Supporting Self-management and Quality of Life in Bipolar Disorder With the PolarUs App (Alpha): Protocol for a Mixed Methods Study.

BACKGROUND: Quality of life (QoL) is increasingly being recognized as a key outcome of interventions for bipolar disorder (BD). Mobile phone apps can increase access to evidence-based self-management strategies and provide real-time support. However, although individuals with lived experiences desire support with monitoring and improving broader health domains, existing BD apps largely target mood symptoms only. Further, evidence from the broader mobile health (mHealth) literature has shown that the desires and goals of end users are not adequately considered during app development, and as a result, engagement with mental health apps is suboptimal. To capitalize on the potential of apps to optimize wellness in BD, there is a need for interventions developed in consultation with real-world users designed to support QoL self-monitoring and self-management. OBJECTIVE: This mixed methods pilot study was designed to evaluate the alpha version of the newly developed PolarUs app, developed to support QoL self-monitoring and self-management in people with BD. Co-designed using a community-based participatory research framework, the PolarUs app builds on the web-based adaptation of a BD-specific QoL self-assessment measure and integrates material from a web-based portal providing information on evidence-informed self-management strategies in BD. The primary objectives of this project were to evaluate PolarUs app feasibility (via behavioral use metrics), the impact of PolarUs (via the Brief Quality of Life in Bipolar Disorder scale, our primary outcome measure), and explore engagement with the PolarUs app (via quantitative and qualitative methods). METHODS: Participants will be residents of North America (N=150), aged >18 years, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of BD type 1, BD type 2, or BD not otherwise specified as assessed by structured diagnostic interview. An embedded mixed methods research design will be adopted; qualitative interviews with a purposefully selected subsample (approximately, n=30) of participants will be conducted to explore in more depth feasibility, impact, and engagement with the PolarUs app over the 12-week study period. RESULTS: At the time of publication of this protocol, the development of the alpha version of the PolarUs app was complete. Participant enrollment has begun in June 2022. Data collection is expected to be completed by December 2022. CONCLUSIONS: Beyond contributing knowledge on the feasibility and impact of a novel app to support QoL and self-management in BD, this study will also provide new insights related to engagement with mHealth apps. Furthermore, it will function as a case study of successful co-design between people with BD, health care providers, and BD researchers, providing a template for the future use of community-based participatory research frameworks in mHealth intervention development. The results will be used to further refine the PolarUs app and inform the design of a larger clinical trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/36213.

Pharmacology: Non-Insulin Agents.

The landscape of diabetes treatment has evolved significantly in recent years. While metformin remains first-line for the treatment of type 2 diabetes, 2 new classes of medications (sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide agonists) are becoming mainstays in therapy. These classes boast strong efficacy and desired long-term outcomes, offering cardiovascular and renal protection, as well as other benefits such as weight loss and low risk of hypoglycemia. Most recent guidelines have highlighted the importance of using shared decision making and patient-centered choices when determining medication outcomes.

Use of smartphone apps in bipolar disorder: An international web-based survey of feature preferences and privacy concerns.

BACKGROUND: Smartphone apps have potential for delivering interventions and supporting self-management in bipolar disorder (BD), however clinical trials of mental health apps have high dropout rates and low sustained use in real-world contexts. To support the development of app-based interventions, we explored use of and attitudes towards apps amongst people with BD, specifically concerns about privacy and preferences for various app features. METHODS: An international web-based survey was used to investigate concerns about privacy and the perceived importance of various app features among people with BD. Quantitative findings were summarised using descriptive statistics. Qualitative content analysis was used to investigate free-text responses. RESULTS: A total of 919 people completed the survey; 97.5% reported using smartphone apps in general. Concerns regarding data security were prevalent. Commonly prioritised mHealth features included content quality/accuracy, ease and flexibility of use, cost, and data security. The ability to share data with others, rewards for use, inter-app connectivity, and peer support were endorsed as important by fewer than half of respondents. Qualitative findings suggested that sustained app use could be supported by novel and positive content, customisation, meaningful use of data, interactivity, and perceived real-world benefits. CONCLUSIONS: The findings of the present study offer important design considerations for the development and evaluation of future app-based interventions for BD. Importantly, some features that have previously been suggested as clinically beneficial or likely to support engagement were perceived ambivalently, emphasising the need for in-depth consultation with potential end users during app development.

