Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD.

BACKGROUND: Physical inactivity is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). It is therefore crucial for patients to have a physically active lifestyle. The aims of this feasibility study were to assess a tablet-based physical activity behavioural intervention in virtual groups for COPD regarding 1) patients' acceptance 2) technology usability 3) patients' exercise programme adherence and 4) changes in patients' physical activity level. METHODS: We used an application with functionality for a virtual peer group, a digital exercise diary, a follow-along exercise video, and visual rewards on the home screen wallpaper. The exercise programme combined scheduled virtual group exercising (outdoor ground walking, indoor resistance and strength training) with self-chosen individual exercises. Ten participants with COPD were enrolled into two exercise training groups. Patients' acceptance was assessed by semi-structured interviews, technology usability was assessed by the System Usability Scale, and exercise programme adherence and level of physical activity by self-reporting. The interviews were also used for the latter three aspects. RESULTS: The virtual peer group was experienced as motivating, helping participants to get started and be physically active. They updated their own activity status and kept track of the others' status. Having a time schedule for the virtual group exercises helped them to avoid postponing the exercise training. All participants recorded individual exercises in the diary, the exercise video was well received and used, and most participants paid attention to the visual rewards. All participants found the technology easy both to learn and to use. The exercise programme adherence was good, with, on average, 77% attendance for the virtual group exercises, and all participants performed additional individual exercises. The average number of physical activity sessions per week was doubled from 2.9 (range 0-10, median 2) at baseline to 5.9 (range 3.3-10.33, median 4.8) during the intervention period. CONCLUSION: The results indicate that the tablet-based intervention may be feasible in COPD, and that it was acceptable, encouraged a sense of peer support and fellowship in the group and motivated participants to physical activity and exercise training in daily life. Further assessment is needed on patient outcomes.

Determination of 3'-phosphoadenosine-5'-phosphosulfate in cells and Golgi fractions using hydrophilic interaction liquid chromatography-mass spectrometry.

3'-Phosphoadenosine-5'-phosphosulfate (PAPS) is a key player in the sulfation of biomolecules, but methods for selective measurements are lacking. A liquid chromatography-mass spectrometry (LC-MS) approach for measuring PAPS was developed. A central feature of the method was employing hydrophilic interaction liquid chromatography (HILIC), which is highly suited for separating very polar/charged compounds, and is compatible with electrospray MS. Using simple instrumentation, the analysis time per sample was below 10min and the method was characterized by easy sample preparation. The method was used to monitor decreasing levels of PAPS as function of sodium chlorate treatment (an inhibitor of PAPS synthesis) in whole-cell lysates as well as Golgi-fractions. The method allowed PAPS to be chromatographically separated from ADP and ATP, which can interfere with measurements if a less resolving LC-MS method is used.

Proteomics tools reveal startlingly high amounts of oxytocin in plasma and serum.

The neuropeptide oxytocin (OT) is associated with a plethora of social behaviors, and is a key topic at the intersection of psychology and biology. However, tools for measuring OT are still not fully developed. We describe a robust nano liquid chromatography-mass spectrometry (nanoLC-MS) platform for measuring the total amount of OT in human plasma/serum. OT binds strongly to plasma proteins, but a reduction/alkylation (R/A) procedure breaks this bond, enabling ample detection of total OT. The method (R/A + robust nanoLC-MS) was used to determine total OT plasma/serum levels to startlingly high concentrations (high pg/mL-ng/mL). Similar results were obtained when combining R/A and ELISA. Compared to measuring free OT, measuring total OT can have advantages in e.g. biomarker studies.

A critical evaluation of Amicon Ultra centrifugal filters for separating proteins, drugs and nanoparticles in biosamples.

