Can butyrate prevent colon cancer? The AusFAP study: A randomised, crossover clinical trial.

Increased colonic butyrate from microbial fermentation of fibre may protect from colorectal cancer (CRC). Dietary butyrylated high amylose maize starch (HAMSB) delivers butyrate to the large bowel. The objective of this clinical trial (AusFAP) is to evaluate potential chemoprotective effects of HAMSB on polyposis in individuals with a genetic form of colon cancer, Familial Adenomatous Polyposis (FAP). The study is a multi-site, double blind, randomised, placebo-controlled crossover trial undertaken at major hospitals in Australia. After a baseline endoscopy participants consume either 40g/day of HAMSB or placebo (low amylose maize) starch for 26 weeks. After another endoscopic examination participants consume the alternate starch for 26 weeks. A third endoscopy at 52 weeks is followed by 26 weeks' washout and a final endoscopy at 78 weeks. Primary outcome measure is the global large bowel polyp number. Secondary measures include global polyp size counts, and number and size of polyps at two tattoo sites: one cleared of polyps at baseline, and another safely chosen with polyps left in situ during the study. Other secondary outcome measures include the effects of intervention on cellular proliferation in colonic biopsies, faecal measures including short chain fatty acid concentrations, and participants' dietary intakes. Generalized linear mixed models analysis will be used to estimate differences in primary outcomes between intervention and placebo periods. This study represents the first clinical evaluation of the effects of increased colonic butyrate on polyp burden in FAP which, if effective, may translate to lower risk of sporadic CRC in the community. Australian New Zealand Clinical Trials Registry Number: 12612000804886.

Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non-English-Speaking Patients.

BACKGROUND: There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients' interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content. OBJECTIVE: This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non-English-speaking backgrounds when an interpreter is not available. METHODS: This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017. RESULTS: In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t80=5.69; P<.001) than interactions with patients from non-English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non-English-speaking backgrounds were rated as more successful than interactions without the app (F2,119=8.17; P<.001; η2=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t80=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating. CONCLUSIONS: Through the use of the app, a number of patients from non-English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care.

A SMART on FHIR Prototype for Genomic Test Ordering.

Queensland Genomics recently undertook a number of Clinical Demonstration Projects (CDPs) to demonstrate the benefits of genomics in clinical practice. Integration of this testing requires the health system to provide the infrastructure for the appropriate ordering of these tests. Ordering of genomics tests will likely require greater exchange of information between the ordering clinician and the lab that is producing a clinical test report. The clinical demonstration projects were used to understand the information flow and the use of genomic, phenotypic and other information through the test ordering, analysis and reporting stages. This information was used to inform a set of requirements for a genomics test ordering and reporting system. A prototype of this system was developed as a SMART on FHIR application. This prototype will inform a future production system with FHIR Resources, software interfaces and interoperability requirements.

CALD Assist-Nursing: Improving communication in the absence of interpreters.

AIMS AND OBJECTIVES: To develop a communication app to support nursing staff during the provision of standard care of patients from non-English-speaking backgrounds (NESBs), when an interpreter is not available. This paper reports on the user needs analysis phase that informed the development, content and functionality of the app. BACKGROUND: In 2014 we developed CALD Assist, a communication app to support patient interactions with allied health clinicians when interpreters are not present. It includes 95 commonly used phrases professionally interpreted into 10 languages and grouped by discipline. This work expands upon our previous app to meet the needs of the nursing workforce. DESIGN: Qualitative through focus groups, observations and interviews, with a quantitative component from observational data and staff surveys. METHODS: Four focus groups with hospital staff, ten interviews with patients from NESBs and 85 observation sessions of everyday patient-staff interactions followed by staff surveys (n = 85) were held between January and June 2017. RESULTS: Baseline data prior to app development revealed that staff confidence of the patients' level of understanding and the success of the interaction were significantly greater for English-speaking (ES) patients, than for non-English-speaking patients. A total of 143 phrases were identified and subdivided into 16 categories for inclusion in the new app. CONCLUSION: Staff participants highlighted that patients from NESBs are a challenging patient group to interact with. Patient and staff participants identified a range of areas where the nursing app could benefit, including pain management, mobility, hygiene and nutrition. RELEVANCE TO CLINICAL PRACTICE: The proposed app can be used to reduce variances in practice and provide a timely and positive patient experience for patients from NESBs who are unable to communicate in English during hospital admissions.

Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups.

BACKGROUND: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians' inability to communicate directly with them. OBJECTIVE: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. METHODS: CALD Assist's design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. RESULTS: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians' confidence in their assessment increased with use of the CALD Assist app: clinicians' reports of "complete confidence" increased from 10% (3/30) to 42% (5/12), and assessment reports of "no confidence" decreased from 57% (17/30) to 17% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. CONCLUSIONS: Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store.

Designing Technology for Assessments of CALD Patients.

Interpreters are required to aid communication between clinicians and culturally and linguistically diverse (CALD) patients to ensure appropriate and timely care. Demand for interpreting services however, often exceeds supply. A mobile app to translate clinical assessment questions in 10 common languages using pictorial, written and voice-over prompts to assist patient assessments when interpreters are unavailable has been developed. This paper reports on the User Needs Analysis that informed the app. The analysis consisted of focus groups with allied health clinicians to understand pertinent aspects of initial allied health assessments and the communication needs to be addressed in the design of an app-based patient assessment tool. Outcomes show that of primary importance to clinicians was the ability to not only ask the patients questions, but to communicate information to increase understanding of, and ensure compliance with, treatments and interventions to promote patient function and comfort.