Clustering patients and caregivers for technology design: A step prior to the design of an innovative technological device for the detection of epileptic seizures.

AIMS: Seizure detection using heart rate variability, from a detailed analysis by deep learning analysis system, may help patients with epilepsy to manage their symptoms. This exploratory study aims to identify patient and caregiver groups, according to acceptability factors. METHODS: Two versions of the same questionnaire were designed to survey quality of life, self-efficacy, and patients with epilepsy and caregivers on seizure detection acceptability using a patch, after watching a video that described a patch connected to a companion application. Participation was voluntary and anonymous. RESULTS: Responses from 68 patients with epilepsy and 33 caregivers were collected. Patients with epilepsy were grouped into three clusters: supportive, indeterminate, and reluctant to use the technology. Caregivers were also grouped into three clusters: supportive, reluctant to use the technology, either with sensitivity to their environment, or with hedonic motivation. The clusters enable the distinction between participants in self-efficacy. CONCLUSIONS: Clustering of patients with epilepsy and caregivers should be a prerequisite to the design of a technological device intended to promote self-management of seizure detection. These groupings distinguish those who are favorable, reluctant or undecided to use the technology. These can be based on an assessment of self-efficacy.

A triadic approach to health and dependence in aging adults: incongruence in perception.

PURPOSE: Taking charge of dependent people is a major challenge. Numerous studies focus on the congruence of the dyadic perceptions of the actors. This study looks into the congruence of perceptions concerning dependence (i.e., physical and mental losses that prevent carrying out everyday tasks) and pathologies affecting older people within the triad: the aged person living at home, the informal caregiver, and the in-home professional caregiver. METHODS: A face-to-face questionnaire examining dependence and pathologies was administered separately to the three actors of 58 triads. This database has been analyzed mainly with techniques of data mining (MCA and AHC). RESULTS: The perception of pathologies and dependence are perceivably different depending on the actors. Within a same triad, perceptions of these two points-taken together or individually-turn out to be very dispersed. We bring to light three factors that structure 94% (with Benzécri's correction) of the congruence in perception within triads, and we propose a typology in four clusters of triads on this theme. CONCLUSIONS: The congruence analyses of the triads showed that incongruence in cross-perceptions of older people, formal, and informal caregivers on pathologies and dependence is clearly structured. Four quite distinct clusters have emerged, which could be exploited in the framework of public policies on the management of dependency in the home setting, to effectively alleviate the incongruence in the triads.

Acceptance of Telemonitoring Among Patients with Obstructive Sleep Apnea Syndrome: How is the Perceived Interest by and for Patients?

BACKGROUND: Obstructive sleep apnea syndrome, a chronic respiratory disease, requires regular adherence to Continuous Positive Airway Pressure (CPAP) therapy. Telemonitoring may be relevant to support adherence, but nonetheless this raises ethical issues around the intrusive nature of the daily life of patients Objective: To explore the acceptance of telemonitoring by patients and the impact of this on adherence. MATERIALS AND METHODS: A prospective and observational study has been performed with 160 patients who initiated their CPAP therapy. The acceptability of telemonitoring was studied using an attitudes' scale of 8 items. A total of 160 patients (111 men, 49 women) responded to the questionnaire at 1 month upon treatment. The adoption of both telemonitoring and adherence behavior were observed at 10 months of therapy. RESULTS: A majority (78%) of patients expressed a favorable attitude toward telemonitoring, but nearly 40% consider this device like intrusive. However, at 10 months of treatment, 78% of patients are still telemonitored. We did not observe a significant difference between telemonitoring patients and nontelemonitoring patients with respect to the mean duration of use of CPAP therapy. However, the risk of stopping CPAP therapy is significantly more important in patients who refused telemonitoring. DISCUSSION AND CONCLUSION: It seems reductive to consider telemonitoring as a simple tool of surveillance to support adherence. It may be preferable to consider telemonitoring as a follow-up proposal. This will allow for more reactive management and close to the needs of the patients, in particular as telemonitoring is, in general, well accepted by patients.

