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1.
Nurs Leadersh (Tor Ont) ; 34(1): 30-37, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33837687

RESUMO

In the field of digital health research, nurse leaders have an opportunity to be integral to the design, implementation and evaluation of virtual care interventions. This case study details the experiences of two emerging nurse leaders during the COVID-19 pandemic in providing research and clinical leadership for a national virtual health trial. These nurse leaders trained and led a national team of 70 nurses across eight participating centres delivering the virtual care and remote monitoring intervention, using the normalization process theory. This case study presents a theoretically informed approach to training and leadership and discusses the experiences and lessons learned.


Assuntos
Assistência ao Convalescente/tendências , Liderança , Monitorização Ambulatorial/métodos , Relações Enfermeiro-Paciente , Alta do Paciente/normas , Consulta Remota/instrumentação , COVID-19/epidemiologia , Canadá/epidemiologia , Computadores de Mão/provisão & distribuição , Humanos , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Procedimentos Cirúrgicos Operatórios
2.
CMAJ Open ; 9(1): E142-E148, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33653769

RESUMO

BACKGROUND: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial to determine if virtual care with remote automated monitoring (RAM) compared with standard care will increase the number of days adult patients remain alive at home after being discharged following nonelective surgery. METHODS: We are conducting a randomized controlled trial in which 900 adults who are being discharged after nonelective surgery from 8 Canadian hospitals are randomly assigned to receive virtual care with RAM or standard care. Outcome adjudicators are masked to group allocations. Patients in the experimental group learn how to use the study's tablet computer and RAM technology, which will measure their vital signs. For 30 days, patients take daily biophysical measurements and complete a recovery survey. Patients interact with nurses via the cellular modem-enabled tablet, who escalate care to preassigned and available physicians if RAM measurements exceed predetermined thresholds, patients report symptoms, a medication error is identified or the nurses have concerns they cannot resolve. The primary outcome is number of days alive at home during the 30 days after randomization. INTERPRETATION: This trial will inform management of patients after discharge following surgery in the COVID-19 pandemic and offer insights for management of patients who undergo nonelective surgery in a nonpandemic setting. Knowledge dissemination will be supported through an online multimedia resource centre, policy briefs, presentations, peer-reviewed journal publications and media engagement. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04344665.


Assuntos
Assistência ao Convalescente/tendências , Monitorização Ambulatorial/métodos , Alta do Paciente/normas , Consulta Remota/instrumentação , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Canadá/epidemiologia , Computadores de Mão/provisão & distribuição , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , SARS-CoV-2/genética , Interface Usuário-Computador
3.
J Am Psychiatr Nurses Assoc ; 27(1): 33-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31509052

RESUMO

BACKGROUND: Parent training is a method for strengthening parenting skills, reducing child behavior problems, and promoting positive parent-child relationships. However, few parents have access to these evidence-based programs. The ezParent program, a tablet-based delivery adaptation of the group-based Chicago Parent Program, is a parent training program designed to address the needs of families raising young children in urban poverty. AIMS: This study aimed to explore (a) parents' perceptions of the benefits and barriers associated with their use of the ezParent program and (b) the ways in which the ezParent components and perceived usability varied by program use (module completion). METHOD: An explanatory mixed-methods design was used with the overall intent to use the qualitative data to help explain in greater detail the quantitative results. RESULTS: Fifty-nine parents of 2- to 5-year-old children from two pediatric primary care clinics serving predominantly low-income and racial/ethnic minority families in Chicago (Cohort 1) and Baltimore (Cohort 2) participated in follow-up interviews. Among those interviewed, 23 (38.9.5%) parents completed all six modules and 12 parents (20.3%) completed none of the modules. However, of those 12, 8 (67%) logged in to the program and completed portions of Module 1. Parents who completed more modules reported more program benefits, and those who completed fewer modules reported more barriers. CONCLUSIONS: Exploring users' experience with current digital applications, researchers and application developers can better design future tablet-based interventions to be both effective and acceptable by consumers.


Assuntos
Computadores de Mão/provisão & distribuição , Relações Pais-Filho/etnologia , Poder Familiar/psicologia , Pais/educação , Percepção , Pobreza , Interface Usuário-Computador , Adulto , Baltimore , Chicago , Comportamento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Masculino , Comportamento Problema
4.
Cytometry B Clin Cytom ; 92(6): 451-455, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-25917935

RESUMO

BACKGROUND: Point-of-care (POC) CD4 T-cell counting is increasingly recognized as providing improved linkage-to-care during management of HIV infection, particularly in resource-limited settings where disease burden is highest. This study evaluated prototype POC CD4 T-cell counters from MBio Diagnostics in the context of low CD4 count, hospitalized patients in Mozambique. This study measured system performance when presented with challenging, low count samples from HIV/AIDS patients with acute illnesses resulting in hospitalization. METHODS: Forty whole blood samples were collected from donors on the medical service at Maputo Central Hospital and absolute CD4 counts were generated on the MBio CD4 system and a reference laboratory using flow cytometry. RESULTS: The mean and median CD4 counts by the flow cytometry reference were 173 and 80 cells/µL, respectively. Correlation between the MBio CD4 System and the reference was good. Bland-Altman analysis showed a mean bias of +15 cells/µL (+9 to +21 cells/µL, 95% CI), and limits of agreement of -47 to 77 cells/µL. For samples with counts >100 cells/µL (N = 14), the mean coefficient of variation was 7.3%. For samples with counts <50 cells/µL, mean absolute bias of replicate samples was 4.8 cells/µL. When two MBio readers were compared, Bland-Altman bias was -4 cells/µL (-13 to +6 cells/µL, 95% CI), and limits of agreement of -63 and +55 cells/µL. CONCLUSIONS: The MBio System holds promise as a POC system for quantitation of CD4 T cells in resource-limited settings given system throughput (80-100 cartridges/day), design simplicity, and ease-of-use. © 2015 International Clinical Cytometry Society.