Beyond clicks and downloads: a call for a more comprehensive approach to measuring mobile-health app engagement.

Downloading a mobile health (m-health) app on your smartphone does not mean you will ever use it. Telling another person about an app does not mean you like it. Using an online intervention does not mean it has had an impact on your well-being. Yet we consistently rely on downloads, clicks, 'likes' and other usage and popularity metrics to measure m-health app engagement. Doing so misses the complexity of how people perceive and use m-health apps in everyday life to manage mental health conditions. This article questions commonly used behavioural metrics of engagement in mental health research and care, and proposes a more comprehensive approach to measuring in-app engagement.

Insight into Health Care Outcomes for Persons Living with Heart Failure Using Health Data Analytics.

The Integrated Funding Model (IFM) is designed to measure the impact of a bundled model of health care for patients with Congestive Heart Failure (CHF) for a period of 60 days post discharge. CHF is a primary reason for patient admissions. The goal of this study is to gain insight into the effectiveness of the IFM pathway intervention on health care outcomes for persons living with CHF, using Health data Analytics.

An open circuit voltage decay system for performing injection dependent lifetime spectroscopy.

Of all of the material parameters associated with a semiconductor, the carrier lifetime is by far the most complex and dynamic, being a function of the dominant recombination mechanism, the equilibrium number of carriers, the perturbations in carriers (e.g., carrier injection), and the temperature, to name the most prominent variables. The carrier lifetime is one of the most important parameters in bipolar devices, greatly affecting conductivity modulation, on-state voltage, and reverse recovery. Carrier lifetime is also a useful metric for device fabrication process control and material quality. As it is such a dynamic quantity, carrier lifetime cannot be quoted in a general range such as mobility; it must be measured. The following describes a stand-alone, wide-injection range open circuit voltage decay system with unique lifetime extraction algorithms. The system is initially used along with various lifetime spectroscopy techniques to extract fundamental recombination parameters from a commercial high-voltage PIN diode.

An evaluation system for experimental silicon and silicon carbide super gate turn off thyristors.

This paper describes the design and implementation of a small-scale pulsed power system specifically intended to evaluate the suitability of experimental silicon and silicon carbide high power Super Gate Turn Off thyristors for high action (500 A(2) s and above) pulsed power applications where energy is extracted from a storage element in a rapid and controlled manner. To this end, six of each type of device was placed in a controlled three phase rectifier circuit which was in turn connected to an aircraft ground power motor-generator set and subjected to testing protocols with varying power levels, while parameters such as offset firing angle were varied.

Automated modular high energy evaluation system for experimental thyristor devices.

A high energy, modular, completely automated test bed with integrated data acquisition and characterization systems was successfully designed in order to perform both safe operating area as well as very high volume reliability testing on experimental silicon carbide Super Gate Turn Off (SGTO) thyristors. Although the system follows a modular design philosophy, with each functional block acting as a peripheral to a main control module and can be adapted to arbitrary power and pulse width levels, for the specific SGTO devices initially evaluated it was configured to have the device discharge variable current levels of up to 6 kA into a 0.5 Ω resistive load with a relatively square pulse fixed at 100 µs full width at half maximum delivering energy levels up to 1.8 kJ to the load.

Taste and mouthfeel assessment of porous and non-porous silicon microparticles.

Unlike the trace minerals iron, copper and zinc, the semiconductor silicon has not had its organoleptic properties assessed. Nanostructured silicon provides the nutrient orthosilicic acid through hydrolysis in the gastrointestinal tract and is a candidate for oral silicon supplements. Mesoporous silicon, a nanostructured material, is being assessed for both oral drug and nutrient delivery. Here we use taste panels to determine the taste threshold and taste descriptors of both solid and mesoporous silicon in water and chewing gum base.Comparisons are made with a metal salt (copper sulphate) and porous silica. We believe such data will provide useful benchmarks for likely consumer acceptability of silicon supplemented foodstuffs and beverages.

Supporting children's grief within an adult and pediatric palliative care program.

