ABSTRACT
Introduction: Technologies such as electronic prescribing, clinical decision support systems, and electronic medication dispensers, are increasingly being introduced into healthcare. Existing toolkits focus on the implementation of such technologies, rather than identifying and mitigating any unintended consequences technologies may have on patient safety. They also focus on high-level organisational issues instead of those faced by end-users: frontline staff, patients and carers. Aim(s): To identify and classify types of unintended consequences that may be encountered by technologies' end-users, in order to inform development of a tool for identifying and preventing technology-related risks on patient safety. Method(s): Five focus group discussions with healthcare professionals, patients and carers were conducted through video-conferencing. Healthcare professionals with experience of using/implementing healthcare technologies and known to the research team via professional networks were invited to participate. Patient/carer participants were recruited using convenience sampling via an external research-participant organisation. Participants were asked to identify patient safety risks associated with the use of healthcare technologies, drawn from their own experiences and through consideration of hypothetical risks. Discussions were audio-recorded and transcribed verbatim. Transcripts were analysed by two researchers (NVivo R1.6) and two public partners (manually), using iterative inductive thematic analysis. Result(s): Eleven healthcare professionals and 29 patients and carers participated in focus groups. Three focus groups comprised patients, carers, and healthcare professionals. Two involved solely patients and carers. Analysis revealed five areas of unintended consequences (Table 1). Most unintended consequences identified by patients and carers were similar to those described by healthcare professionals. Healthcare professionals also described additional unintended consequences associated with technologies designed specifically for their use. Conclusion(s): A limitation of the study is that many of the unintended consequences identified related to virtual health technologies used during the COVID-19 pandemic, which may affect generalisability. A strength is that unintended consequences that have been overlooked in existing literature, such as the build-up of patients' psychological dependence on technologies, were identified. Developing a tool based on these will allow implementers and users of healthcare technologies to consider such issues and address the potential risks they may have on patient safety before healthcare technologies are fully implemented in practice.
ABSTRACT
The COVID-19 pandemic induced a global recession and tipped millions into extreme poverty. In low-income countries, Russia's invasion of Ukraine is expected to further deepen poverty and worsen food insecurity. This article describes the wide range of socio-economic impacts which these overlapping crises are having on the various world regions and calls on the international community to take common, determined action.
ABSTRACT
Introduction: Housebound patients may face challenges to their medicines management due to reduced household mobility and potential lack of access to healthcare services. Previous literature has explored the medication-related needs of housebound patients from pharmacists' perspectives (1-2). However little work has focussed on the patient/family perspective. In this study, we used data obtained from those staying at home as much as possible during the COVID-19 pandemic to fill this gap. Aim: To explore home medicine practices and safety for people who were housebound during the COVID19 pandemic and to create guidance, from the patient/family perspective, for enabling pharmacists to facilitate safe medicine practices for this population. Methods: Interviews were carried out with people who were taking at least one long term medication and met the criteria for ?shielding' and/or were over 70 years of age during the first wave of the COVID-19 pandemic in the UK and/or their family carers. Respondents were recruited through patient and public involvement representatives, the research team's networks, and support groups. Potential participants were approached via personal contact and social media. Interviews were conducted by telephone or video conferencing and participants asked about their medicines management while staying at home. Inductive thematic analysis was carried out. Patient and public involvement representatives were involved in the data analysis alongside the researchers. Results: Fifty people were interviewed (16 males, 34 females;mean age 68 years, range 26-93 years). Interview data suggested diversity of experiences of medicines management while staying at home. Some respondents reported no or little change, others an initial crisis followed by re-stabilisation, and others that the pandemic was a tipping point, exacerbating underlying challenges and having negative effects on their health and wellbeing. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing medicine-related healthcare services. Key factors identified as facilitating a smooth transition included patients' own agency, support from family, friends and community, good communication with pharmacy staff, continuity of pharmacy services and synchronisation of medicines supply so that a maximum of one collection/delivery was required each month. Conclusion: The study findings that we have presented relate to the UK only;this may limit the generalisability of our findings to other countries. Findings from Ireland are in the process of being analysed and will provide a basis of comparison. In addition, more females took part than males, despite efforts to address this. However, our findings suggest pharmacy staff can support medicines management for people who are housebound by synchronisation of medicines supply, delivering medicines where possible, developing/raising awareness of alternative means of communication, providing continuity of pharmacy services and signposting any community support available.
