What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting?

BACKGROUND: The anticipated increase in uptake of intrauterine system (IUS) fittings is slower than predicted by the National Institute for Health and Clinical Excellence (NICE). There is evidence to suggest that this is because of a high perceived cost of providing this contraceptive method. Whereas studies to date have all guessed at these costs, we calculated the actual costs of providing the IUS. METHODS: We tracked the notes of 283 women who had an IUS fitted in our community sexual and reproductive health service for 5 years. We recorded duration of use, measured the actual cost of all appointments and interventions over the lifespan of the device, and compared our findings with NICE predicted costs. RESULTS: With 70% complete follow-up, the average duration of use of the IUS was 3.44 years compared to NICE's prediction of 3.32. The average annual cost of providing an IUS for contraception in community clinics was £54.55 per woman; this compares with £70.49 modelled by NICE for provision in primary care. Most (80%) of the cost is incurred in the first year. The cost of managing problems is small. CONCLUSIONS: Providing the IUS for contraception was 23% cheaper in the present study than that predicted by NICE and cheaper than providing combined oral contraception in our service. Fitting IUSs in community clinics may be cheaper than in primary care. Streamlining the patient pathway will reduce costs further. Restricting access to the IUS because of initial cost is a false economy.

Engagement and Participant Experiences With Consumer Smartwatches for Health Research: Longitudinal, Observational Feasibility Study.

BACKGROUND: Wearables provide opportunities for frequent health data collection and symptom monitoring. The feasibility of using consumer cellular smartwatches to provide information both on symptoms and contemporary sensor data has not yet been investigated. OBJECTIVE: This study aimed to investigate the feasibility and acceptability of using cellular smartwatches to capture multiple patient-reported outcomes per day alongside continuous physical activity data over a 3-month period in people living with knee osteoarthritis (OA). METHODS: For the KOALAP (Knee OsteoArthritis: Linking Activity and Pain) study, a novel cellular smartwatch app for health data collection was developed. Participants (age ≥50 years; self-diagnosed knee OA) received a smartwatch (Huawei Watch 2) with the KOALAP app. When worn, the watch collected sensor data and prompted participants to self-report outcomes multiple times per day. Participants were invited for a baseline and follow-up interview to discuss their motivations and experiences. Engagement with the watch was measured using daily watch wear time and the percentage completion of watch questions. Interview transcripts were analyzed using grounded thematic analysis. RESULTS: A total of 26 people participated in the study. Good use and engagement were observed over 3 months: most participants wore the watch on 75% (68/90) of days or more, for a median of 11 hours. The number of active participants declined over the study duration, especially in the final week. Among participants who remained active, neither watch time nor question completion percentage declined over time. Participants were mainly motivated to learn about their symptoms and enjoyed the self-tracking aspects of the watch. Barriers to full engagement were battery life limitations, technical problems, and unfulfilled expectations of the watch. Participants reported that they would have liked to report symptoms more than 4 or 5 times per day. CONCLUSIONS: This study shows that capture of patient-reported outcomes multiple times per day with linked sensor data from a smartwatch is feasible over at least a 3-month period. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10238.

Impact of Education on Professional Involvement for Student Registered Nurse Anesthetists' Political Activism: Does Education Play a Role?

National and state legislative decisions have an impact on the care that Certified Registered Nurse Anesthetists (CRNA) provide their patients. Historically, professional advocacy resulted in CRNA title recognition and direct reimbursement for CRNA services and led to providing states an opt-out option for medical supervision when billing Medicare and Medicaid. It is critical that CRNAs continue to grow as advocacy leaders and, in preparing for this role, each CRNA must be provided with the knowledge and skills to be successful. The objective of this research project was to determine the impact that CRNA advocacy education in Pennsylvania nurse anesthesia educational programs has on students' professional involvement. Two surveys were distributed to all 12 Pennsylvania nurse anesthesia educational programs to determine the quality and quantity of advocacy education incorporated into their program and how it affected the professional political involvement of senior student registered nurse anesthetists. Pearson r calculations were conducted to assess for correlations between variables. The results showed a strong positive correlation between advocacy education in nurse anesthesia educational programs and the impact it has on students' professional advocacy involvement (r = 0.481, P = .001).

Collecting Symptoms and Sensor Data With Consumer Smartwatches (the Knee OsteoArthritis, Linking Activity and Pain Study): Protocol for a Longitudinal, Observational Feasibility Study.

