Evaluation of the use of a Renal Health application by kidney transplant recipients / Avaliação do uso do aplicativo Renal Health por transplantados renais / Evaluación del uso de la Aplicación Renal Health por parte de los receptores de trasplante renal

Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.

Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.

The intention to use mHealth applications among Dutch older adults prior and during the COVID pandemic.

Background: Mobile health (mHealth) applications are widely valued for their potential to increase self-management among older adults and reduce their healthcare demands. However, the intention to use mHealth of Dutch older adults before the COVID-19 pandemic was modest. Healthcare access was considerably reduced during the pandemic and mHealth services substituted for in person health services. As older adults utilize health services more frequently and have been particularly vulnerable to the pandemic, they can be viewed to have especially benefitted from the transition toward mHealth services. Furthermore, one might expect their intention to use these services and reap the potential benefits has increased, especially during the pandemic. Objective: The aim of this study was to examine whether the intention of Dutch older adults to use medical applications increased during the COVID pandemic and how the explanatory power of the extended Technology Acceptance Model (TAM) developed for this purpose was affected by the onset of the pandemic. Methods: We conducted a cross-sectional survey using two samples collected before (n = 315) and after (n = 501) the onset of the pandemic. Data was collected using questionnaires which were distributed digitally and on paper, by convenience sampling and snowballing. Participants were 65 years or older, lived independently or in a senior living facility, without cognitive impairment. A controlled analysis was performed to test for significant differences in the intention to use mHealth. The before and after differences in extended TAM variables and their relationship with intention to use (ITU) were analyzed using controlled (multivariate) logistic and linear regression models. These models were also used to explore whether the onset of the pandemic had an effect on ITU not captured by the extended TAM model. Results: While the two samples differed in ITU (p = 0.017; uncontrolled) there was no statistically significant difference in ITU in the controlled logistic regression analysis (p = 0.107). The scores of the extended TAM variables explaining intention to use were all significantly higher, except for Subjective norm and Feelings of Anxiety. The relationships of these variables with intention to use before and after the onset of the pandemic were similar, except for Social relationships which lost its significance. We found no indications of effects of the pandemic on intention to use not captured by our instrument. Conclusion: The intention to use mHealth applications of Dutch older adults has not changed since the onset of the pandemic. The extended TAM model has robustly explained intention to use, with only minor differences after the first months of the pandemic. Interventions targeting facilitation and support are likely to promote the uptake of mHealth. Follow-up studies are needed to investigate whether the pandemic has had long term effects on the ITU of the older adult.

An analysis of the distribution and spectrum of alpha thalassemia mutations in Rasht City, North of Iran.

Background: Alpha thalassemia is one of the most common hereditary hemoglobin disorders worldwide, particularly in the Middle East, including Iran. Therefore, determining the spectrum and distribution of alpha thalassemia mutation is a fundamental component of preventive approaches and management strategies. Methods: The present study reviews the genetic testing and blood laboratory results of 455 candidates eligible for marriage who were suspected of being thalassemia carriers and on whom genetic testing was performed from 21 March 2013 to 31 December 2020 in Rasht City. Results: A total of 114 (25.05%) alpha thalassemia cases were identified. Fifteen different alpha mutations were found. The most common mutation among the study population was -α3.7 deletion in 55 patients (48.24%), followed by Hb Constant Spring (C.S) in 21 patients (18.42%) and poly A2 in 16 (14.03%). Also, most of the patients were silent carriers. The deletion type of mutation was much more common than non-deletion mutations. Conclusion: Our study reveals genetic heterogeneity and alpha thalassemia diversity among the Rasht City population. We expect that these findings will help guide premarital screening and genetic counseling, prenatal diagnosis of thalassemia, preventive strategy development, as well as a compilation of the alpha thalassemia catalog in Guilan province.

Evaluation of the use of a Renal Health application by kidney transplant recipients.

OBJECTIVE: to evaluate the use of a renal health application by kidney transplant recipients. METHOD: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. RESULTS: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). CONCLUSION: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.

Gender differences regarding intention to use mHealth applications in the Dutch elderly population: a cross-sectional study.