Perception of domestic risks among carers for dependent older persons.

BACKGROUND: Despite growing interest for home care, little evidence exists on the perception of domestic risk among carers for dependent older persons. This study aims to characterize the risks to which carers of aging dependent individuals are exposed, and to determine whether these risk dimensions are predictive for effective support, for burden, and for psychological distress. METHODS: Seventy care partners were questioned about the risk situations identified at the homes of the old people they care for, about the burden they felt in their role, and about their feelings of psychological distress. Securing was evaluated by means of sensibility measures, and overprotection was evaluated by means of specificity measures. RESULTS: Risk rates were high for loneliness of the old people, wandering, burns, and unsatisfactory health monitoring. There was very little overlap between identification of the risks and implementation of solutions by the caregiver, except for the risks that involved heat. The distinction between accurate securing and overprotection is especially important, because the burden of care partners was linked to uncontrolled domestic risks. CONCLUSION: Typologies of reactions to risk, characterized by a signal detection approach, could contribute to a better understanding of the situations experienced by care partners, especially situations of neglect and of overprotection.

Determination of risks of lower adherence to CPAP treatment before their first use by patients.

A better understanding of Continuous Positive Airway Pressure (CPAP) adherence is a priority in improving patient care. To Identify adherence typology with a longitudinal approach, and explore the early determinants of lower adherence to CPAP. Obstructive sleep apnea patients (N = 204). Prospective and longitudinal study.A classification into four profiles was observed: "Regular Adherents," "Non-Regular Adherents," "Persistent Non-Adherents," and "Non-Persistent Non-Adherents." Specific biopsychosocial factors make it possible to evaluate the risk of belonging to a lower adherence profile. We propose a novel approach of CPAP treatment adherence. Several pre-determinants have been identified.

[Professional exhaustion among caregivers in nursing homes raises the perception of residents' aggressiveness and poor quality of caregiver-resident relationship]. / L'épuisement professionnel chez les soignants en EHPAD : quels liens entre perception de l'agressivité des résidents et qualité de la relation soignants-résidents ?

This study is aimed to explore whether professional exhaustion among caregivers working in nursing homes causes an increased perception of resident aggressiveness and a lower satisfaction in the relationship between the caregiver and the resident. The data were collected from a sample of 52 nurses and caregivers working in retirement homes. We compared the perception of aggressiveness and relational satisfaction in 26 caregivers to 26 without a professional exhaustion condition, using the Maslach Burnout Inventory, Yudofsky's Manifest Aggression Scale, and Wilguski's Caregiver Satisfaction Scale. The results show that caregivers with professional exhaustion have a much greater perception of resident aggressiessiveness. This perception of aggressiessiveness generates a relational dissatisfaction with the resident. Professional exhaustion is therefore associated with higher perception of aggressiveness and relational dissatisfaction.

A preliminary study of psychological factors affecting patients' acceptance of CPAP therapy for sleep apnoea syndrome.

BACKGROUND: Many patients abandon continuous positive airway pressure (CPAP) treatment after initial acceptance. This may be for physical or psychological reasons. METHODS: We have carried out semi-structured interviews, constructed from the Health Belief Model (HBM) with a convenience sample of patients who had recently abandoned CPAP treatment after at least 6 months of use. We explored their understanding and experiences of their OSA and of the CPAP therapy and their reasons for stopping treatment. RESULTS: Nine patients were interviewed (age 32-70 years; 8 males). Four patients were not clear about the nature, severity, or consequences of sleep apnoea syndrome (SAS) and did not consider themselves to be ill. Three expected to be cured by the machine. Only one patient spoke of life-threatening risk. Eight of the nine patients had other health disorders. Seven stopped CPAP because of negative experiences, including problems with the mask and noise from the machine. Two patients felt 'liberated' on stopping treatment. CONCLUSIONS: Studies at the initiation stage of CPAP treatment are needed in order to identify factors impeding acceptance, which can be addressed early. The Health Belief Model, which emphasises subjective health experience and patients' beliefs about treatment, may be a useful tool for such investigations.