Qual Life Res. 2024 Dec 11. doi: 10.1007/s11136-024-03864-0. Online ahead of print.

ABSTRACT

OBJECTIVES: Little is known about the efficacy of remotely delivered outcome measures (psychological/health-related assessments) in a signed language for Deaf people. The objective is to explore the equivalence of two modes of remote delivery of health-related quality of life outcome measures in British Sign Language (BSL): asynchronous online assessment versus synchronous live face-to-face online assessment in sign language.

METHODS: Thirty-one participants were recruited through Deaf networks and sign language media. Measures used were validated BSL versions of the EQ-5D-5L, EQ-VAS and CORE-10. A randomised, crossover trial was conducted between March and May 2023 with seventeen first receiving asynchronous assessment and sixteen first receiving synchronous live online assessment. This study explored whether the outcomes of the two assessments are equivalent regardless of modality of delivery. Demographic data were collected, and eight participants took part in semi-structured qualitative interviews exploring modality preferences and the impact of each modality.

RESULTS: The mean difference between pre-recorded and live modes was 0.034 for EQ-5D-5L BSL (90% CI 0.015-0.051), 4.33 mean difference for EQ-VAS BSL (90% CI 0.697-8.083), and mean difference of 0.17 for CORE-10 BSL (90% CI - 1.4065 to 1.1775). The confidence intervals for each of the EQ-5D-5L BSL, EQ-VAS BSL, and CORE-10 BSL lie within the prespecified equivalence margins which suggested that the two modes are equivalent.

CONCLUSION: The results demonstrate that EQ-5D-5L BSL, EQ-VAS BSL, and CORE-10 BSL may be considered as equivalent across modes of remote delivery. This further strengthens the validation of existing standardised assessments in BSL. A BSL version of the abstract is available in Supplementary Video 1.

PMID:39658723 | DOI:10.1007/s11136-024-03864-0

Skeletal Radiol. 2024 Dec 10. doi: 10.1007/s00256-024-04850-w. Online ahead of print.

ABSTRACT

Antihistamines, such as diphenhydramine, are active ingredients of a wide variety of antiallergics, sedatives, and sleep preparations and are often abused for purposes of euphoric effects or suicidal attempts. Antihistaminic overdose presents with symptoms of increased anticholinergic activity including urinary retention, mydriasis, and dry mucous membranes. However, antihistamine-induced rhabdomyolysis is a rare condition that presents with widespread skeletal muscle breakdown and release of metabolites into the circulation, resulting in myalgias and acute kidney injury. In this article, we report a rare case of rhabdomyolysis following the ingestion of a large quantity of diphenhydramine for a suicide attempt, who also presented with significantly elevated creatine kinase and acute renal injury. To our knowledge, this is the first case report of diphenhydramine rhabdomyolysis with MRI findings' correlation.

PMID:39658588 | DOI:10.1007/s00256-024-04850-w

J Formos Med Assoc. 2024 Dec 9:S0929-6646(24)00558-8. doi: 10.1016/j.jfma.2024.11.021. Online ahead of print.

ABSTRACT

Yunlin County, Taiwan, faces healthcare challenges given its super-aged population, limited medical accessibility, and a rise in chronic wounds. To address these issues, we introduced the "Fight Out to CARE" project, dispatching wound nurses to patients' locations to perform Cleansing, Avoidance, Removal, and Enhancement (CARE) under tele-supervision from a plastic surgeon. The program was conducted weekly in 2018 and twice monthly in 2019 for 53 weeks. We included 189 patients with 349 wounds in 17 homes and 17 long-term care facilities across 11 towns. Pressure injuries (PIs) comprised 67% of all wounds, with 96% of PIs categorized as full-thickness (FTPIs), including Stage 3, Stage 4, and Unstageable. Overall, 174 wounds healed, with 43% of PIs and 41% of FTPIs healed; 37% of PIs healed within 12 weeks. This innovative approach improved accessibility to chronic wound care and demonstrates promising healing outcomes, providing a valuable reference for chronic wound care policy.

