Video-based smartphone app ('VIDEA bewegt') for physical activity support in German adults: a single-armed observational study.

OBJECTIVES: The primary objective of this study was to investigate the effect of the video-based smartphone app 'VIDEA bewegt' over eight programme weeks on physical activity in German adults. DESIGN: The study used a single-arm observational design, assessing the app's effectiveness under real-life conditions. Data were collected from July 2019 to July 2020. SETTING: The app is enabling users to access video-based educational content via their smartphone. A clinical visit or in-person contact was not required. PARTICIPANTS: All individuals registered in the freely available app were invited to take part in the study. INTERVENTIONS: The app aims to increase physical activity in everyday life. It combines educative videos on lifestyle-related benefits and instructional videos of strength and endurance exercises to do at home with motivational components like goal setting, documentation of progress and personalised messages. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were physical activity based one MET minutes per week (metabolic equivalent) and step numbers.Secondary outcomes included physical self-efficacy (motivational, maintenance, recovery self-efficacy), health-related quality of life: Mental Health Component Summary score and Physical Health Component Summary score. RESULTS: Of 97 people included in the data analysis, 55 successfully completed the programme and all questionnaires. Significant increases over eight programme weeks (between T0 and T2) were observed in physical activity based on MET minutes per week, health-related quality of life, and recovery self-efficacy. Time spent sitting and body mass index significantly decreased for those completing the programme. CONCLUSIONS: Although significant benefits of physical activity were observed following a complete-case analysis, results should be dealt with caution. Studies with a larger and less heterogeneous sample and robust study designs able to measure causal effects would be desirable. TRIAL REGISTRATION NUMBER: DRKS00017392.

Video-based smartphone app ('VIDEA bewegt') for physical activity support in German adults: a study protocol for a single-armed observational study.

INTRODUCTION: Insufficient physical activity is one of the most important risk factors for non-communicable diseases. Physical activity should therefore be intensively promoted in all age groups. Several trials suggest that it can be effectively increased through smartphone interventions.However, few of the smartphone-interventions available on the market have been scientifically evaluated. Therefore, the described study aims to assess the short-term and long-term effects of the smartphone intervention 'VIDEA bewegt' to increase physical activity. The trial is designed as a single-armed observational trial to assess effects under real-life conditions. METHODS AND ANALYSIS: The intervention consists of the smartphone-application 'VIDEA bewegt', which is a video-based preventative programme to improve physical activity in everyday life. The application contains several features and components including educational videos, documentation of activity and motivational exercises. A sample size of at least 106 participants is aimed for.The primary objective of this study is to determine the effect of the application on physical activity in German adults. Secondary objectives are to evaluate the self-efficacy, health-related quality of life and usability of 'VIDEA bewegt'.Data collection is based on online questionnaires, as well as system-internal recorded data.Changes of outcomes from baseline to programme completion and follow-up will be calculated. ETHICS AND DISSEMINATION: The Ethics Committee of the Technical University Dresden approved the study on 25 May 2019 (EK 272062019). All data are processed anonymously and stored on servers only accessible by authorised personnel. The results of the study and the results of the usability test are aimed to be published in a scientific journal. TRIAL REGISTRATION NUMBER: German Clinical Trials Registry (DRKS00017392).

Contraception choices in a cohort of HIV+ women in the era of highly active antiretroviral therapy.

BACKGROUND: The study was conducted to determine whether increased desire for fertility coupled with increased awareness of reduction in mother-to-child HIV transmission (MTCT) with increased availability and use of highly active antiretroviral therapy (HAART) has been associated with reduction in use of tubal sterilization as a form of contraception among women infected with HIV. STUDY DESIGN: One hundred HIV+ women, 18 to 45 years of age, receiving care at university-affiliated HIV facilities between October 2008 and February 2009, were surveyed about their contraceptive knowledge and practices. We performed descriptive analysis of population characteristics to determine contraception choices and fertility desires following initiation of HAART. RESULTS: The study group was composed of women with median age of 35 years, 55% African American, 18% Caucasians, 19% Hispanic and 8% "other". Most (63%) were single; 36% were married. Contraception choices were condom 61%, injectable contraceptive 7%, pills 6% and only 3% said they used female sterilization. Thirty-four percent of respondents said that their choice of contraception was based primarily on ease of use, 19% said that their choice was primarily based on convenience and only 9% said that their choice was primarily based on provider recommendation. Desire for future childbearing increased to 19% following knowledge that MTCT can be reduced by taking antiretroviral therapy (ARV) and to 22% following initiation of ARV. CONCLUSIONS: Initiation of ARV and awareness that maternal treatment can reduce MTCT may explain lower use of female sterilization as a form of contraception among a cohort of HIV+ women in the post HAART era.

Medical error reporting, patient safety, and the physician.

OBJECTIVES: To shed light on factors that may help explain inaccurate medical error reporting and do not receive much attention: ob-gyns' comfort with reporting medical errors and personal experience with being injured while receiving medical care. METHODS: Questionnaires were sent to a total of 600 members of the American College of Obstetricians and Gynecologists between September and December 2006. The questionnaire included demographics and three questions about practice patterns and opinions about patient safety: (1) How comfortable are you reporting medical errors? (2) Have you or a friend/family member ever been injured while receiving medical care? (3) How frequently do you witness medical errors? RESULTS: A 53.2% response rate was obtained. Only 56.3% of ob-gyns "felt free" to frequently report medical errors, with no differences by sex or age. One in 5 (20.8%) reported that they or a family member had been injured by a medical error. Ob-gyns who reported that they or a friend or family member had been injured during medical care more frequently reported witnessing medical errors. CONCLUSIONS: Our results show that many physicians do not feel free to report errors. Research on the decision making of physicians (e.g., person-who effect, regret avoidance, and the availability heuristic) may provide useful insights to problems with medical error reports.

