Use of a digital tool to support the diagnostic process in memory clinics-a usability study.

BACKGROUND: Both memory clinic professionals and patients see value in digital tools, yet these hardly find their way to clinical practice. We explored the usability of a digital tool to support the diagnostic work-up in daily memory clinic practice. We evaluated four modules that integrate multi-modal patient data (1.cognitive test; cCOG, and 2. MRI quantification; cMRI) into useful diagnostic information for clinicians (3. cDSI) and understandable and personalized information for patients (4. patient report). METHODS: We conducted a mixed-methods study in five Dutch memory clinics. Fourteen clinicians (11 geriatric specialists/residents, two neurologists, one nurse practitioner) were invited to integrate the tool into routine care with 43 new memory clinic patients. We evaluated usability and user experiences through quantitative data from questionnaires (patients, care partners, clinicians), enriched with thematically analyzed qualitative data from interviews (clinicians). RESULTS: We observed wide variation in tool use among clinicians. Our core findings were that clinicians: 1) were mainly positive about the patient report, since it contributes to patient-centered and personalized communication. This was endorsed by patients and care partners, who indicated that the patient report was useful and understandable and helped them to better understand their diagnosis, 2) considered the tool acceptable in addition to their own clinical competence, 3) indicated that the usefulness of the tool depended on the patient population and purpose of the diagnostic process, 4) addressed facilitators (ease of use, practice makes perfect) and barriers (high workload, lack of experience, data unavailability). CONCLUSION: This multicenter usability study revealed a willingness to adopt a digital tool to support the diagnostic process in memory clinics. Clinicians, patients, and care partners appreciated the personalized diagnostic report. More attention to education and training of clinicians is needed to utilize the full functionality of the tool and foster implementation in actual daily practice. These findings provide an important step towards a lasting adoption of digital tools in memory clinic practice.

Cerebral autoregulation in normal pregnancy and preeclampsia.

OBJECTIVE: To test the hypothesis that preeclampsia is associated with impaired dynamic cerebral autoregulation. METHODS: In a prospective cohort analysis, cerebral blood flow velocity of the middle cerebral artery (determined by transcranial Doppler), blood pressure (determined by noninvasive arterial volume clamping), and end-tidal carbon dioxide were simultaneously collected during a 7-minute period of rest. The autoregulation index was calculated. Values of 0 and 9 indicated absent and perfect autoregulation, respectively. Student t test was used, with P<.05 considered significant. RESULTS: Women with preeclampsia (before treatment, n=20) and their normotensive counterparts (n=20) did not differ with respect to baseline characteristics, except for earlier gestational age at delivery (36 3/7 [24 4/7-40 2/7] compared with 39 2/7 [32 0/7-41 0/7]; P<.001) and higher blood pressure in women with preeclampsia. Autoregulation index was significantly reduced in preeclamptic women compared with normotensive women in the control group (5.5±1.7 compared with 6.7±0.6; P=.004). There was no correlation between the autoregulation index and blood pressure. CONCLUSION: Women with preeclampsia have impaired dynamic cerebral autoregulation. The fact that blood pressure does not correlate with autoregulation functionality may explain why cerebral complications such as eclampsia can occur without sudden or excessive elevation in blood pressure. LEVEL OF EVIDENCE: II.