Application-based management of perioperative anticoagulant therapy: description of POPACTApp.

PURPOSE: Perioperative management of oral anticoagulation (OAC) is a constant challenge in interventional and surgical procedures. When deciding to discontinue OAC, the risk of thromboembolic events must be balanced against the risk of bleeding during and after the planned procedure. These risks differ across patients and must be considered individually. METHODS: POPACTApp, an application for the perioperative or peri-interventional management of oral anticoagulants, was developed using a human-centered design process (ISO 9241-210:2010). The treatment concept developed here can be adapted to a patient's individual risk profile. POPACTApp provides recommendations based on guidelines, consensus statements, and study data. After entering patient-specific risk factors, the attending physician using POPACTApp receives a clear and direct presentation of a periprocedural treatment concept, which should enable the efficient use of the program in everyday clinical practice. The perioperative treatment concept is presented via a timeline, including (1) the decision on whether to interrupt OAC, (2) the timing of the last preoperative administration of OAC in cases of interruption, (3) the decision on whether and how to bridge with heparins, and (4) the decision about when to reinitiate anticoagulation. RESULTS: A task-based survey to evaluate POPACTApp's usability conducted with 20 surgeons showed that all clinicians correctly interpreted the recommendations provided by the app. Further, a questionnaire using a 7-point Likert scale from - 3 (negative) to + 3 (positive) revealed the following results to three specific questions: (1) satisfaction with the current standard procedure in the respective unit of the participant (0.15; SD = 1.57), (2) individual satisfaction with the POPACTApp application (2.7; SD = 0.47), and (3) estimation of the usefulness of POPACTApp for clinical practice (2.7; SD = 0.47). CONCLUSIONS: POPACTApp provides clinicians with an individual risk-optimized treatment concept for the perioperative or peri-interventional management of OAC based on current guidelines, consensus statements, and study data, enabling the standardized perioperative handling of OAC in daily clinical practice.

Development and psychometric evaluation of the Interactive Test of Interpersonal Behavior (ITIB): a pilot study examining interpersonal deficits in chronic depression.

Chronic depression is assumed to be caused and maintained by interpersonal deficits. We describe the development and psychometric evaluation of the Interactive Test of Interpersonal Behavior (ITIB) that we developed for self-assessment of these deficits. Participants with chronic depression (CD, N = 15), episodic depression (ED, N = 15) and healthy controls (HC, N = 15) participated in this pilot study. They completed the ITIB and a number of pen and paper questionnaires including the Lübeck Questionnaire of Preoperational Thinking (LQPT) and the inventory of interpersonal problems (IIP). The ITIB was highly acceptable for use in these participants. Internal consistency for the ITIB was adequate for group comparisons (Cronbach's alpha = 0.649). Item-total correlations indicated adequate discriminatory power of five of the six items. The ITIB correlated moderately with the LQPT (r = 0.524) and the IIP (r = -0.568). The ITIB score differed significantly between the diagnostic groups (ANOVA F(2,42) = 6.22, p = 0.004). It was the only measure that - albeit at a trend level - was associated with diagnostic group (CD vs. ED) on multinomial logistic regression analysis (B = 0.049 ± 0.029; OR 1.051; p = 0.088). We found preliminary evidence that the ITIB is an acceptable and psychometrically adequate measure of interpersonal behavior that distinguishes between patients with CD and patients with ED. If replicated with an improved version of the test, our results could support the hypothesis that having interpersonal problems is a core deficit in patients with CD.