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IntroductionDevelopments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.PurposeTo assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.MethodsWe will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings’ website.

Objective To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes. Methods This comparative cross-sectional study was done at a tertiary care teaching institute. We enrolled all hospitalized children aged 1 month–18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma. Results During the study period 34 cases of MIS-C and 83 cases of Dengue fever were enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. MIS-C with shock was seen in 15 cases (44%), MIS-C without shock in 17 cases (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients [100.2 (85.1) vs 16.9 (29.3) mg/dL] (P

Objective:A high-fibre diet is associated with a lower risk for diseases. However, few adults meet the dietary fibre recommendation. Therefore, the effects and acceptance of an algorithm-generated personalised dietary advice (PDA) compared with general advice (GA) on fibre intake were investigated.Design:A 6-week, single-blind randomised controlled trial with a 3-month follow-up.Setting:PDA was based on habitual intake and provided fibre-rich alternatives using a website; GA contained brochures. Dietary intake was assessed at baseline, week 1, week 6 and 3-month follow-up. Both groups evaluated their advice at week 6. All participants had access to PDA from week 7 until 3-month follow-up.Participants:Two groups of healthy adults: PDA (n 34) and GA (n 47). For 3-month follow-up analysis, participants were re-divided into visitors (n 52) and non-visitors (n 26) of the PDA.Results:At week 6, energy intake remained stable in both groups, but fibre intake per 1000 kcal increased non-significantly in both groups (PDA = Δ0·5 ± 2·8; GA = Δ0·8 ± 3·1, P = 0·128). Importantly, a significantly higher percentage of PDA participants adhered to the recommendation compared with week 1 (PDA = 21 % increase; GA = 4 % increase, P ≤ 0·001). PDA participants evaluated the advice significantly better compared with GA participants. At 3-month follow-up, fibre intake increased compared with baseline (visitors = Δ2·2 ± 2·6, P < 0·001; non-visitors = Δ1·5 ± 1·9, P = 0·001), but was insignificantly different between groups. Visitors had a decrease and non-visitors had an increase in energy intake (visitors =Δ − 132 ± 525; non-visitors = Δ109 ± 507, P = 0·055).Conclusions:The algorithm-generated PDA was well accepted and stimulated adherence to the recommendations more than GA, indicating to be a suitable and cost-efficient method for improving dietary fibre intake in healthy adults.

Background Health services in many countries are promoting digital-first models of access to general practice based on offering online, video, or telephone consultations before a face-to-face consultation. It is claimed that this will improve access for patients and moderate the workload of doctors. However, improved access could also potentially increase doctors’ workload. Objective The aim of this study was to explore whether and under what circumstances digital-first access to general practice is likely to decrease or increase general practice workload. Methods A process map to delineate primary care access pathways was developed and a model to estimate general practice workload constructed in Microsoft Excel (Microsoft Corp). The model was populated using estimates of key variables obtained from a systematic review of published studies. A MEDLINE search was conducted for studies published in English between January 1, 2000, and September 30, 2019. Included papers provided quantitative data about online, telephone, or video consultations for unselected patients requesting a general practice in-hours consultation for any problem. We excluded studies of general practitioners consulting specialists, consultations not conducted by doctors, and consultations conducted after hours, in secondary care, in specialist services, or for a specific health care problem. Data about the following variables were extracted from the included papers to form the model inputs: the proportion of consultations managed digitally, the proportion of digital consultations completed without a subsequent consultation, the proportion of subsequent consultations conducted by telephone rather than face-to-face, consultation duration, and the proportion of digital consultations that represent new demand. The outcome was general practice workload. The model was used to test the likely impact of different digital-first scenarios, based on the best available evidence and the plausible range of estimates from the published studies. The model allows others to test the impact on workload of varying assumptions about model inputs. Results Digital-first approaches are likely to increase general practice workload unless they are shorter, and a higher proportion of patients are managed without a subsequent consultation than observed in most published studies. In our base-case scenarios (based on the best available evidence), digital-first access models using online, telephone, or video consultations are likely to increase general practitioner workload by 25%, 3%, and 31%, respectively. An important determinant of workload is whether the availability of digital-first approaches changes the demand for general practice consultations, but there is little robust evidence to answer this question. Conclusions Digital-first approaches to primary care could increase general practice workload unless stringent conditions are met. Justification for these approaches should be based on evidence about the benefits in relation to the costs, rather than assumptions about reductions in workload. Given the potential increase in workload, which in due course could worsen problems of access, these initiatives should be implemented in a staged way alongside careful evaluation.