BACKGROUND: The Knee OsteoArthritis, Linking Activity and Pain (KOALAP) study is the first to test the feasibility of using consumer-grade cellular smartwatches for health care research. OBJECTIVE: The overall aim was to investigate the feasibility of using consumer-grade cellular smartwatches as a novel tool to capture data on pain (multiple times a day) and physical activity (continuously) in patients with knee osteoarthritis. Additionally, KOALAP aimed to investigate smartwatch sensor data quality and assess whether engagement, acceptability, and user experience are sufficient for future large-scale observational and interventional studies. METHODS: A total of 26 participants with self-diagnosed knee osteoarthritis were recruited in September 2017. All participants were aged 50 years or over and either lived in or were willing to travel to the Greater Manchester area. Participants received a smartwatch (Huawei Watch 2) with a bespoke app that collected patient-reported outcomes via questionnaires and continuous watch sensor data. All data were collected daily for 90 days. Additional data were collected through interviews (at baseline and follow-up) and baseline and end-of-study questionnaires. This study underwent full review by the University of Manchester Research Ethics Committee (#0165) and University Information Governance (#IGRR000060). For qualitative data analysis, a system-level security policy was developed in collaboration with the University Information Governance Office. Additionally, the project underwent an internal review process at Google, including separate reviews of accessibility, product engineering, privacy, security, legal, and protection regulation compliance. RESULTS: Participants were recruited in September 2017. Data collection via the watches was completed in January 2018. Collection of qualitative data through patient interviews is still ongoing. Data analysis will commence when all data are collected; results are expected in 2019. CONCLUSIONS: KOALAP is the first health study to use consumer cellular smartwatches to collect self-reported symptoms alongside sensor data for musculoskeletal disorders. The results of this study will be used to inform the design of future mobile health studies. Results for feasibility and participant motivations will inform future researchers whether or under which conditions cellular smartwatches are a useful tool to collect patient-reported outcomes alongside passively measured patient behavior. The exploration of associations between self-reported symptoms at different moments will contribute to our understanding of whether it may be valuable to collect symptom data more frequently. Sensor data-quality measurements will indicate whether cellular smartwatch usage is feasible for obtaining sensor data. Methods for data-quality assessment and data-processing methods may be reusable, although generalizability to other clinical areas should be further investigated. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10238.

How the weather affects the pain of citizen scientists using a smartphone app.

Patients with chronic pain commonly believe their pain is related to the weather. Scientific evidence to support their beliefs is inconclusive, in part due to difficulties in getting a large dataset of patients frequently recording their pain symptoms during a variety of weather conditions. Smartphones allow the opportunity to collect data to overcome these difficulties. Our study Cloudy with a Chance of Pain analysed daily data from 2658 patients collected over a 15-month period. The analysis demonstrated significant yet modest relationships between pain and relative humidity, pressure and wind speed, with correlations remaining even when accounting for mood and physical activity. This research highlights how citizen-science experiments can collect large datasets on real-world populations to address long-standing health questions. These results will act as a starting point for a future system for patients to better manage their health through pain forecasts.

Analysis of clinic attendances by under-14s to sexual health clinics in Gwent, South Wales, UK.

OBJECTIVES: To determine the gender, sexual history and reason(s) for visit for under-14s (young people) attending the authors' sexual health clinics. METHODS: Analysis of case notes of 242 young people who made a total of 598 visits to a sexual health clinic in Gwent, South Wales, UK between 1 January and 31 December 2003. RESULTS: Of the 242 young people studied, 41% were male and males were responsible for 42% of visits. There was no written record relating to 7% of the total visits. Median age at both first registration and first heterosexual intercourse (when recorded) was 12 years for males and 13 years for females. Some 57% of females and 30% of males were already sexually active at first registration. Details relating to a young person's partner and their experience of sex (e.g. willingness, autonomy and consensual nature of sex) were infrequently recorded, especially for males. 96% of males requested condoms and 99% received them, whilst 72% of females requested condoms and/or hormonal contraception and 86% received them. 35% of females were seen for the consequences of sex (i.e. pregnancy testing, emergency contraception, screening and/or treatment of sexually transmitted infections and unplanned pregnancies). 80% of these subsequently received condoms and/or hormonal contraception. The majority of young people saw a nurse exclusively (96% males, 71% females). CONCLUSIONS: Of the young clients seen, 41% are male. Sexual history details are infrequently recorded, particularly for males. The majority of young people accessing the authors' service are taking action to protect their sexual health and most will see a nurse exclusively.

Audit of under-14s who attend sexual health clinics in Gwent, South Wales, UK: identifying young people at risk of abuse and exploitation.

BACKGROUND: The authors' service has child protection guidance listing locally agreed 'markers' of potential abuse and exploitation to aid identification of vulnerable young people. OBJECTIVES: To review whether staff are identifying markers of sexual abuse and exploitation, and to review documentation relating to assessment of Fraser criteria in under-14s (young people) attending sexual health clinics in Gwent, South Wales, UK. METHODS: Analysis of case notes of 242 young people who made 598 visits to a sexual health clinic between 1 January and 31 December 2003. RESULTS: A total of 81 references to a marker of potential abuse or exploitation were recorded at 8% of visits and for 11% of young people. For 72 references a marker was present and for nine was absent. There was no reference to a marker being present or absent for any young males or for 81% of females. Increasing attendance was associated with increasing prevalence of recorded markers. All young people with three or more markers identified as present were referred onwards compared with 53% of those with one or two markers present. Referral did not deter future attendance. Reference to Fraser guidance assessment was recorded at 35% of visits or for 64% of young people and fully demonstrated at 7% of visits or for 16% of young people. There was no recorded assessment for 18% of females and 60% of males. CONCLUSIONS: The authors' service is not recording sufficient information to help identify young people (particularly males) at risk of abuse or exploitation or to demonstrate the service's compliance with Fraser guidance.