Personal Electronic Records of Medications (PERMs) for medication reconciliation at care transitions: a rapid realist review.

BACKGROUND: Medication reconciliation (MedRec), a process to reduce medication error at care transitions, is labour- and resource-intensive and time-consuming. Use of Personal Electronic Records of Medications (PERMs) in health information systems to support MedRec have proven challenging. Relatively little is known about the design, use or implementation of PERMs at care transitions that impacts on MedRec in the 'real world'. To respond to this gap in knowledge we undertook a rapid realist review (RRR). The aim was to develop theories to explain how, why, when, where and for whom PERMs are designed, implemented or used in practice at care transitions that impacts on MedRec. METHODOLOGY: We used realist methodology and undertook the RRR between August 2020 and February 2021. We collaborated with experts in the field to identify key themes. Articles were sourced from four databases (Pubmed, Embase, CINAHL Complete and OpenGrey) to contribute to the theory development. Quality assessment, screening and data extraction using NVivo was completed. Contexts, mechanisms and outcomes configurations were identified and synthesised. The experts considered these theories for relevance and practicality and suggested refinements. RESULTS: Ten provisional theories were identified from 19 articles. Some theories relate to the design (T2 Inclusive design, T3 PERMs complement existing good processes, T7 Interoperability), some relate to the implementation (T5 Tailored training, T9 Positive impact of legislation or governance), some relate to use (T6 Support and on-demand training) and others relate iteratively to all stages of the process (T1 Engage stakeholders, T4 Build trust, T8 Resource investment, T10 Patients as users of PERMs). CONCLUSIONS: This RRR has allowed additional valuable data to be extracted from existing primary research, with minimal resources, that may impact positively on future developments in this area. The theories are interdependent to a greater or lesser extent; several or all of the theories may need to be in play to collectively impact on the design, implementation or use of PERMs for MedRec at care transitions. These theories should now be incorporated into an intervention and evaluated to further test their validity.

HIV, cancer, and coping: The cumulative burden of a cancer diagnosis among people living with HIV.

OBJECTIVES: People living with HIV (PLWH) have increased risk for cancer and worse cancer-specific survival. We explored the emotional burden of cancer and HIV as a potential driver of cancer mortality. RESEARCH APPROACH: Semi-structured qualitative interviews with PLWH and cancer. PARTICIPANTS: 27 PLWH who had either completed cancer treatment, were currently undergoing treatment, or experienced challenges in completing treatment. METHODOLOGICAL APPROACH: An inductive qualitative approach using the constant comparative method. FINDINGS: Participants drew strong parallels between being diagnosed with HIV and cancer. Many described HIV-related stigma that hindered social support. Cancer treatment side effects were a major challenge, impacting treatment adherence for both cancer and HIV. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: There is a need for convenient, affordable, and visible services to support PLHIV as they navigate cancer care. Services should be tailored to the unique needs of this population by addressing HIV-related stigma, building social support, and fostering resilience.

IoT/Sensor-Based Infrastructures Promoting a Sense of Home, Independent Living, Comfort and Wellness.

This paper presents the results of three interrelated studies concerning the specification and implementation of ambient assisted living (AAL)/Internet of Things (IoT)/sensor-based infrastructures, to support resident wellness and person-centered care delivery, in a residential care context. Overall, the paper reports on the emerging wellness management concept and IoT solution. The three studies adopt a stakeholder evaluation approach to requirements elicitation and solution design. Human factors research combines several qualitative human⁻machine interaction (HMI) design frameworks/methods, including realist ethnography, process mapping, persona-based design, and participatory design. Software development activities are underpinned by SCRUM/AGILE frameworks. Three structuring principles underpin the resident's lived experience and the proposed 'sensing' framework. This includes (1) resident wellness, (2) the resident's environment (i.e., room and broader social spaces which constitute 'home' for the resident), and (3) care delivery. The promotion of resident wellness, autonomy, quality of life and social participation depends on adequate monitoring and evaluation of information pertaining to (1), (2) and (3). Furthermore, the application of ambient assisted living technology in a residential setting depends on a clear definition of related care delivery processes and allied social and interpersonal communications. It is argued that independence (and quality of life for older adults) is linked to technology that enables interdependence, and specifically technology that supports social communication between key roles including residents, caregivers, and family members.

The case for change: aviation worker wellbeing during the COVID 19 pandemic, and the need for an integrated health and safety culture.