Background The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

Background Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward.

BackgroundNews media coverage of antimask protests, COVID-19 conspiracies, and pandemic politicization has overemphasized extreme views but has done little to represent views of the general public. Investigating the public’s response to various pandemic restrictions can provide a more balanced assessment of current views, allowing policy makers to craft better public health messages in anticipation of poor reactions to controversial restrictions.ObjectiveUsing data from social media, this infoveillance study aims to understand the changes in public opinion associated with the implementation of COVID-19 restrictions (eg, business and school closures, regional lockdown differences, and additional public health restrictions, such as social distancing and masking).MethodsCOVID-19–related tweets in Ontario (n=1,150,362) were collected based on keywords between March 12 and October 31, 2020. Sentiment scores were calculated using the VADER (Valence Aware Dictionary and Sentiment Reasoner) algorithm for each tweet to represent its negative to positive emotion. Public health restrictions were identified using government and news media websites. Dynamic regression models with autoregressive integrated moving average errors were used to examine the association between public health restrictions and changes in public opinion over time (ie, collective attention, aggregate positive sentiment, and level of disagreement), controlling for the effects of confounders (ie, daily COVID-19 case counts, holidays, and COVID-19–related official updates).ResultsIn addition to expected direct effects (eg, business closures led to decreased positive sentiment and increased disagreements), the impact of restrictions on public opinion was contextually driven. For example, the negative sentiment associated with business closures was reduced with higher COVID-19 case counts. While school closures and other restrictions (eg, masking, social distancing, and travel restrictions) generated increased collective attention, they did not have an effect on aggregate sentiment or the level of disagreement (ie, sentiment polarization). Partial (ie, region-targeted) lockdowns were associated with better public response (ie, higher number of tweets with net positive sentiment and lower levels of disagreement) compared to province-wide lockdowns.ConclusionsOur study demonstrates the feasibility of a rapid and flexible method of evaluating the public response to pandemic restrictions using near real-time social media data. This information can help public health practitioners and policy makers anticipate public response to future pandemic restrictions and ensure adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed, but controversial, restrictions.

Background The Neonatal Tetanus Surveillance System (NTSS) in Yemen was established in 2009 to identify high-risk areas, determine trends, and evaluate elimination activities. Since its launch, the NTSS had never been evaluated. Objective This study aimed to assess the performance of NTSS and determine its strengths and weaknesses to recommend improvements. Methods The US Centers for Disease Control and Prevention (CDC) guidelines were used for evaluating the NTSS. Stakeholders at the central, district, and facility levels were interviewed to rate the attributes of the NTSS. The percentage scores for attributes were ranked as poor ( Results The overall usefulness score percentage was 38%, which indicates a poor performance. The performance of the NTSS was rated as average on flexibility (score percent: 68%) and acceptability (score percent: 64%) attributes and poor on stability (score percentage: 33%), simplicity (score percentage: 57%), and representativeness (score percentage: 39%) attributes. About 65% of investigation forms were completed within 48 hours of notification date. Data quality was poor, as 41% of the core variables were missing. Conclusions The overall performance of the NTSS was poor. Most of the system attributes require improvement, including stability, simplicity, quality of data, and completeness of investigation. To improve the performance of NTSS, the following are recommended: capacity building of staff (focal points), strengthening NTSS through technical support and government funding to ensure its sustainability, establishing electronic investigation forms for improving the system data quality, and expansion of NTSS coverage to include all private health care facilities.