BACKGROUND: In light of the increasing demands in health care, a call has been made for the development of new strategies. One of these strategies is placing a higher emphasis on individuals, who are expected to better manage their own health and illness. mHealth applications could increase this self-management behaviour among older adults. However, it is crucial to know the intention to use mHealth of older adults before implementing these services. Even less is known regarding differences between genders on factors influencing this intention to use mHealth applications. OBJECTIVE: The aim of this study was to study the gender differences regarding the relationship between technology acceptance factors and the intention to use mHealth applications in the Dutch elderly population. METHODS: We conducted a quantitative cross-sectional study using questionnaires. The participants were 65 years or older, lived independently or in a senior living facility, without cognitive impairment. Logistic regression with interaction terms was done to determine gender differences in the relationship between the intention to use mHealth applications and technology acceptance factors. RESULTS: While we found that half of the studied population had intention to use medical applications (50.3%) a notable difference was observed within gender groups which showed more men had intention to use medical applications rather than women (59.4% vs. 43.4% respectively). Adjusted logistic regression analysis per factor on the male and female part of the study population respectively showed that the factors Perceived usefulness (OR 21,69 and 2,39, resp.), Perceived ease of use (OR 7,21 and 2,74), Attitude toward use (OR 24,61 and 4,94), Sense of control (OR 4,12 and 2,67), Personal innovativeness (OR 2,54 and 1,58), Self-perceived effectiveness (OR 3,21 and 2,34), Service availability (OR 4,38 and 2,51) and Facilitating circumstances (OR 3,04 and 2,18) had a statistically significant influence on intention to use in both models. Logistic regression with interaction terms showed that two of the technology acceptance factors differed statistically significant in their relationship with intention to use when comparing females to males, namely Perceived usefulness (OR 0,11) and Attitude toward use (OR 0.24). Both factors were more strongly associated with intention to use for men compared to women. CONCLUSION: Policymakers and interventions aiming to stimulate the uptake of mHealth applications should acknowledge gender differences. Interventions based on improving the Perceived usefulness and Attitude toward use among female users could be a means to stimulate the full potential of medical applications and improve the uptake.

Study protocol ROTATE-trial: anterior cruciate ligament rupture, the influence of a treatment algorithm and shared decision making on clinical outcome- a cluster randomized controlled trial.

BACKGROUND: Anterior cruciate ligament (ACL) rupture is a very common knee injury in the sport active population. There is much debate on which treatment (operative or non-operative) is best for the individual patient. In order to give a more personalized recommendation we aim to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture. METHODS: The ROTATE-trial is a multicenter, open-labeled cluster randomized controlled trial with superiority design. Randomization will take place on hospital level (n = 10). Patients must meet all the following criteria: aged 18 year or older, with a complete primary ACL rupture (confirmed by MRI and physical examination) and maximum of 6 weeks of non-operative treatment. Exclusion criteria consists of multi ligament trauma indicated for surgical intervention, presence of another disorder that affects the activity level of the lower limb, pregnancy, and insufficient command of the Dutch language. The intervention to be investigated will be an adjusted treatment decision strategy, including an advice from our treatment algorithm. Patient reported outcomes will be conducted at baseline, 3, 6, 12 and 24 months. Physical examination of the knee at baseline, 12 and 24 months. Primary outcome will be function of the knee measured by the International Knee Documentation Committee (IKDC) questionnaire. Secondary outcomes are, among others, the Tegner activity score, the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Healthcare use, productivity and satisfaction with ((non-)operative) care are also measured by means of questionnaires. In total 230 patients will be included, resulting in 23 patients per hospital. DISCUSSION: The ROTATE study aims to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture compared to current used treatment strategy. Using a treatment algorithm might give the much-wanted personalized treatment recommendation. TRIAL REGISTRATION: This study is approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam and prospectively registered at the Dutch Trial Registry on May 13th, 2020. Registration number: NL8637.

Digital Health and Possible Solutions to Improve the Care in the Field of Nephrology.

Digital health is an area that emerges from the association between health needs and technological solutions. With the growing access of people to the internet and the ease of acquiring equipment that allows internet connection, we are observing an exponential increase in the strategies that use technology to connect patients and healthcare providers. Telenephrology is a channel of communication that facilitates the access to the nephrologist for both primary care physicians and patients and has been implemented in several countries. Applications for smartphones are frequently used by both patients and healthcare providers, and these tools are changing the way we practice nephrology and medicine in general. Social networks emerge as an important way of communicating between healthcare professionals and patients and a source of connection for people with the same interests. Artificial intelligence, big data, and other technological solutions, including wearable devices that measure and monitor different health parameters, are revolutionizing healthcare and the field of nephrology. Implantable devices are in development, including devices to monitor electrolytes in dialysis patients, systems to track medication intake, wearables to monitor exercises, monitoring of blood pressure, heart rate, arrhythmia, and peripheral oxy-hemoglobin saturation, among others. The wearable artificial kidney, a device which would perform renal function during ambulation and social activities outside of the hospital, has been under investigation for many years. In this chapter, we highlight the most recent advances in digital health applied to nephrology.