"What about the kids?" is a dominant and consuming question for caregivers supporting children/youth around the dying and death of a family member. The concerns and fears encompassed in this question can overwhelm caregivers as they put vast amounts of energy into trying to protect children/youth from the suffering and pain that awaits them. Perhaps the hardest lesson these caregivers must learn is that they cannot protect their child/youth from the death any more than they can stop the death from happening. Instead, what is needed most from children/youth is to be included, prepared, and provided with a safe place for emotional expression. Children, as well as adults, will grieve in their own specific way, mediated by their developmental level, circumstances of the illness and death, and protective factors available to them. Providing comprehensive, whole-person care to palliative patients with children/youth in their care ought to include psychoeducation and support for all members of the family. Our communities' bereaved children/youth will be impacted by the death of their family members in countless ways throughout their lives. As professionals caring for people who are dying, we have a responsibility to mediate this impact to the best of our ability.

Interprofessional stroke rehabilitation for stroke survivors using home care.

OBJECTIVE: To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. METHODS: Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. RESULTS: A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). CONCLUSIONS: A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.

Assessing change in clinical teaching skills: are we up for the challenge?

BACKGROUND: The faculty development community has been challenged to more rigorously assess program impact and move beyond traditional outcomes of knowledge tests and self ratings. PURPOSE: The purpose was to (a) assess our ability to measure supervisors' feedback skills as demonstrated in a clinical setting and (b) compare the results with traditional outcome measures of faculty development interventions. METHODS: A pre-post study design was used. Resident and expert ratings of supervisors' demonstrated feedback skills were compared with traditional outcomes, including a knowledge test and participant self-evaluation. RESULTS: Pre-post knowledge increased significantly (pre = 61%, post = 85%; p < .001) as did participant's self-evaluation scores (pre = 4.13, post = 4.79; p < .001). Participants' self-evaluations were moderately to poorly correlated with resident (pre r = .20, post r = .08) and expert ratings (pre r = .43, post r = -.52). Residents and experts would need to evaluate 110 and 200 participants, respectively, to reach significance. CONCLUSIONS: It is possible to measure feedback skills in a clinical setting. Although traditional outcome measures show a significant effect, demonstrating change in teaching behaviors used in practice will require larger scale studies than typically undertaken currently.

A gaming adventure.

Nurse orientees regularly express concern about managing difficult clinical situations. Using this information, preceptors developed an educational "adventure" game, incorporating clinical scenarios applicable to an inpatient psychiatric treatment program. The scenarios are timeless and can be generalized to other healthcare settings. This game has proven to be fun, effective, and nonthreatening and it integrates easily into staff training.

Achieving compliance with the European Working Time Directive in a large teaching hospital: a strategic approach.

This paper describes the strategy which achieved European Working Time Directive (EWTD) compliance at the Royal Free Hampstead NHS Trust in medicine and surgery. Compliance with EWTD regulations was assessed by diary card exercise, clinical care assessed through critical incident reports, electronic handover documents and nursing reports, training opportunities assessed by unit training directors, cost controls assessed by finance department analysis, and workload assessed by staff attendance on wards, in casualty and in theatres. There was a change in focus of care to a consultant-led, specialist registrar- (SpR-)driven service extending into evenings and on weekends, coupled with a move to a multi-skilled team for night cover, and to a move from traditional on-call shifts to a full shift system across both medicine and surgery. Compliance with the EWTD was achieved whilst maintaining good standards of clinical care, ensuring training opportunities for doctors in training, controlling payroll costs, removing the need for locums, and reducing workload for both junior doctors and consultants.

Patellar position after total knee arthroplasty: influence of femoral component malposition.

Patellar shift, tilt, and rotation were analyzed in 7 cadaveric knee specimens during simulated quadriceps loading, in the intact knee, and after implant reconstruction. Femoral component medialization, lateralization, and external rotation were also investigated. Relative motion of the patella with respect to the femur was measured using an electromagnetic tracking system. The spatial position of the patella did not change with standardized total knee arthroplasty (P <.05). After malpositioning of the femoral component, patellar rotation also did not change (P >.05); however, patellar tilt was altered by femoral component external rotation malposition (P <.05), and patellar shift was affected by all femoral component malpositions (P <.05). The spatial position of the patella relative to the femoral shaft was changed with any femoral component malposition, suggesting that the soft tissues were abnormally tensioned. This could result in subsequent wear on the patellar component and, therefore, early failure.