BackgroundHuman papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV attributes to most cancers including anal, oral, cervical, and penile. Despite infection rates in the United States, recommendations and communication campaigns have traditionally focused on females. Because of this, males lack knowledge about reasons for vaccination, the benefits of being vaccinated, and their HPV risk, overall. Gaming as a health education strategy can be beneficial as mechanism that can promote behavior change for this key demographic because of the popularity of gaming.ObjectiveWe sought to explore the relationship between gamification and HPV vaccine uptake.MethodsInterviews were conducted with experts (n=22) in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology, and health communication on how a game should be developed to increase HPV vaccination rates among males.ResultsOverwhelmingly, theoretical models such as the health belief model were identified with key constructs such as self-efficacy and risk perception. Experts also suggested using intervention mapping and logic models as planning tools for health promotion interventions utilizing a digital game as a medium. In game and out of game measures were discussed as assessments for quality and impact by our expert panel.ConclusionsThis study shows that interventions should focus on whether greater utilization of serious games, and the incorporation of theory and standardized methods, can encourage young men to get vaccinated and to complete the series of HPV vaccinations.

Background The Symptom Assessment and Management (SAM) program is a structured, online, nurse-supported intervention to support symptom self-management in people receiving adjuvant chemotherapy post surgery for breast or colorectal cancer. Objective The objective of this study was to describe the development, implementation strategy, and evaluation of the SAM system. Methods The development of the SAM program involved 3 phases. In phase 1, the web app was developed through consultation with consumers and clinicians and of the literature to ensure that the system was evidence-based and reflected the realities of receiving treatment and supporting patients through treatment. In phase 2, 7 participants recorded the severity of 6 symptoms daily over the course of 1 cycle of chemotherapy. In phase 3, 17 participants recorded their symptoms daily over the course of 3 cycles of chemotherapy. Once symptoms were recorded, participants received immediate feedback on the severity of their symptoms and self-management recommendations, which could include seeking immediate medical attention. Data on quality of life, symptom burden, anxiety and depression, distress, and self-efficacy were collected during treatment; participants’ perceptions of the SAM program were evaluated following participation via interview. Results The outcomes of the SAM project include the development of a system that is reliable and easy to use and navigate. Participants reported benefits related to using the SAM program that included feeling more in control of managing their symptoms and feeling reassured. Engagement with the system on a daily basis was variable, with some participants completing the symptom tracker daily and others engaging some of the time. The feedback from all participants was that the system was easy to navigate and the information was relevant and supportive. Conclusions The SAM program has the potential to enhance the management of symptoms for people receiving chemotherapy treatment. The system creates an accurate repository of symptoms that can be accessed easily and highlight patterns in symptom experience. These can be shared with clinicians, with patient permission, to inform and support treatment plans. The potential to predict the risk of developing severe symptoms can be developed to anticipate the need for care and support. Further considerations on how to increase engagement with the system, the value of the system for people diagnosed with other tumor types and treatment regimes, and the incorporation of the system into everyday clinical practice are needed.

Background: The aim of this study was to describe the epidemiology of prelabour rupture of membranes (PROM) in China and to assess the association between clinical practice following the guidelines and early neonatal infections. Methods: We conducted a prospective cohort study of 15926 deliveries in ShenZhen Baoan Women's and Children's Hospital, Xibei Women's and Children's Hospital and Chengdu Women's and Children's Hospital between August 1, 2017, to March 31, 2018. Clinical data were collected for each participant. The epidemiology of PROM was described. The association between PROM with early neonatal infectious outcomes and the influence of the implementation of the guideline on early neonatal infectious outcomes were assessed. Findings: The incidence of PROM was 18•7%. PROM was showed to be a risk factor for neonatal infectious diseases (adjusted OR 1•92, 95%CI 1•49~2•49, p

Background Public involvement adds value to numerous aspects of health research, yet few studies have attempted to evaluate its impact on research. Evidence of such impact is needed to develop recommendations for best practice and ensure adequate resourcing.Aim To evaluate public involvement within a large interdisciplinary Science, Technology, Engineering and Mathematics (STEM) research project that focused on digital health.Methods The evaluation was conducted with members of the project’s Public Advisory Groups (PAG) and with researchers who had participated in involvement activities. Two questionnaires were designed based on a public involvement value systems and clusters framework.Results Responses from members of the PAG (n=10) were mostly positive towards normative values, which include moral, ethical, and political aspects of involvement in research, and towards values concerning the conduct of public involvement and best practices. Researchers’ responses (n=16) indicated they felt that involvement was generally effective and increased the quality, relevance, and generalisability of their work. However, their responses about the validity of involvement in research were varied. They also highlighted several challenges including how well public involvement impacted on research, how decisions made in the research might differ from the views generated from public involvement, and barriers to researchers’ participation.Discussion and conclusion Our evaluation suggests that members of the public and the researchers value involvement. However, there is need to consider how to embed public involvement to an even greater extent in STEM contexts and a need to address any barriers for researchers’ own involvement.