Relationship Between Perceived Risks of Using mHealth Applications and the Intention to Use Them Among Older Adults in the Netherlands: Cross-sectional Study.

BACKGROUND: Considering the increasing demand for health services by older people and the ongoing COVID-19 pandemic, digital health is commonly viewed to offer a pathway to provide safe and affordable health services for older adults, thus enabling self-management of their health while health care systems are struggling. However, several factors cause older people to be particularly reluctant to adopt digital health technologies such as mobile health (mHealth) tools. In addition to previously studied technology acceptance factors, those related to perceived risks of mHealth use (eg, leakage of sensitive information or receiving incorrect health recommendations) may further diminish mHealth adoption by older adults. OBJECTIVE: The aim of this study was to explore the relationship between perceived risks of using mHealth applications and the intention to use these applications among older adults. METHODS: We designed a cross-sectional study wherein a questionnaire was used to collect data from participants aged 65 years and older in the Netherlands. Perceived risk was divided into four constructs: privacy risk, performance risk, legal concern, and trust. Linear regression analyses were performed to determine the associations between these perceived risk constructs and the intention to use mHealth applications. RESULTS: Linear regression per perceived risk factor showed that each of the four constructs is significantly associated with the intention to use mobile medical applications among older adults (adjusted for age, sex, education, and health status). Performance risk (ß=-.266; P=<.001), legal concern (ß=-.125; P=.007), and privacy risk (ß=-.100; P=.03) were found to be negatively correlated to intention to use mHealth applications, whereas trust (ß=.352; P=<.001) was found to be positively correlated to the intention to use mHealth applications. CONCLUSIONS: Performance risk, legal concern, and privacy risk as perceived by older adults may substantially and significantly decrease their intention to use mHealth applications. Trust may significantly and positively affect this intention. Health care professionals, designers of mHealth applications, and policy makers can use these findings to diminish performance risks, and tailor campaigns and applications to address legal and privacy concerns and promote mHealth uptake and health care access for older adults, especially during the COVID-19 pandemic.

Factors Affecting Portal Usage Among Chronically Ill Patients During the COVID-19 Pandemic in the Netherlands: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users' satisfaction among patients who are chronically ill during the COVID-19 pandemic. OBJECTIVE: This study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers. METHODS: An online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of four parts: (1) demographics including age and hours of daily internet use; (2) physical health status including COVID-19 infection, perceived level of control, and hospital visits; (3) mental health status including depression and life satisfaction; and (4) portal use including response waiting time and awareness. Descriptive, correlation, univariate, and multivariate analyses were conducted to identify factors that affect portal use, users' willingness to recommend, and nonusers' likelihood of future portal use. RESULTS: A total of 652 patients responded, and 461 valid questionnaires were included. Among the 461 patients, 67% (n=307) were identified as patient portal users. Of the nonusers, 55% (85/154) reported not being aware of the existence of a patient portal at their hospital. Significant predictors of portal use include level of control (P=.04), hospital visit time (P=.03), depression scale (P=.03), and status of life satisfaction (P=.02). Among portal users, waiting time to get a response via the portal (P<.001) and maximum acceptable waiting time (P<.001) were the strongest predictors for willingness to recommend the portal; among nonusers, the model predicted that those who were not aware of patient portals (P<.001) and were willing to wait moderately long (P<.001) were most likely to use the portal in the future. CONCLUSIONS: This study provides insights into factors that influence portal use and willingness to recommend, based on which health care providers can improve the adoption of patient portals and their services. It suggests that health care providers should leverage efficient operations management to improve responsiveness and reduce waiting time to enhance user satisfaction and willingness to recommend use. Health care organizations need to increase portal awareness among nonusers and train their patients to increase both use and longer adoption of patient portals. Factors including depression and life satisfaction can influence portal use; therefore, future studies on determinants of portal use and nonuse in this specific population are needed.

eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations.

BACKGROUND: eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application's costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. OBJECTIVE: The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. METHODS: We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. RESULTS: We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. CONCLUSIONS: Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons.

Intention to use Medical Apps Among Older Adults in the Netherlands: Cross-Sectional Study.