Amicon(®) Ultra centrifugal filters were critically evaluated for various sample preparations, namely (a) proteome fractionation, (b) sample cleanup prior to liquid chromatography mass spectrometry (LC-MS) measurement of small molecules in cell lysate, and (c) separating drug-loaded nanoparticles and released drugs for accurate release profiling in biological samples. (a) Filters of supposedly differing molar mass (MM) selectivity (10, 30, 50 and 100K) were combined to attempt fractionation of samples of various complexity and concentration. However, the products had surprisingly similar MM retentate/filtrate profiles, and the filters were unsuited for proteome fractionation. (b) Centrifugal filtration was the only clean-up procedure in a FDA-guideline validated LC-MS method for determining anti-tuberculosis agents rifampicin and thioridazine in macrophage cell lysate. An additional organic solvent washing step (drug/protein-binding disruption) was required for satisfactory recovery. (c) The centrifugation filters are well suited for separating drugs and nanoparticles in simple aqueous solutions, but significantly less so for biological samples, as common drug-protein binding disruptors can dissolve NPs or be incompatible with LC-MS instrumentation.

Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD.

BACKGROUND: Comprehensive multidisciplinary pulmonary rehabilitation is vital in the management of chronic obstructive pulmonary disease (COPD) and is considered for any stage of the disease. Rehabilitation programmes are often centre-based and organised in groups. However, the distance from the patient's home to the centre and lack of transportation may hinder participation. Rehabilitation at home can improve access to care for patients regardless of disease severity. We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The aims of this feasibility study were to assess patient acceptability of the delivery mode and components of a comprehensive pulmonary rehabilitation programme for any stage of COPD, as well as the technology usability, patient outcomes and economic aspects. METHODS: Ten participants with COPD in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade I-IV were enrolled in a 9-week home programme and divided into two rehabilitation groups, with five patients in each group. The programme included exercise training and self-management education in online groups of patients, and individual online consultations. The patients also kept a digital health diary. To assess the acceptability of the programme, the patients were interviewed after the intervention using a semi-structured interview guide. In addition the number of sessions attended was observed. The usability of the technology was assessed using interviews and the System Usability Scale questionnaire. The St George's Respiratory Questionnaire (SGRQ) was used to measure health-related quality of life. RESULTS: The mode of delivery and the components of the programme were well accepted by the patients. The programme provided an environment for learning from both healthcare professionals and peers, for asking questions and discussing disease-related issues and for group exercising. The patients considered that it facilitated health-enhancing behaviours and social interactions with a social group formed among the participants. Even participants who were potentially less homebound appreciated the home group and social aspects of the programme. The participants found the technology easy to learn and use. The acceptability and usability results were consistent with those in our previous study of patients with very severe COPD. Only the mean change in the SGRQ total score of -6.53 (CI 95 % -0.38 to -12.68, p = 0.04) indicates a probable clinically significant effect. Economic calculations indicated that the cost of the programme was feasible. CONCLUSIONS: The results of this study indicate that comprehensive pulmonary rehabilitation delivered in home-based online groups may be feasible in COPD. The mode of delivery and components of the programme appeared to be acceptable across patients with different disease severity. The results in terms of patient outcomes are inconclusive, and further assessment is needed.

Liquid chromatography-mass spectrometry platform for both small neurotransmitters and neuropeptides in blood, with automatic and robust solid phase extraction.

Neurons communicate via chemical signals called neurotransmitters (NTs). The numerous identified NTs can have very different physiochemical properties (solubility, charge, size etc.), so quantification of the various NT classes traditionally requires several analytical platforms/methodologies. We here report that a diverse range of NTs, e.g. peptides oxytocin and vasopressin, monoamines adrenaline and serotonin, and amino acid GABA, can be simultaneously identified/measured in small samples, using an analytical platform based on liquid chromatography and high-resolution mass spectrometry (LC-MS). The automated platform is cost-efficient as manual sample preparation steps and one-time-use equipment are kept to a minimum. Zwitter-ionic HILIC stationary phases were used for both on-line solid phase extraction (SPE) and liquid chromatography (capillary format, cLC). This approach enabled compounds from all NT classes to elute in small volumes producing sharp and symmetric signals, and allowing precise quantifications of small samples, demonstrated with whole blood (100 microliters per sample). An additional robustness-enhancing feature is automatic filtration/filter back-flushing (AFFL), allowing hundreds of samples to be analyzed without any parts needing replacement. The platform can be installed by simple modification of a conventional LC-MS system.