Background Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising.

Background The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

Heart failure is a complex disease with poor outcome. This complexity may prevent care providers from covering all aspects of care. This could not only be relevant for individual patient care, but also for care organisation. Disease management programmes applying a multidisciplinary approach are recommended to improve heart failure care. However, there is a scarcity of research considering how disease management programme perform, in what form they should be offered, and what care and support patients and care providers would benefit most. Therefore, the Improving kNowledge Transfer to Efficaciously Raise the level of Contemporary Treatment in Heart Failure (INTERACT-in-HF) study aims to explore the current processes of heart failure care and to identify factors that may facilitate and factors that may hamper heart failure care and guideline adherence. Within a cross-sectional mixed method design in three regions of the North-West part of Europe, patients (n = 88) and their care providers (n = 59) were interviewed. Prior to the in-depth interviews, patients were asked to complete three questionnaires: The Dutch Heart Failure Knowledge scale, The European Heart Failure Self-care Behaviour Scale and The global health status and social economic status. In parallel, retrospective data based on records from these (n = 88) and additional patients (n = 82) are reviewed. All interviews were audiotaped and transcribed verbatim for analysis.

Background Health system reform is essential to make desired Changes. In Iran, first phase of Health Reform Plan (HRP) was implemented in hospitals affiliated with Ministry of Health and Medical Education (MHME) in 2014. Aim The present study was carried out to evaluate the performance of hospitals affiliated with Urmia University of Medical Sciences at the time of the implementation of HRP. Methods This cross-sectional study carried out in two stages, before (2012- 2013) and during (2014- 2015) implementation of the HRP in district and teaching hospitals. Data collection and evaluation of performance of hospitals was performed using indices issued by MHME using graphical and statistical analysis. Results Average bed occupancy rate and bed turnover rate increased and the average length of stay decreased in the majority of hospitals during the study period. The highest and lowest bed occupancy rate was observed in district hospitals. All hospitals were shifted toward the third zone in Pabon Lasso (PL) diagram. Conclusion This study confirmed that the implementation of the defined package of HRP in hospitals affiliated with UUMS resulted in increased admissions and hospitalization and improved performance.

International audience; Background: Pain management in emergency departments is a complex objective. The absence of a care pathway or a high level of activity complicates diagnostic or analgesic therapeutic strategies. Medical innovation can impact both individual practices and the functioning of an emergency department.Objective: We then wanted to understand how medico-economic studies on pain were carried out in an emergency department.Study design: We reviewed the literature of the last 20 years (between 1998 and 2018).Setting: Of 846 titles screened, a total of 268 abstracts qualified for further screening, and 578 titles were excluded. A total of 14 studies qualified for inclusion in the review. Studies on medico-economics in an emergency department are very diverse. None of the methods used are identical; the studies differ in their very nature (prospective, retrospective, cost-effectiveness, etc.) and the determination of emergency room costs differs according to the part of the world studied. In addition, organizational impact is rarely measured, although it is an essential dimension for choosing or not a medical innovation.

Background: Facebook is increasingly being used as part of mass media campaigns in public health, including the Make Healthy Normal (MHN) campaign in New South Wales, Australia. Therefore, it is important to understand what role Facebook can play in mass media campaigns and how best to use it to augment or amplify campaign effects. However, few studies have explored this. Objective: This study aimed to investigate usage of and engagement with the MHN Facebook page and to identify influential factors in driving engagement with the page. Methods: We examined both post-level and page-level analytic data from Facebook from the campaign’s launch in June 2015 to September 2017. For post-level data, we conducted a series of negative binomial regressions with four different outcome measures (likes, shares, comments, post consumers), including some characteristics of Facebook posts as predictors. We also conducted time series analyses to examine associations between page-level outcomes (new page likes or “fans” and number of engaged users) and different measures of exposure to the page (number of unique users reached and total count of impressions) and to television advertising. Results: Of the 392 posts reviewed, 20.7% (n=81) received a paid boost and 58.9% (n=231) were photo posts. We found that posts that received a paid boost reached significantly more users and subsequently received significantly more engagement than organic (unpaid) posts (P