BACKGROUND: The increasing health service demand driven by the aging of the global population calls for the development of modes of health service delivery that are less human resource-intensive. Electronic health (eHealth) and medical apps are expected to play an important role in this development. Although evidence shows mobile medical apps might be effective in improving the care, self-management, self-efficacy, health-related behavior, and medication adherence of older adults, little is known about older adults' intention to use these technologies when needed, or the factors influencing this intention. OBJECTIVE: The objective of this study was to investigate the relationship of technology acceptance factors and intention to use mobile medical apps among community-dwelling older adults. METHODS: Data was collected using questionnaires. The factors selected from the literature have been validated using Cronbach α and tested for significance using logistic regressions. RESULTS: Almost half (49.7%) of the included older adults reported no intention to use medical apps. Adjusted logistic regression analysis per factor showed that the factors Attitude toward use (odds ratio [OR] 8.50), Perceived usefulness (OR 5.25), Perceived ease of use (OR 4.22), Service availability (OR 3.46), Sense of control (OR 3.40), Self-perceived effectiveness (OR 2.69), Facilities (OR 2.45), Personal innovativeness (OR 2.08), Social relationships (OR 1.79), Subjective norm (OR 1.48), and Feelings of anxiety (OR 0.62) significantly influenced the intention to use mobile medical apps among older adults, whereas the factor Finance (OR 0.98) did not. When considered together, a controlled multivariate logistic regression yielded high explained variances of 0.542 (Cox-Snell R2) and 0.728 (Nagelkerke R2). CONCLUSIONS: The high odds ratios and explained variance indicate that the factors associated with the intention to use medical apps are largely understood and the most important factors have been identified. To advance the evidence base, experimental controlled research should investigate the causality between the factors, intention to use, and actual use. For this purpose, our evidence suggests that policies designed to improve Attitude toward use appear most effective, followed by policies addressing Perceived usefulness, Perceived ease of use, Service availability, and Sense of control.

The Renal Health Instagram: An Analysis of Comments.

Chronic kidney disease (CKD) is a Public Health problem affecting a considerable number of patients worldwide. CKD treatment is complex and requires patients' education. Based on this we have created technological tools, including an application for smartphones and a profile on Instagram (Renal Health) aiming to educate patients to self-monitor and cope with their disease, to increase adherence to treatment. In this study, we have analyzed the spontaneous feedbacks patients, and other people have posted on the Renal Health Instagram (comments) to investigate which information was needed the most by which types of patients. During the first 15 months since the release of this profile, there were 3380 followers, a total of 449 posts, with 36,079 "likes". Most of the followers were patients and parents, they gave spontaneous testimonials of their experiences with having kidney disease, and were thankful for the information provided and for the response we gave to their questions. From the analysis of the comments, we found that information on nutrition, physical activities and kidney transplant were the most discussed and valued. Our results also showed that the main use of this medium for dialysis and transplant patients was to share their experience. The Renal Health Instagram was considered a good digital platform of trusted information for both patients and the general population and also a space for sharing experiences in the context of kidney disease epidemics.

The usability aspects of medication-related decision support systems in the inpatient setting: A systematic review.

Effort has been made to study the effect of medication-related clinical decision support systems in the inpatient setting; however, there is not much known about the usability of these systems. The goal of this study is to systematically review studies that focused on the usability aspects such as effectiveness, efficiency, and satisfaction of these systems. We systematically searched relevant articles in Scopus, Embase, and PubMed from 1 January 2000 to 1 January 2016, and found 22 articles. Based on Van Welie's usability model, we categorized usability aspects in terms of usage indicators and means. Our results showed that evidence was mainly found for effectiveness and efficiency. They showed positive results in the usage indicators errors and safety and performance speed. The means warnings and adaptability also had mostly positive results. To date, the effects satisfaction of clinical decision support system remains understudied. Aspects such as memorability, learnability, and consistency require more attention.

Usability aspects of medication-related decision support systems in the outpatient setting: A systematic literature review.

In this study, we evaluated the usability aspects of medication-related clinical decision support systems in the outpatient setting. Articles published between 2000 and 2016 in Scopus, PubMed and EMBASE were searched and classified into three usability aspects: Effectiveness, Efficiency and Satisfaction. Using Van Welie et al.'s usability model, we categorized usability aspects in terms of usage indicators and means. Out of the 1999 articles, 24 articles met the selection criteria of which the main focus was on reducing inappropriate medication, prescription rate and prescription errors. Evidence could mainly be found for Effectiveness and showed high rates of positive results in reducing medication errors. To date, the effects of Efficiency and Satisfaction of clinical decision support systems regarding medication prescription remain understudied. Usability aspects such as memorability, learnability, adaptability, shortcuts and consistency require more attention. Studies are needed for better insight into the user model and to design a knowledge/task model for clinical decision support systems regarding medication prescription.

