Clinical Outcomes of Free, Public Skin Cancer Screening Events, Rhode Island, 2015-2019.

BACKGROUND: In Rhode Island, malignant melanoma of skin causes about 30 deaths a year. Early detection has been shown to reduce mortality risk. METHODS: Dermatology volunteers and public health professionals convened 27 free skin cancer screenings at public beaches in 2015-2019 to raise skin cancer awareness and screen patients for malignancy. Participants with suspicious lesions were referred for follow-up and later telephoned to ascertain outcomes. RESULTS: Of 2354 people screened, 597 (25%) were referred. 319 of 597 (53%) were later reached by telephone. 196 of 319 (61%) who had kept appointments by the time of the telephone call reported the following diagnoses: 7 malignant melanomas, 32 keratinocyte carcinomas, and 34 actinic keratoses, yielding 3.0 as number needed to biopsy (NNB), and 18.3 as number needed to screen (NNS). CONCLUSIONS: Our results demonstrate the value of convenient skin cancer screening events, suggesting the desirability of additional interventions of this type.

Human factors and usability of an incentive spirometer patient reminder (SpiroTimer™).

INTRODUCTION: To address the problem of incentive spirometry (IS) noncompliance, a use-tracking IS reminder device (SpiroTimer™) was developed. In a recent randomized clinical trial, the SpiroTimer™ improved IS use compliance, length of stay, and mortality. For successful, safe, and effective implementation of a new medical device, human factors and usability must be evaluated. This study aims to evaluate the SpiroTimer™'s human factors as they pertain to intended users, use environments, and uses. MATERIAL AND METHODS: Immediately following the completion of the randomized clinical trial of the SpiroTimer™, before the providers were informed of the results of the study, a human factors and usability survey was distributed in-person to all nurses involved in the trial. Variations in nurse user perspectives were evaluated. RESULTS: A total of 52 nurses (100% response rate) completed the survey. In general, most nurses felt IS use compliance is poor (65%; 34/52, p = 0.0265) and should be improved (94%; 49/52, p < 0.001). Nurses agreed the SpiroTimer™ ameliorated patient IS use compliance (82%; 41/50, p < 0.001), IS effectiveness (74 %; 37/50, p < 0.001), and patient engagement in their own care (88%; 44/ 50, p < 0.001). Nurses reported the SpiroTimer™ helped remind them to work with their patients on IS (70%; 35/50, p = 0.0047) while reducing the number of times they had to remind their patients to use their IS (70%; 35/50, p = 0.0047). They felt that they would use the SpiroTimer™ with all their patients (82%; 41/50, p < 0.001) and that they would recommend the SpiroTimer™ to a colleague (74%; 37/50, p < 0.001). Ultimately, most nurses believed the SpiroTimer™ should become part of routine patient care (78%; 39/50, p < 0.001). DISCUSSION: For a new medical technology to a medical device to be effectively implemented, human factors and usability must be demonstrated. Nurses believe the clinically effective SpiroTimer™ helps both patients and nurses and should become part of routine care.

Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting: A Randomized Clinical Trial.

Importance: Incentive spirometers (ISs) were developed to reduce atelectasis and are in widespread clinical use. However, without IS use adherence data, the effectiveness of IS cannot be determined. Objective: To evaluate the effect of a use-tracking IS reminder on patient adherence and clinical outcomes following coronary artery bypass grafting (CABG) surgery. Design, Setting, and Participants: This randomized clinical trial was conducted from June 5, 2017, to December 29, 2017, at a tertiary referral teaching hospital and included 212 patients who underwent CABG, of whom 160 participants were randomized (intent to treat), with 145 completing the study per protocol. Participants were stratified by surgical urgency (elective vs nonelective) and sex (men vs women). Interventions: A use-tracking, IS add-on device (SpiroTimer) with an integrated use reminder bell recorded and timestamped participants' inspiratory breaths. Patients were randomized by hourly reminder "bell on" (experimental group) or "bell off" (control group). Main Outcomes and Measures: Incentive spirometer use was recorded for the entire postoperative stay and compared between groups. Radiographic atelectasis severity (score, 0-10) was the primary clinical outcome. Secondary respiratory and nonrespiratory outcomes were also evaluated. Results: A total of 145 per-protocol participants (112 men [77%]; mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective procedure) were evaluated, with 74 (51.0%) in the bell off group and 71 (49.0%) in the bell on group. The baseline medical and motivation-to-recover characteristics of the 2 groups were similar. The mean number of daily inspiratory breaths was greater in bell on (35; 95% CI, 29-43 vs 17; 95% CI, 13-23; P < .001). The percentage of recorded hours with an inspiratory breath event was greater in bell on (58%; 95% CI, 51-65 vs 28%; 95% CI, 23-32; P < .001). Despite no differences in the first postoperative chest radiograph mean atelectasis severity scores (2.3; 95% CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P = .48), the mean atelectasis severity scores for the final chest radiographs conducted before discharge were significantly lower for bell on than bell off group (1.5; 95% CI, 1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P = .04). Of those with early postoperative fevers, fever duration was shorter for bell on (3.2 hours; 95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P = .04). Having the bell turned on reduced noninvasive positive pressure ventilation use rates (37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P = .03) for participants undergoing nonelective procedures. Bell on reduced the median postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7; P = .048) and the intensive care unit length of stay for patients undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI, 3-4; P = .02). At 6 months, the bell off mortality rate was higher than bell on (9% vs 0%, P = .048) for participants undergoing nonelective procedures. Conclusions and Relevance: The incentive spirometer reminder improved patient adherence, atelectasis severity, early postoperative fever duration, noninvasive positive pressure ventilation use, ICU and length of stay, and 6-month mortality in certain patients. With the reminder, IS appears to be clinically effective when used appropriately. Trial Registration: ClinicalTrials.gov identifier: NCT02952027.