BackgroundThe task of monitoring and managing the entire emergency department (ED) is becoming more important due to increasing pressure on the ED. Recently, dashboards have received the spotlight as health information technology to support these tasks. ObjectiveThis study aimed to describe the development of a real-time autonomous dashboard for the ED and to evaluate perspectives of clinical staff on its usability. MethodsWe developed a dashboard based on three principles—“anytime, anywhere, at a glance;” “minimal interruption to workflow;” and “protect patient privacy”—and 3 design features—“geographical layout,” “patient-level alert,” and “real-time summary data.” Items to evaluate the dashboard were selected based on the throughput factor of the conceptual model of ED crowding. Moreover, ED physicians and nurses were surveyed using the system usability scale (SUS) and situation awareness index as well as a questionnaire we created on the basis of the construct of the Situation Awareness Rating Technique. ResultsThe first version of the ED dashboard was successfully launched in 2013, and it has undergone 3 major revisions since then because of geographical changes in ED and modifications to improve usability. A total of 52 ED staff members participated in the survey. The average SUS score of the dashboard was 67.6 points, which indicates “OK-to-Good” usability. The participants also reported that the dashboard provided efficient “concentration support” (4.15 points), “complexity representation” (4.02 points), “variability representation” (3.96 points), “information quality” (3.94 points), and “familiarity” (3.94 points). However, the “division of attention” was rated at 2.25 points. ConclusionsWe developed a real-time autonomous ED dashboard and successfully used it for 5 years with good evaluation from users.

BACKGROUND AND PURPOSE: One of the most common ways used in most of the countries and Iran to determine the status of teacher training is the evaluation by students. The most common method of evaluation is the survey questionnaire, the content of a number of questions about educational activities provided to the students. The researchers plan to evaluate the students' and experts' performances at Mazandaran University of Medical Sciences on the process of evaluating the performance of teachers, they examined in 2014. MATERIALS AND METHODS: This study surveys the students and experts in the evaluation of faculty members' performance process. The study subjects were 3904 students and 37 evaluation expert of Mazandaran University of Medical Sciences. Using Cochran sampling formula of 350 students through proportional stratified random sampling were selected. The experts' viewpoint, method was used. Data collection tools consisted of 14 questions with answers Yes, or, I don't know. Descriptive Statistical analysis of the data and chi-square test was performed. RESULTS: From total of 350 students, 346 and the entire 37 evaluations expert participated in this study. Most of the students, 80 (23.12%) and the largest number of experts, 8 (21.62%) were from Sari Allied Medical Sciences Faculty. Most of the demographic information about gender were, 255 female students (74.56%) and 29 female experts (78.37%). In most age groups of students, 188 (55.62 percent) were in the category of 18 to 20 years, and the experts, 19 (51.35%) were in the category of 22 and 31 years. Most students, 232 of them (70.95%) were in semester 2 and 4. Most experts, 20 (54.05 percent) were under 10 years of work experience. The comparison between the views of students and experts in the evaluation process between the schools of Mazandaran University of Medical Sciences, Sari School of Nursing and Midwifery, there was difference between the opinions of experts and students (p-value=0.01. It showed 86.7% student and 33.3% of experts is satisfied with the evaluation process. CONCLUSION: on comparison of students and experts viewpoints on the implementation of the evaluation process, it is noteworthy that among students of different opinions on how the evaluation process. It worth to mention that there is insignificant difference between their viewpoints and majority of students and evaluation experts with the evaluation the process. In addition, the experts evaluated at different schools, most of them are satisfied the process.