Chronic Kidney Disease and the Use of Social Media as Strategy for Health Education in Brazil.

Chronic kidney disease (CKD) is a Public Health problem worldwide. Treatment in complex and depends on patient education to achieve adequate adherence. We describe in this paper novel strategies for patients' education based on internet (youtube and instagram), through videos, images and texts information directed for patients in a project developed in Brazil.

For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners.

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners' intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded. The survey consisted of six questions for each of 20 clinical rules. Despite concerns about interruption, doctors tended to choose more interruptive forms of support. Doctors wanted support when they felt the rule represented minimal care, perceived a need to improve care, and felt responsible for the action and that they might forget to perform the action; doctors declined support due to feeling that it was unnecessary and due to concerns about interruption.

Advantages of a Web-Based Real-Time Bed-Management System for Hospital Admission Monitoring in Iran.

Lack of up-to-date information of hospitals beds, specifically in emergencies, is a significant problem in many large countries; The Ministry of Health and Medical Education of Iran (MOHME) designed and implemented a dynamic system that reports the status of beds in 2012. This system created great opportunities for national bed management, including real-time hospital admission monitoring, especially for emergency departments, ICUs and CCUs. Therefore, an additional online system was planned to be implemented for monitoring hospital admissions, including a national alert system. Prior to the design of this system, a study was done using literature study and expert opinion to investigate the advantages and features that this monitoring system was required to have. We used the MoSCoW method to prioritize the requirements of the system. This system was designed to have the following advantages, among other things: the hospitals as well as government should be able to track the patients, manage patient distribution in healthcare centers, and make policy for supplying extra beds. It should also be possible for the hospitals executive board, as well as the government, to monitor the performance of the hospitals regarding patient admissions (i.e., the rate of rejection of patients with severe conditions).

An email-based intervention to improve the number and timeliness of letters sent from the hospital outpatient clinic to the general practitioner: A pair-randomized controlled trial.

OBJECTIVE: Letters from the hospital to the general practitioner are important for maintaining continuity of care. Although doctors feel letters are important, they are often not written on time. To improve the number and timeliness of letters sent from the hospital outpatient department to the general practitioner using an email-based intervention evaluated in a randomized controlled trial. MATERIALS AND METHODS: Users were interviewed to determine the requirements for the intervention. Due to high between-doctor variation at baseline, doctors were matched for baseline performance and pair-randomized. The effectiveness of the intervention was assessed using meta-analytic methods. The primary outcome was the number of patient visits which should have generated a letter that had a letter by 90 days after the visit. Satisfaction was assessed with an anonymous survey. RESULTS: The intervention consisted of a monthly email reminder for each doctor containing a list of his or her patients who were (over)due for a letter. Doctors in the intervention group had 21% fewer patient visits which did not have a letter by 90 days (OR = 5.7, p = 0.0020). Satisfaction with the system was very high. DISCUSSION: This study examines the effect of a simple reminder in absence of other interventions, and provides an example of an effective non-interruptive decision support intervention. CONCLUSION: A simple email reminder improved the number and timeliness of letters from the outpatient department to the general practitioner, and was viewed as a useful service by its users.

A novel ß-carotene-associated carrot (Daucus carota L.) pectic polysaccharide.

OBJECTIVE: Carrot (Daucus carota L.) is a nutritional source with enriched ß-carotene (0.01%) and pectins (0.8%). Although studies have highlighted the association between ß-carotene and carrot pectic polysaccharide (CRPP), the precise binding of ß-carotene to CRPP and its biological implications were not yet clearly understood. The aim of the present study is to report for the first time a natural carbohydrate polymer-CRPP-with associated ß-carotene. METHODS: The presence of ß-carotene in CRPP and its binding is demonstrated by various studies including differential extraction followed by liquid chromatography (LC), liquid chromatography mass spectrometry (LC MS), and Fourier transform infrared spectroscopy (FTIR). Further, we show the binding via its release from CRPP using LC, fermentation studies and scanning electron microscopy (SEM) studies. The role of ß-carotene in induction of apoptosis and the galactic-3 inhibitory property was also studied. RESULTS: The presence of ß-carotene in CRPP was demonstrated, as well as an association between ß-carotene and CRPP, apoptotic and galectin-3 inhibitory properties of CRPP, and upregulation of connexin 43 by CRPP. CONCLUSION: The data highlights that with the combination of ß-carotene with CRPP, the prooxidant effect of ß-carotene may be reduced, an apoptotic effect may be enhanced, and the anticancer potential of CRPP thus may be strengthened via galectin-3 inhibition.