PMID:39658417 | DOI:10.1016/j.jfma.2024.11.021

Saudi Med J. 2024 Dec;45(12):1374-1382. doi: 10.15537/smj.2024.45.12.20240672.

ABSTRACT

OBJECTIVES: To compare the effectiveness of providing telepharmacy anticoagulation to on-site clinics in achieving optimal outcomes for patients newly starting warfarin.

METHODS: This single-center retrospective cohort study included adult patients who started warfarin for the first time and were monitored by clinical pharmacists either on-site or via telepharmacy anticoagulation clinics between January 2017 and March 2024. The primary outcome is to compare the time in therapeutic range (TTR) between the 2 groups. The secondary outcome is the occurrence of anticoagulation therapy-related complications.

RESULTS: We included 191 patients, with 77 in the telepharmacy group and 114 in the on-site group. The baseline characteristics were similar for both groups. The primary outcome- time in therapeutic range (TTR)-was not significantly different between thetelepharmacy and the on-site groups (50% versus 53.8%, p=0.455) and remained so after univariable and multivariable adjustments (OR [odd ratio]= 0.63, p=0.14 and OR=0.58, p=0.102). Additionally, there were no significant differences in secondary outcomes, including thromboembolism and bleeding (p=1 for both).

CONCLUSION: This study demonstrates that patients who receive warfarin for the first time at an anticoagulation clinic can use the telepharmacy method without the fear undesirable outcomes. Results of this study support the continued use and expansion of telepharmacy services in Saudi Arabia. However, further research larger sample sizes and multiple centers is needed to confirm these findings.

PMID:39658120 | DOI:10.15537/smj.2024.45.12.20240672

Telemed J E Health. 2024 Dec 10. doi: 10.1089/tmj.2024.0397. Online ahead of print.

ABSTRACT

Background: Many neonatal intensive care units (NICUs) lack access to subspecialist consultants and may transfer patients requiring subspecialty care to referral facilities or seek informal consultation. The objective of this work was to evaluate the feasibility, acceptability, and impact of extending pediatric subspecialty services from a children's hospital to a level III NICU via teleconsultation and describe processes, facilitators, and challenges. Methods: Monitored consultations for 1 year and surveyed clinicians regarding feasibility, perceived benefits, and challenges. Results: Fifty-nine teleconsultations were conducted. NICU providers indicated improved care quality with subspecialty input. Subspecialists reported advantages of documenting, billing, and providing more complete care, but noted logistical strains. Both parties perceived better interdisciplinary communication. Conclusions: This teleconsultation service was feasible, generally acceptable, improved access to subspecialty services, and improved NICU clinicians' perceived care quality. Challenges included infrastructure development costs, workflow training time, logistics, and subspecialist patient volumes. This is among the first descriptions of a pediatric subspecialty teleconsultation service supporting a NICU.

PMID:39658022 | DOI:10.1089/tmj.2024.0397

J Psychiatr Pract. 2024 Nov 1;30(6):400-410. doi: 10.1097/PRA.0000000000000819.

ABSTRACT

Recently, the field of psychiatry has experienced a transformative shift with the integration of digital tools into traditional therapeutic approaches. Digital psychiatry encompasses a wide spectrum of applications, ranging from digital phenotyping, smartphone applications, wearable devices, virtual/augmented reality, and artificial intelligence (AI). This convergence of digital innovations has the potential to revolutionize mental health care, enhancing both accessibility and patient outcomes. However, despite significant progress in the field of digital psychiatry, its implementation presents a plethora of challenges and ethical considerations. Critical problems that require careful investigation are raised by issues such as data privacy, the digital divide, legal frameworks, and the dependability of digital instruments. Furthermore, there are potential risks and several hazards associated with the integration of digital tools into psychiatric practice. A better understanding of the growing field of digital psychiatry is needed to promote the development of effective interventions and improve the accuracy of diagnosis. The overarching goal of this review paper is to provide an overview of some of the current opportunities in digital psychiatry, highlighting both its potential benefits and inherent challenges. This review paper also aims at providing guidelines for future research and for the proper integration of digital psychiatry into clinical practice.

