Two novel prehabilitation apps to help patients stop smoking and risky drinking prior to hip and knee arthroplasty.

PURPOSE: Daily smoking or risky drinking increases the risk of complications after surgery by ~50%. Intensive prehabilitation aimed at complete cessation reduces the complication rate but is time-consuming. The purpose of this study was to carry out preoperative pilot tests (randomized design) of the feasibility (1A) and validation (1B) of two novel prehabilitation apps, habeat® (Ha-app) or rehaviour® (Re-app). METHODS: Patients scheduled for hip or knee arthroplasty with daily smoking, risky drinking, or both were randomised to one of the two apps. In part 1A, eight patients and their staff measured feasibility on a visual analog scale (VAS) and were interviewed about what worked well and the challenges requiring improvement. In part 1B, seven patients and their staff tested the improved apps for up to two weeks before validating the understanding, usability, coverage, and empowerment on a VAS and being interviewed. RESULTS: In 1A, all patients and staff returned scores of ≥5 for understanding the apps and mostly suggested technical improvements. In 1B, the scores varied widely for both apps, with no consensus achieved. Two of four patients (Ha-app) and one-third of the patients (Re-app) found the apps helpful for reducing smoking, but without successful quitting. The staff experienced low app competencies among patients and high time consumption. Specifically, patients most often needed help for the Ha-app, and the staff most often for Re-app; however, the staff reported the Re-app dashboard was more user-friendly. Support and follow-up from an addiction specialist staff member were suggested to complement the apps, thereby increasing the time consumption for staff. CONCLUSIONS: This pilot study to test prototype apps generated helpful feedback for the app developers. Based on the patient and staff comments, multiple improvements in functionality seem required before scaling up the evaluation for effect on prehabilitation and postoperative complications.

Recommendations and quality criteria to improve the early diagnosis of primary biliary cholangitis. / Recomendaciones y criterios de calidad para mejorar el diagnóstico precoz de la colangitis biliar primaria.

OBJECTIVE: The study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. PATIENTS AND METHODS: It was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. RESULTS: Seven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient's quality of life. Consider their point of view and agree on recommendations and care¼ and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually¼, respectively. CONCLUSIONS: The implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

[Influence of the time factor on hospitalised patient's opinion]. / Influencia del factor tiempo en la opinión del paciente hospitalizado.

BACKGROUND AND OBJECTIVE: An important controversy at the time of studying the perceived quality is which is the best time to know the patient's opinion. The objective of this work was to find out whether this opinion is different at the time of discharge and one month later. PATIENTS AND METHOD: We included patients who were discharged between October 1999 and March 2000. We designed a specific opinion survey with 44 items. The survey was administered at the time of discharge. Individuals who responded to the first survey were sent the same one by e-mail 30 days after the discharge. RESULTS: The first survey was responded by 1,061 subjects and the second one by 485 (45.71%). Overall, answers from subjects who responded the survey in both phases showed a 65% agreement rate and a 35% disagreement rate. On the other hand, 84% of questions showed answers with a low agreement's Kappa index, while 6% had a good agreement. CONCLUSION: Globally considered, the average satisfaction expressed by subjects was equivalent in the two phases of the study, yet the individual degree of satisfaction varied.

Health professionals' sex and attitudes of health science students to health claims.

INTRODUCTION: The huge influx of women into medicine may modify discriminatory attitudes towards health professionals. The aim of this study was to confirm the possible influence of health professionals' biological sex on the perception of the suitableness of health claims and on the attribution of responsibility in the case of presumed malpractice. METHODS: A total of 448 health science students, 123 of whom were male and 325 of whom were female, made up the sample. They represented 63% of students enrolled on their courses. They were asked to read a story about a fictitious event that results in a health claim. The story had 2 versions that differed only in the genders of the professionals involved. The students had to answer a 5-point Likert scale questionnaire with 12 items, 7 of which referred to the pertinence of the claim, 2 to the responsibility of the medical staff, 1 to the responsibility of the nursing staff, 1 to the responsibility of the health authority and 1 to the responsibility of the hospital where the incident occurred. Each student judged only 1 of the 2 possible versions, which were randomly distributed. Almost all the students invited to collaborate did so. Group differences were assessed by 2-way anova analysis. RESULTS: Significantly more responsibility was assigned to the male nurse than to the female nurse. Male students, but not female students, considered the claim more valid in version B. CONCLUSION: These results show that, at least amongst our sample of health science students, negative prejudices towards female professionals do not exist.