A review of patient safety in women's healthcare: why has our progress been so slow?

The rate of improvement in patient safety is slow. The goal of this review is to address the results of a survey of Ob-Gyn physicians regarding important patient safety issues. A sample of 600 obstetricians and gynecologists were sent a survey asking them about their beliefs, activities, problems, and source of information regarding patient safety with a response rate of 53.2%. Results about beliefs and patient safety activities have been reported [Stumpf et al., 2009]. Misdiagnosis (95.6%), failure to follow-up with patients (94.9%), and administration of the wrong medication or dosage of a medication (90.5%) were the most often reported patient safety problems. Obstetricians and gynecologists most often use printed materials, CMEs, journals, and practice guidelines for information regarding patient safety. Ob-Gyns prefer to learn new patient safety information using printed materials and post graduate classes rather than materials on compact disk or online webcasts. A majority of respondents recognize patient safety as an important issue. Education about the importance of patient safety may be a less pertinent topic when compared to the need for education about implementing specific tools for patient safety and moving from awareness to action.

Obstetrician-gynecologists' opinions about patient safety: costs and liability remain problems; are mandated reports a solution?

BACKGROUND: To elucidate the patient safety practices of obstetrician-gynecologists (OB/GYNs), the perceived barriers to patient safety improvements in obstetrics and gynecology, and OB/GYN's beliefs about mandated reporting. METHODS: A sample of 600 OB/GYNs was sent a survey from the American College of Obstetricians and Gynecologists about their beliefs and practice regarding patient safety. RESULTS: The response rate was 53.2%. More than 92% of respondents said that patient safety is important in women's health care. The most important barriers to improving patient safety were cost of new technologies and concern about liability. Half agreed that mandatory reporting would improve patient safety. Physicians who practice in states with mandated error reporting were no more or less likely to think that these mandates improve patient safety than physicians who do not work in states with mandates. Physicians who practice in states with "I'm Sorry" laws more strongly disagreed that mandates improve patient safety than physicians who do not work in states with "I'm Sorry" laws. DISCUSSION AND CONCLUSIONS: It may be effective to aim at making patient safety activities more affordable to increase implementation. In addition, the effects of reporting and disclosure laws on physicians' concerns with liability should be examined more closely.

Serious postpartum infection due to MRSA in an asymptomatic carrier: case report and review.

Infection with methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide problem and is no longer acquired only in a hospital setting. Community-associated MRSA is an emerging pathogen of increasing interest to both obstetricians and neonatologists, reported in all three trimesters of pregnancy and postpartum, and in neonatal intensive care units, leading to severe outcomes, including neonatal death. This case report describes a serious and potentially life-threatening infection (including wound abscess, septicemia, septic thrombophlebitis, and septic pulmonary emboli) that developed in an otherwise healthy postpartum woman who had screened positive for MRSA in nares, vagina, and rectum at the time of her prior admission in labor as part of a research study. We conclude that asymptomatic nasal, vaginal, and rectal colonization with MRSA occurs in pregnancy and may be a risk factor for serious systemic infection after delivery.

Practical solutions to improve safety in the obstetrics/gynecology office setting and in the operating room.

There are great opportunities to enhance patient safety in office practice, but the pattern of medical errors and techniques to reduce their frequency appears to differ from the hospital environment. A focus on decreasing the risks of prescribing errors and tracking errors may be particularly fruitful in the office setting, such as electronic prescribing, electronic medical records, the use of detailed patient instructions, unambiguous prescribing, and meticulous follow-up of test results. The surgical environment presents its own unique set of risks to patient safety, particularly because of the catastrophic consequences that may result from even infrequent events. Vigilance against stress and fatigue is particularly important. Patient safety in surgery is promoted by routine use of the "universal protocol," antibiotic prophylaxis, thromboprophylaxis, open communication among all members of the surgical team, and clear guidelines for introducing new procedures and technology.

Voluntary review of quality of care peer review for patient safety.

Voluntary Review of Quality of Care (VRQC) is a confidential, voluntary, consultative peer review service offered to healthcare institutions by the American College of Obstetricians and Gynecologists (ACOG). Institutions may request ACOG's VRQC team of practicing, Board-certified obstetricians and gynecologists to visit the institution in order to evaluate the degree to which practice patterns are consistent with published guidelines, and to suggest possible avenues for improvement. Since the VRQC program began in 1986, over 230 site visits have been conducted using a clinically-oriented and evidence-based approach to examine the quality of patient care delivered. In the 20-year experience of VRQC, deficiencies in system function were more commonly cited than individual practitioner problems, confirming the observations of other patient safety projects. Issues identified in the VRQC reviews can serve as needs assessment for designing Continuing Medical Education activities. Services such as VRQC provided by national medical specialty organizations may assist institutions to implement practice guidelines, performance standards, quality improvement and patient safety initiatives.