PMID:39655966 | DOI:10.1097/PRA.0000000000000819

J Psychiatr Pract. 2024 Nov 1;30(6):389-399. doi: 10.1097/PRA.0000000000000815.

ABSTRACT

PURPOSE OF REVIEW: Provider shortages and other barriers to traditional mental health care have led to the development of technology-based services designed to enhance access and improve the efficiency and convenience of treatment. We reviewed research on computer-assisted cognitive behavior therapy (CCBT) and mobile mental health applications to assess the effectiveness of these methods of delivering or augmenting treatment, evaluating patient and provider uptake, and making recommendations on the clinical use of these tools in the treatment of depression and anxiety.

RESULTS: Research on CCBT has found solid evidence for efficacy when the use of a therapeutic computer program is supported by a clinician or other helping professional. Lower levels of efficacy have been found when CCBT is used as a stand-alone treatment. Current CCBT programs have many desirable features; however, few of the current programs incorporate services such as artificial intelligence that have the potential to help improve communication with patients. An increasing number of mobile apps have been created that claim to be useful for depression and/or anxiety, yet caution is warranted before using most due to limited research on effectiveness, low retention rates, and other issues like safety concerns.

SUMMARY: Growth in the development of CCBT and mental health applications for depression/anxiety has provided several tools that could enhance treatment delivery. A large number of randomized, controlled trials have documented the effectiveness of CCBT, while research on mobile apps has been much less robust. The advantages and disadvantages of these digital technologies are identified, and recommendations are made for clinical use.

PMID:39655965 | DOI:10.1097/PRA.0000000000000815

Med Devices (Auckl). 2024 Dec 5;17:471-490. doi: 10.2147/MDER.S492389. eCollection 2024.

ABSTRACT

BACKGROUND: Patients who have experienced a cryptogenic stroke (CS) may benefit from extended monitoring and possible earlier detection of atrial fibrillation (AF), allowing for the timely initiation of appropriate pharmacotherapy.

OBJECTIVE: This economic study aimed to evaluate the clinical and cost outcomes of using mid-term cardiac monitors (referred to as "ePatch") versus ILR-only in post-CS patients in the UK, Netherlands (NL) and Sweden.

METHODS: An existing cost-minimization model was modified to fit healthcare settings in the UK, Netherlands and Sweden. The model's target population was composed of adult patients who had previously experienced a CS, but had no documented history of AF. The model compares the one-year direct medical costs between two groups: one group receiving wearable ePatch, the other group proceeding directly to ILR.

RESULTS: When applied to a group of 1,000 patients, the ePatch versus ILR approach resulted in cost savings, due to combination of reduced expenses and decreased modelled occurrence of recurrent strokes in all three countries studied. In the base case analysis, the cost savings per patient with detected AF for ePatch ranged from 3.4-6.0 times, depending on the country.

CONCLUSION: Utilizing ePatch extended wear Holter for mid-term ECG monitoring in CS patients represents a cost-saving alternative to monitoring with ILR. The cost savings were achieved by reducing device expenses and by prevention of recurrent strokes via earlier anticoagulation initiation. Preventing recurrent strokes in this population is highly significant, as it can lead to improved long-term health outcomes and reduced overall healthcare costs.

PMID:39655268 | PMC:PMC11626978 | DOI:10.2147/MDER.S492389

J Vitreoretin Dis. 2024 Dec 7:24741264241302858. doi: 10.1177/24741264241302858. Online ahead of print.

