lab Keizo Asami, Recife, Brazil
| | | | | | | | - Marlo Libel
- Ending Pandemics, San Francisco, CA, United States
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Rane TM, Mahanta TG, Ryavanki SP, Gogoi B, Boruah M. Home-based newborn care voucher initiative in Assam: An evaluation. Indian J Public Health 2020; 64:66-71. [PMID: 32189686 DOI: 10.4103/ijph.ijph_188_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community. Objective This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam. Methods A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers. Results Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns. Conclusions HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.
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Affiliation(s)
| | - Tulika Goswami Mahanta
- Associate Professor, Department of Community Medicine, Tezpur Medical College, Tezpur, Assam, India
| | | | - Bivash Gogoi
- Statistician, MCH Cell, AMC, Dibrugarh, Assam, India
| | - Manjit Boruah
- Assistant Professor, Department of Community Medicine, Assam Medical College, Dibrugarh, Assam, India
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Migliorini L, Cardinali P, Rania N. How Could Self-Determination Theory Be Useful for Facing Health Innovation Challenges? Front Psychol 2019; 10:1870. [PMID: 31474910 PMCID: PMC6702320 DOI: 10.3389/fpsyg.2019.01870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
This paper offers a presentation of the characteristics of self-determination theory (SDT) in the health context as well as attempts to identify how this theory could be useful for facing health innovation challenges. Health innovation is based on scientific advances that have more complex relationships with health. This paper encourages the use of the SDT approach to face health innovation, both for physiological and pathological processes. In particular, the focus is on the changes and lifestyle choices related to physiological pregnancy and birth and to oncological genetic tests in the Italian context. The health innovation paradigm focuses on patients taking responsibility for making important health-related choices, and we think that SDT can offer new stimuli in light of the changes implemented from innovations in the field of health. The aim is that this manuscript will stimulate researchers to test the potential of this theory in the field of changing health-related processes. Practitioners are called upon to revise their orientation toward patients and, according to SDT, they should support autonomy rather than control the promotion of health-related change.
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Affiliation(s)
- Laura Migliorini
- Department of Education Sciences, University of Genoa, Genoa, Italy
| | - Paola Cardinali
- Department of Education Sciences, University of Genoa, Genoa, Italy
| | - Nadia Rania
- Department of Education Sciences, University of Genoa, Genoa, Italy
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Tziraki-Segal C, De Luca V, Santana S, Romano R, Tramontano G, Scattola P, Celata C, Gelmi G, Ponce Márquez S, Lopez-Samaniego L, Zavagli V, Halkoaho A, Grimes C, Tomás MT, Fernandes B, Calzà L, Speranza P, Coppola L, Jager-Wittenaar H, O'Caoimh R, Pietilä AM, Carriazo AM, Apostolo J, Iaccarino G, Liotta G, Tramontano D, Molloy W, Triassi M, Viggiani V, Illario M. Creating a Culture of Health in Planning and Implementing Innovative Strategies Addressing Non-communicable Chronic Diseases. Front Sociol 2019; 4:9. [PMID: 33869336 PMCID: PMC8022497 DOI: 10.3389/fsoc.2019.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/01/2019] [Indexed: 06/12/2023]
Abstract
Ongoing demographic changes are challenging health systems worldwide especially in relation to increasing longevity and the resultant rise of non-communicable diseases (NCDs). To meet these challenges, a paradigm shift to a more proactive approach to health promotion, and maintenance is needed. This new paradigm focuses on creating and implementing an ecological model of Culture of Health. The conceptualization of the Culture of Health is defined as one where good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities where citizens have the opportunity to make choices and be co-producers of healthy lifestyles. Based on Antonovsky's Salutogenesis model which asserts that the experience of health moves along a continuum across the lifespan, we will identify the key drivers for achieving a Culture of Health. These include mindset/expectations, sense of community, and civic engagement. The present article discusses these drivers and identifies areas where policy and research actions are needed to advance positive change on population health and well-being. We highlight empirical evidence of drivers within the EU guided by the activities within the thematic Action Groups of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA), focusing on Lifespan Health Promotion and Prevention of Age-Related Frailty and Disease (A3 Action Group). We will specifically focus on the effect of Culture on Health, highlighting cross-cutting drivers across domains such as innovations at the individual and community level, and in synergies with business, policy, and research entities. We will present examples of drivers for creating a Culture of Health, the barriers, the remaining gaps, and areas of future research to achieve an inclusive and sustainable asset-based community.