ABSTRACT
RATIONALE: There is an increasing need for remote monitoring in childhood respiratory disease, however many tools rely on active adherence, technique, or subjectivity. Respiratory rate (RR) is an important and objective sign, yet is underutilized;no reliable methods for long-term monitoring exist. Current gold-standards-wearable polysomnography devices (PSG)-measure nocturnal RR using uncomfortable sensors such as effort belts and nasal cannulae and are suitable only for discrete, single-night recordings, particularly in children. In the post-COVID-19 era, reliable and accepted RR monitoring in the home will have significant potential for improving respiratory clinical care and research. METHODS: In a healthy pediatric population, we evaluated accuracy of a passive, non-contact bedside device (Albus Home RD) that uses wireless motion sensors to capture RR, as compared to a goldstandard, wearable PSG (SOMNOtouch™ RESPIRATORY, by Somnomedics). The table-top Albus Home RD was positioned adjacent to participants in their home bedroom environment. Sleeping conditions were normal and varied in bed-size, presence of bed-or room-sharers, clothing, and bedding. Gold-standard PSG RR data were recorded using manual count of the raw respiratory traces derived from thoracoabdominal respiratory-effort belts. 10-minute periods from each hour of monitoring were chosen, where sufficient data were available and free from confounding movement and artefacts. Data from Albus Home RD were then analyzed using proprietary signal processing algorithms to output corresponding 30-second RR segments (as breaths/minute). RR results for each device for the selected segments were time-synchronized and compared for each 30-second segment. As per previous respiratory rate validation literature, accuracy was reported as proportion of RR measurements within +/-10% or +/-2 breaths/minute of the PSG RR. RESULTS: 9 healthy children (6 males, 3 females) participated in overnight monitoring;ages and BMI ranged 6-16 years and 13.3-20.0 respectively. Albus Home RD RR measurements for 1220 thirty-second RR segments were compared against the gold-standard with overall accuracy of 93%. Mean Absolute Percentage Error was 0.05 (SD=0.06). CONCLUSIONS: Albus Home RD passively measured nocturnal RR with 93% accuracy in 610 minutes of analysis in real-world environments compared to the current gold-standard. Using wireless sensors and proprietary signal processing algorithms, the Albus Home RD is a valid bedside, non-contact monitor of RR for children aged 6-16 years-old. The nontouch, passive nature of this monitor could enable previously infeasible longitudinal home monitoring in clinical care and research. This low-burden system has significant potential to facilitate longer-term, remote monitoring in pediatric respiratory disease.
ABSTRACT
RATIONALE: Reliable remote respiratory monitoring that is acceptable to patients is crucial for healthcare systems and clinical research in the post-COVID-19 era. Existing methods (such as peak-flow, diaries, and pulse oximetry) are limited by adherence and technique or confounded by subjectivity and recall bias. Nocturnal periods provide important signs in respiratory disease activity, yet accurate and unobtrusive methods for home monitoring are lacking. Current gold-standard tools - wearable polysomnography (PSG) devices - capture objective signs such as respiratory rate (RR) but require uncomfortable sensors, which are unsuitable for use beyond a few nights. Emerging monitoring solutions must minimize patient-burden to facilitate long-term engagement in clinical care and research. METHODS: In healthy adults, we evaluated accuracy of a passive, non-contact bedside device (Albus Home RD), that uses wireless motion sensors to capture RR, compared to gold-standard, wearable PSG (SOMNOtouch™ RESPIRATORY, Somnomedics). The table-top Albus Home RD was positioned on the bedside adjacent to the participant in their normal home bedroom environment. Participants slept with usual clothing and bedding;sleeping arrangements ranged from single- to king-size beds with single- and co-sleepers. Gold-standard PSG RR data were recorded using manual count of the raw respiratory traces derived from thoracoabdominal respiratory-effort belts. 10-minute periods from each hour of monitoring were chosen, where sufficient data were available and free from confounding movement and artefacts. Data from Albus Home RD were then analyzed using proprietary signal processing algorithms to output corresponding 30-second RR segments (as breaths/minute). RR results for each device for the selected periods were time-synchronized and compared for each 30-second segment. As per previous validation literature, accuracy was reported as proportion of RR measurements within +/-10% or +/-2 breaths/minute of the PSG RR. RESULTS: 16 healthy adults (9 males, 7 females) participated in overnight monitoring;ages and BMI ranged 20-74 years and 19-38 respectively. Albus Home RD RR measurements for 1540 thirty-second segments were compared against the gold-standard with overall accuracy of 92.4%. Mean Absolute Percentage Error was 0.06 (SD=0.07). CONCLUSIONS: Albus Home RD passively measured RR with 92% accuracy in adults compared to gold-standard in 770 minutes of analysis. Using wireless sensors and proprietary signal processing algorithms, the Albus Home RD is a valid bedside, non-contact monitor of RR in real-world environments. The non-touch, passive nature of this monitor can enable low-burden, long-term home nocturnal monitoring. This system provides new possibilities for remote clinical care and objective data gathering in longitudinal research studies. .