Introduction: Scuba diving represents a combination of exercise and changes in environmental conditions. This study aimed to evaluate changes in haematological parameters after recreational scuba diving in order to identify clinically significant changes. Materials and methods: The study included males, 17 recreational divers, median age (range) 41(30-52) years. Blood samples were taken before diving, immediately after diving to 30 meters for 30 minutes, 3 hours and 6 hours after diving. Complete blood counts were analyzed on the Cell Dyn Ruby haematology analyzer. Statistical significance between successive measurements was tested using Friedman test. The difference between the two measurements was judged against desirable bias (DSB) derived from biological variation and calculated reference change values (RCV). The difference higher than RCV was considered clinically significant. Results: A statistically significant increase and difference judging against DSB was observed: for neutrophils immediately, 3 and 6 hours after diving (18%, 34% and 36%, respectively), for white blood cells (WBCs) 3 and 6 hours after diving (20% and 25%, respectively), for lymphocytes (20%) and monocytes (23%) 6 hours after diving. A statistically significant decrease and difference judging against DSB was found: immediately after diving for monocytes (- 15%), 3 and 6 hours after diving for red blood cells (RBCs) (- 2.6% and -2.9%, respectively), haemoglobin (- 2.1% and - 2.8%, respectively) and haematocrit (- 2.4% and - 3.2%, respectively). A clinically significant change was not found for any of the test parameters when compared to RCV. Conclusions: Observed statistically significant changes after recreational scuba diving; WBCs, neutrophils, lymphocytes, monocytes increase and RBCs, haemoglobin, haematocrit decrease, probably will not affect clinical decision.

Introduction Although serum-providing blood tubes with a barrier are still widely used due to their significant advantages, the use of blood tubes with a barrier to provide plasma is becoming widespread. We compared 22 analytes in a BD Vacutainer® Barricor LH Plasma tube for local clinical validation of this new lithium heparin tube with a barrier. Materials and methods Samples from 44 volunteers were collected in different tubes (Becton Dickinson and Company): Z tube without additive (reference), clot-activator tube with gel (SST), lithium heparin tube without gel (LiH), and lithium heparin tube with barrier (Barricor). Analyte concentrations in different tubes were compared with the reference tube. All tubes were also evaluated according to additional testing (different centrifugation durations, blood-sampling techniques and individual differences). Results Aspartate aminotransferase (AST), glucose (Glc), potassium (K), lactate dehydrogenase (LD), sodium (Na), and total protein (TP) had a significant bias in Barricor (9.19%, - 3.24%, - 4.88%, 21.60%, - 0.40%, 5.03%, respectively) relative to the reference tube. There was no statistical difference between different centrifugation durations and individual differences for AST, K and LD in LiH and/or Barricor (P > 0.05). There was a significant bias for LD between LiH and Barricor in terms of blood-sampling techniques (21.2% and 12.4%, respectively). Conclusions Recently, the use of plasma has become prominent due to some of its advantages. In this study, plasma AST, K, LD, Glc and TP levels in Barricor were clinically different in comparison to serum. The results of additional tests showed that higher levels of LD in Barricor did not result from haemolysis, and they might be related to other factors including number of platelets, cellular fragility, or functional environment.

Background A longstanding barrier to progress in psychiatry, both in clinical settings and research trials, has been the persistent difficulty of accurately and reliably quantifying disease phenotypes. Mobile phone technology combined with data science has the potential to offer medicine a wealth of additional information on disease phenotypes, but the large majority of existing smartphone apps are not intended for use as biomedical research platforms and, as such, do not generate research-quality data. Objective Our aim is not the creation of yet another app per se but rather the establishment of a platform to collect research-quality smartphone raw sensor and usage pattern data. Our ultimate goal is to develop statistical, mathematical, and computational methodology to enable us and others to extract biomedical and clinical insights from smartphone data. Methods We report on the development and early testing of Beiwe, a research platform featuring a study portal, smartphone app, database, and data modeling and analysis tools designed and developed specifically for transparent, customizable, and reproducible biomedical research use, in particular for the study of psychiatric and neurological disorders. We also outline a proposed study using the platform for patients with schizophrenia. Results We demonstrate the passive data capabilities of the Beiwe platform and early results of its analytical capabilities. Conclusions Smartphone sensors and phone usage patterns, when coupled with appropriate statistical learning tools, are able to capture various social and behavioral manifestations of illnesses, in naturalistic settings, as lived and experienced by patients. The ubiquity of smartphones makes this type of moment-by-moment quantification of disease phenotypes highly scalable and, when integrated within a transparent research platform, presents tremendous opportunities for research, discovery, and patient health.