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Affiliation(s)
- Chariklia Tziraki-Segal
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV- Community Clubs for Elders, Jerusalem, Israel
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Rosa Romano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Paola Scattola
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Corrado Celata
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Giusi Gelmi
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Sara Ponce Márquez
- International Research Projects Office (IRPO), Universidad de Deusto, Bilbao, Spain
| | - Luz Lopez-Samaniego
- Progress and Health Foundation, Regional Ministry of Health of Andalucía, Seville, Spain
| | | | - Arja Halkoaho
- School of Health Care and Social Services Education and R&D, Tampere University of Applied Sciences, Tampere, Finland
| | - Corrina Grimes
- Public Health Agency of Northern Ireland, Belfast, United Kingdom
| | - Maria Teresa Tomás
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Beatriz Fernandes
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Laura Calzà
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Speranza
- General Affairs Unit, Federico II University Hospital, Naples, Italy
| | - Liliana Coppola
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Rónán O'Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Joao Apostolo
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - William Molloy
- Clinical Gerontology and Rehabilitation Centre, Gerontology and Rehabilitation School of Medicine, University College of Cork, Cork, Ireland
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Maddalena Illario
- Health Innovation Division, General Directorate for Health, Naples, Italy
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Lehoux P, Miller FA, Grimard D, Gauthier P. Anticipating health innovations in 2030-2040: Where does responsibility lie for the publics? Public Underst Sci 2018; 27:276-293. [PMID: 28795612 DOI: 10.1177/0963662517725715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Considering that public engagement is pivotal to the mission of Responsible Research and Innovation, this article's aim is to examine how members of the public conceive of the relationship between responsibility and prospective health technologies. We organized four face-to-face deliberative workshops and an online forum wherein participants were invited to comment on scenarios involving three fictional technologies in 2030 and 2040. Our analyses describe how participants anticipated these technologies' impacts and formulated two conditions for their use: they should (1) be embedded within professional care and services and (2) include social protection of individual freedom and privacy. By clarifying what technological direction shall be avoided and who shall act responsibly, these conditions emphasize our participants' understanding of society as much as their understanding of science. For new technologies to be deployed in socially responsible ways, public engagement methods should be developed alongside public governance and regulatory strategies.
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Affiliation(s)
- Pascale Lehoux
- University of Montreal, Canada
- University of Montreal, Canada
| | - Fiona A Miller
- University of Toronto, Canada
- University of Montreal, Canada
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Abstract
Innovation policy often focuses on fortifying the incentives of firms that develop and sell new products by offering them lucrative rights to exclude competitors from the market. Regulators also rely on these same firms-and on similar incentives-to develop information about the effects of their products in patients, despite their obvious conflict of interest. The result may be a distorted understanding that leads to overuse of expensive new medical technologies. Recent technological advances have put healthcare payers in an excellent position to play a larger role in future innovation to improve healthcare and reduce its costs. Insurance companies and integrated healthcare providers have custody of treasure troves of data about healthcare provision and outcomes that can yield valuable insights about the effects of medical treatment without the need to conduct costly clinical trials. Some integrated healthcare systems have seized upon this advantage to make notable discoveries about the effects of particular products that have changed the standard of care. Moreover, to the extent that healthcare payers can profit from reducing costs, they will seek to avoid inappropriate use of costly technologies. Greater involvement of payers in healthcare innovation thus offers a potential counterweight to the incentives of product sellers to promote excessive use of costly new products. In recent years, the federal government has sought to promote innovation through analysis of healthcare records in a series of initiatives; some picture insurers as passive data repositories, while others provide opportunities for insurers to take a more active role in innovation. In this paper, we examine the role of health insurers in developing new knowledge about the provision and effects of healthcare-what we call 'demand-side innovation'. We address the contours of this underexplored area of innovation and describe the behavior of participating firms. We examine the effects of current legal rules on demand-side innovation, including insurance regulation, intellectual property rules, privacy protections, and FDA regulation of new healthcare technologies. Throughout, we highlight many policy tools that government can use and is using to facilitate payer innovation outside the traditional toolkit of patents and exclusive rights.
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Anticona Huaynate CF, Pajuelo Travezaño MJ, Correa M, Mayta Malpartida H, Oberhelman R, Murphy LL, Paz-Soldan VA. Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru. BMC Health Serv Res 2015; 15:454. [PMID: 26438342 PMCID: PMC4595324 DOI: 10.1186/s12913-015-1114-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. METHODS Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. RESULTS Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. CONCLUSIONS MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients' travel to distant health facilities. Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.
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Affiliation(s)
- Cynthia Fiorella Anticona Huaynate
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Monica Jehnny Pajuelo Travezaño
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Malena Correa
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Holger Mayta Malpartida
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
- Department of Global Community Health & Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2301, New Orleans, LA, 70112, USA.
| | - Richard Oberhelman
- Universidad Peruana Cayetano Heredia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado, 430. SMP., Lima, Peru.
| | - Laura L Murphy
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
| | - Valerie A Paz-Soldan
- Department of Global Health Systems & Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
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Abstract
Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs' design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.
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Affiliation(s)
- Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Malaysia
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Chaudoir SR, Dugan AG, Barr CHI. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci 2013; 8:22. [PMID: 23414420 PMCID: PMC3598720 DOI: 10.1186/1748-5908-8-22] [Citation(s) in RCA: 472] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 02/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles. METHOD We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. RESULTS Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). DISCUSSION In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation-related constructs in their ongoing and future research.
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Affiliation(s)
- Stephenie R Chaudoir
- Department of Psychology, College of the Holy Cross, 1 College St., Worcester, MA, 01610, USA
- Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Alicia G Dugan
- Connecticut Institute for Clinical and Translational Science, University of Connecticut, Dowling South, Suite 1030, UConn Health Center, 263 Farmington Ave, MC 6233, Farmington, CT, 06030-6233, USA
- Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Colin HI Barr
- Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
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