The workplace is an important setting for health protection, health promotion and disease prevention. Currently, health and wellbeing approaches at an aviation organisational level are not addressing both human and safety needs. This issue has been intensified since the COVID 19 pandemic. This paper reports on the findings of a survey pertaining to aviation worker wellbeing and organisational approaches to managing wellbeing and mental health. The survey was administered at two different time periods during the COVID 19 pandemic (2020 and 2021). Collectively, feedback was obtained from over 3000 aviation workers. Survey feedback indicates that aviation workers are experiencing considerable challenges in relation to their health and wellbeing. These challenges are not being adequately addressed at an organisational level, which creates risk both from an individual and flight safety perspective. The descriptive findings of both surveys along with a regression analysis is used to make a principled case for augmenting the existing approach to managing aviation worker wellbeing (including mental health), at both an organisational and regulatory level. It is argued that aviation organisations, with the support of the regulator should implement a preventative, ethical and evidence-based strategy to managing wellbeing and mental health risk. Critically, aviation organisations need to advance and integrated health, wellbeing, and safety culture. This necessitates an alignment of human, business, and safety objectives, as articulated in concepts of corporate social responsibility (CSR) and responsible work. Critically, this approach depends on trust and the specification of appropriate protections, so that aviation workers feel safe to routinely report wellbeing levels and challenges, and their impact on operational safety.

Improving Access to Cancer Care in the HIV Population: Qualitative Research to Identify Barriers to Care.

Purpose: People living with HIV are less likely to receive cancer treatment and have worse cancer-specific survival, yet underlying drivers of this disparity have minimally been explored. We investigated cancer care barriers from the perspective of patients living with HIV and cancer (PLWHC) to inform future interventions, reduce disparities, and improve outcomes. Methods: We conducted in-depth semistructured interviews with 27 PLWHC. The interview guide explored perceptions of the cancer care experience, treatment decision making, and barriers to cancer treatment. Interview data were analyzed using the constant comparative method of qualitative analysis. Results: Study participants were predominantly men (n=22, 81%) with a median age of 56 years and median annual income of $24,000. Among those who experienced challenges with cancer treatment adherence, barriers included debilitating side effects of cancer treatment, stigma surrounding HIV, issues with coping and mental health, the financial burden of cancer care, and challenges with care accessibility. Despite these challenges, participants indicated that their past experiences of coping with HIV had prepared them to accept and address their cancer diagnosis. Resiliency and social support were key facilitators for cancer treatment adherence. Conclusion: This qualitative study of PLWHC in the United States found that a cancer diagnosis created a substantial added stress to an already challenging situation. Health- and stigma-related stressors impacted patients' ability to fully complete cancer treatment as prescribed. There is a need for improved provider communication and mental health support for PLWHC to ensure equitable access to and completion of cancer treatment.

Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol.

INTRODUCTION: Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences. METHODS AND ANALYSIS: This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to 'cocoon'/'shield' and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient's/carer's perspective. ETHICS AND DISSEMINATION: This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.

Lived Experience, Stakeholder Evaluation and the Participatory Design of Assisted Living Technology.

This paper presents the theoretical and methodological framework underpinning the advancement of new technology enabling seniors domicile in residential homes to live with independence, quality of life and dignity. In addition, it presents the preliminary findings of this research including the emerging user interface design solution.

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer.

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.

A sociotechnical model of the flight crew task.

OBJECTIVE: The objective of this research was to advance an improved model of Flight Crew task performance. BACKGROUND: Existing task models present a "local" description of Flight Crew task performance. METHOD: Process mapping workshops, interviews, and observations were conducted with both pilots and flight operations personnel from five airlines, as part of the Human Integration into the Lifecycle of Aviation Systems (HILAS) project. RESULTS: The functional logic of the process dictates Flight Crew task requirements and specific task workflows. The Flight Crew task involves managing different levels of operational and environmental complexity, associated with the particular flight context. In so doing, the Flight Crew act as a coordinating interface between different human agents involved in the Active Flight Operations process and other processes that interface with this process. CONCLUSION: This article presents a new sociotechnical model of the Flight Crew task. The proposed model reflects a shift from a local explanation of Flight Crew task activity to a broader process-centric explanation. In so doing, it illuminates the complex role of procedures in commercial operations. APPLICATION: The task model suggests specific requirements for pilot task support tools, procedures design, performance evaluation and crew resource management (CRM) training. Also, this model might be used to assess future operational concepts and associated technology requirements. Lastly, this model provides the basis for the operational validation of both existing and future cockpit technologies.