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

BACKGROUND: Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. METHODS: Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. RESULTS: A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. CONCLUSIONS: Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability.

BACKGROUND: The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. METHODS: We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user's own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. RESULTS: Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. CONCLUSIONS: The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.

Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study.

BACKGROUND: This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. METHODS: We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. RESULTS: All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. CONCLUSIONS: As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine may potentially facilitate a communication-based follow-up and improve safety within the home setting, making it easier to choose and live with home dialysis.

Hydrophilic interaction chromatography of nucleoside triphosphates with temperature as a separation parameter.

Eight deoxynucleoside triphosphates (dNTPs) and nucleoside triphosphates (NTPs): ATP, CTP, GTP, UTP, dATP, dCTP, dGTP and dTTP, were separated with two 15 cm ZIC-pHILIC columns coupled in series, using LC-UV instrumentation. The polymer-based ZIC-pHILIC column gave significantly better separations and peak shape than a silica-based ZIC-HILIC column. Better separations were obtained with isocratic elution as compared to gradient elution. The temperature markedly affected the selectivity and could be used to fine tune separation. The analysis time was also affected by temperature, as lower temperatures surprisingly reduced the retention of the nucleotides. dNTP/NTP standards could be separated in 35 min with a flow rate of 200 µL/min. In Escherichia coli cell culture samples dNTP/NTPs could be selectively separated in 7 0min using a flow rate of 100 µL/min.

Video calls for dispatcher-assisted cardiopulmonary resuscitation can improve the confidence of lay rescuers--surveys after simulated cardiac arrest.

Many mobile phones allow two-way video communication, which permits callers to hear and see each other. If used during medical emergencies, bystanders can receive supervision and guidance from medical staff based on visual information. We investigated whether video calls from mobile phones could improve the confidence of lay rescuers. High school students (n = 180) were randomly assigned in groups of three to communicate via video calls or via ordinary mobile phone calls. They received realtime guidance from experienced nurse dispatchers at an emergency medical dispatch centre during 10-min scenarios of simulated cardiac arrest. Each student answered a questionnaire to assess understanding, confidence and usefulness of the technology. The mean age was 17.3 years in the video group and 17.9 years in the audio group. There were 27% male participants in the video group and 34% male participants in the audio group. Seventy-three percent of the students in the video group and 71% in the audio group reported previous cardiopulmonary resuscitation training. Rescuers who had not used video phones had a greater tendency to comment on immature video call technology, while some who had used video phones complained about poor sound quality during video calls. The majority of rescuers in both groups believed that video calls were superior to audio calls during medical emergencies, and this proportion was significantly higher in the video group (P = 0.0002). We found that visual contact and supervision through video calls improved rescuers' confidence in stressful emergencies.

To see or not to see--better dispatcher-assisted CPR with video-calls? A qualitative study based on simulated trials.

BACKGROUND: Video communication through mobile telephone is now available in many parts of the world. We ask how mobile phone video-calls compares with traditional phone calls for dispatcher-assisted cardiopulmonary resuscitation (T-CPR). METHODS: Primary data was collected through individual interviews with six dispatchers after their participation in simulated cardiac arrest. They had 10 scenarios each, during which they guided rescuers on resuscitation. During half of the scenarios they used video-calls, and traditional phone calls for the rest. Concepts from modern systems theory were used to analyse the material. RESULTS: Video-calls influenced the information basis and understanding of the dispatchers. The dispatchers experienced that (1) video-calls are useful for obtaining information and provides adequate functionality to support CPR assistance; (2) their CPR assistance becomes easier; (3) the CPR might be of better quality; but (4) there is a risk of "noise". DISCUSSION: We emphasize visual observation as a way of constructing professional understanding when using video-calls, which may provide a new basis for dispatcher assistance. Video-calls may improve rescuer compliance. The role and content of telephone-directed protocols used by dispatchers may need adjustments when video-calls are used for medical emergencies. CONCLUSION: Video communication can improve the dispatchers' understanding of the rescuer's situation, and the assistance they provide.