Background: Advancements in mobile phone technology have led to the development of smartphones with the capability to run apps. The availability of a plethora of health- and fitness-related smartphone apps has the potential, both on a clinical and public health level, to facilitate healthy behavior change and weight management. However, current top-rated apps in this area have not been extensively evaluated in terms of scientific quality and behavioral theory evidence base. Objective: The purpose of this study was to evaluate the quality of the most popular dietary weight-loss smartphone apps on the commercial market using comprehensive quality assessment criteria, and to quantify the behavior change techniques (BCTs) incorporated. Methods: The top 200-rated Health & Fitness category apps from the free and paid sections of Google Play and iTunes App Store in Australia (n=800) were screened in August 2014. To be included in further analysis, an app had to focus on weight management, include a facility to record diet intake (self-monitoring), and be in English. One researcher downloaded and used the eligible apps thoroughly for 5 days and assessed the apps against quality assessment criteria which included the following domains: accountability, scientific coverage and content accuracy of information relevant to weight management, technology-enhanced features, usability, and incorporation of BCTs. For inter-rater reliability purposes, a second assessor provided ratings on 30% of the apps. The accuracy of app energy intake calculations was further investigated by comparison with results from a 3-day weighed food record (WFR). Results: Across the eligible apps reviewed (n=28), only 1 app (4%) received full marks for accountability. Overall, apps included an average of 5.1 (SD 2.3) out of 14 technology-enhanced features, and received a mean score of 13.5 (SD 3.7) out of 20 for usability. The majority of apps provided estimated energy requirements (24/28, 86%) and used a food database to calculate energy intake (21/28, 75%). When compared against the WFR, the mean absolute energy difference of apps which featured energy intake calculations (23/28, 82%) was 127 kJ (95% CI -45 to 299). An average of 6.3 (SD 3.7) of 26 BCTs were included. Conclusions: Overall, the most popular commercial apps for weight management are suboptimal in quality, given the inadequate scientific coverage and accuracy of weight-related information, and the relative absence of BCTs across the apps reviewed. With the limited regulatory oversight around the quality of these types of apps, this evaluation provides clinicians and consumers an informed view of the highest-quality apps in the current popular app pool appropriate for recommendation and uptake. Further research is necessary to assess the effectiveness of apps for weight management. [JMIR Mhealth Uhealth 2015;3(4):e104]

We complement the empirical evidence on the sustainability of weight loss achieved through cash rewards and, for the first time, rigorously examine the potential of cash rewards to prevent weight cycling. In a three period randomized controlled trial, about 700 obese persons were first assigned to two treatment groups, which were promised cash contingent on the achievement of an individually assigned target weight, and to a control group. Successful participants were subsequently allocated to two treatment groups offered cash rewards for confirming the previously achieved target weight and to a control group. This is the first experiment of this kind that finds effects of weight loss rewards up to 18 months after they were removed. Additional rewards only significantly improve the sustainability of weight loss while they are in place. Die empirische Analyse untersucht zum einen die Nachhaltigkeit einer Gewichtsreduktion, die mittels Geldanreizen erzielt wurde, und zum anderen die Wirksamkeit von Geldanreizen zur Verhinderung des Jo-Jo-Effekts nach einer erfolgreichen Gewichtsreduktion. In einem drei-phasigen Feldexperiment wurden ca. 700 fettleibige Teilnehmer zunächst zufällig auf zwei Anreizgruppen und einer Kontrollgruppe verteilt. Unabhängig von der Gruppenzugehörigkeit sollten ein individuelles Gewichtsreduktionziel erreicht werden, wobei nur Mitglieder der Anreizgruppen eine Geldprämie für das Erreichen des Zieles erhalten konnten. Erfolgreiche Teilnehmer wurden danach erneut zufällig einer Kontrollgruppe und zwei Anreizgruppen zugewiesen, wobei das Halten des Zielgewichts nur für letztere durch eine Geldprämie inzentiviert wurde. Anders als in früheren Experimenten, können Effekt der Abnehmprämie selbst 18 Monate nach ihrem Auslaufen nachgewiesen werden. Monetäre Anreize zur Verhinderung des Jo-Jo-Effekt wirken hingegen nicht über ihr Auslaufen hinaus.