ABSTRACT

Purpose: To investigate how home optical coherence tomography (OCT) influences the clinical decision-making of retina specialists for the management of neovascular age-related macular degeneration (nAMD). Methods: In this retrospective imaging review, 15 retina specialists each evaluated 10 home OCT data segments from 29 eyes being treated for nAMD. Based on OCT data, indications were identified for when eyes should be treated, which antivascular endothelial growth factor should be used, and the specific retinal fluid and time thresholds for notification. Results: Withholding treatment was recommended in 64 (42.7%) of 150 data segments (95% CI, 34.7-50.6), whereas 100% of eyes received treatment on the last day of each data segment. Treatment was recommended in 86 cases (57.3%), with treatment occurring 7 or more days before the actual treatment was advised in 52 (60.5%) of 86 data segments. This earlier treatment would have prevented the accumulation of intraretinal fluid (IRF), subretinal fluid (SRF), and total retinal fluid for 69.1 nL, 162.2 nL, and 231.2 nL days. Retina specialists chose a different type of treatment agent in 35 (40%) of 86 cases. The following notification values were set: IRF, mean 9.8 ± 14.9 nL (median, 5; IQR, 5); SRF, mean 10.2 ± 16.1 nL (median, 5.5; IQR, 5); total retinal fluid, mean 15.2 ± 24.0 nL (median, 10; IQR, 5). The time-based notification interval was set at a mean of 34.7 ± 21.9 days (median, 30; IQR, 2). Conclusions: Home OCT-based decision-making by retina specialists differed substantially from actual clinical care. Home OCT has the potential to facilitate personalized care in nAMD.

PMID:39654701 | PMC:PMC11625398 | DOI:10.1177/24741264241302858

Iran Biomed J. 2024 Dec 1;28(7):51.

ABSTRACT

INTRODUCTION: Hypothyroidism is a common chronic disease that requires patients to have self-care skills such as maintaining a healthy diet, exercising, and following a daily medication regimen. Many patients need more knowledge and health literacy to manage their condition effectively. Using mobile health-based training applications or software could be beneficial in educating patients. Therefore, this study aimed to determine the impact of mobile health-based training on hypothyroid patients' knowledge and health literacy.

METHODS AND MATERIALS: In this semi-experimental study, 70 patients referred to the endocrinology clinics of Zahedan University of Medical Sciences in 1402 were selected and randomly assigned to intervention and control groups using available sampling methods and according to the Inclusion criteria. To collect information, we utilized a demographic and disease information form, as well as a health literacy and knowledge questionnaire. The data collection method employed was self-reporting. In addition to the standard training provided by the doctor, patients in the intervention group received a patient-centered management application specially designed for hypothyroidism. It was installed on their mobile phone, and the daily training message was uploaded to the application for one month. Three months after the training, a post-test was conducted on two groups. Data analysis was performed using the chi-square test, independent t-test, and Pearson correlation coefficient in SPSS software version 26.

RESULTS: The two study groups were homogeneous regarding age, gender, marital status, ethnicity, tobacco consumption, education level, job, place of residence, type of hypothyroidism, underlying disease, source of information, and duration of hypothyroidism (p = 0.05). The average score of health literacy in the intervention group ranged from 36.40 ± 5.18 to 38.77 ± 5.18 before and after the intervention, respectively. In the control group, it ranged from 36.2 ± 7.01 before and 38.77 ± 5.18 after the post-test. The average change in health literacy score in the intervention group was 2. 37 ± 2.42, which was significantly more than the control group (-0.11 ± 2.41; p = 0.0001). The independent t-tests showed that the mean knowledge score in the two groups before the intervention did not differ (p = 0.78). However, after the intervention, the mean and standard deviation of the knowledge score of the intervention group patients was significantly higher than the control group (p = 0.0001). Also, the average change of knowledge score in intervention group patients was 9.54 ± 3.16, significantly more than the control group (-0.20 ± 3.93; p = 0.0001).

CONCLUSION AND DISCUSSION: The study emphasized the importance of patients participating in self-care after receiving disease management information via mobile health technologies. Implementing mobile phone-based information is suggested to enhance patients' knowledge and health literacy.

PMID:39654267