Assuntos
Contagem de Linfócito CD4/instrumentação , Linfócitos T CD4-Positivos/imunologia , Citometria de Fluxo/instrumentação , Infecções por HIV/diagnóstico , Imunofenotipagem/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Complexo CD3/imunologia , Linfócitos T CD4-Positivos/virologia , Estudos de Casos e Controles , Computadores de Mão/economia , Computadores de Mão/provisão & distribuição , Países em Desenvolvimento , Citometria de Fluxo/economia , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Imunofenotipagem/instrumentação , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/virologia , Aplicativos Móveis/economia , Aplicativos Móveis/provisão & distribuição , Moçambique , Padrões de Referência , Reprodutibilidade dos Testes
5.
Cytometry B Clin Cytom ; 92(6): 437-444, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-27406947

RESUMO

CD4 T-cell counting was introduced in clinical laboratories shortly after the discovery of the human immune deficiency virus (HIV) in the early eighties. In western clinical laboratories, improvements in the CD4 T-cell counting methods were mainly driven by progress in the field of flow cytometry and immunology. In contrast, the development of dedicated CD4 T-cell counting technologies were needs driven. When antiretroviral treatment (ART) was made available on a large scale by international Acquired Immune Deficiency Syndrome (AIDS) relief programs to HIV+ patients living in low income countries in 2003, there was a distinct need for simplified and affordable CD4 T-cell counting technologies. The first decade of 2000, several compact flow cytometers appeared on the market, mainly to the benefit of low income countries with limited resources. More recently, however, portable point-of-care (POC) CD4 T-cell counting devices have been developed especially to improve access to affordable monitoring of HIV+ patients in low income countries. The accuracy of these POC instruments is not yet very well documented as many are still under development and clinical validation but preliminary evidence is encouraging. The new HIV treatment guidelines released by the World Health Organization in 2016 give CD4 T-cell counting a less central role in the management of HIV infection. It is, therefore, to be expected that CD4 T-cell counting will be phased out as a tool to assess eligibility of HIV+ patients for ART in the future. However, CD4 T-cell counting will remain a valuable tool for directing treatment against opportunistic infections. © 2016 International Clinical Cytometry Society.


Assuntos
Contagem de Linfócito CD4/instrumentação , Linfócitos T CD4-Positivos/imunologia , Citometria de Fluxo/instrumentação , Infecções por HIV/diagnóstico , Testes Imediatos , Fármacos Anti-HIV/uso terapêutico , Linfócitos T CD4-Positivos/virologia , Computadores de Mão/economia , Computadores de Mão/provisão & distribuição , Países em Desenvolvimento , Citometria de Fluxo/economia , HIV/efeitos dos fármacos , HIV/fisiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Imunofenotipagem/instrumentação , Imunofenotipagem/métodos , Aplicativos Móveis/economia , Aplicativos Móveis/provisão & distribuição , Guias de Prática Clínica como Assunto
6.
JAMA Pediatr ; 170(12): 1202-1208, 2016 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-27802500

RESUMO

Importance: Sleep is vital to children's biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children's lives and may affect their sleep duration and quality. Objective: To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes. Data Sources: A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied. Study Selection: The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation. Data Extraction and Synthesis: Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data. Main Outcomes and Measures: The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol. Results: Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%). Conclusions and Relevance: To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.


Assuntos
Telefone Celular/estatística & dados numéricos , Computadores de Mão/estatística & dados numéricos , Sono/fisiologia , Adolescente , Telefone Celular/provisão & distribuição , Criança , Computadores de Mão/provisão & distribuição , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos do Sono-Vigília/etiologia , Adulto Jovem
7.
Med Ref Serv Q ; 34(3): 265-81, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26211789

RESUMO

An academic medical library expanded its iPad loan service to multiple campus libraries and conducted an assessment of the service. iPads loaded with medical and educational apps were loaned for two-week checkouts from five library campus locations. Device circulation statistics were tracked and users were invited to complete an online survey about their experience. Data were gathered and analyzed for 11 months. The assessment informed the library on how best to adapt the service, including what resources to add to the iPads, and the decision to move devices to campuses with more frequent usage.


Assuntos
Acesso à Informação , Computadores de Mão/provisão & distribuição , Bibliotecas Médicas , Universidades , Aplicativos Móveis , Estudos de Casos Organizacionais , Inquéritos e Questionários , Texas
8.
Epilepsy Behav ; 21(2): 184-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21514896

RESUMO

Up to 29% of patients with epilepsy report "prodromal" sensations more than 30 minutes prior to seizures. We developed and implemented an objective methodology to prospectively assess the sensitivity and specificity of these subjective experiences using personal digital assistants (PDAs). The key property, in contrast to paper-based diaries, is the internal recording of the patient's entering time of prodromes and seizures. Of 500 patients with epilepsy interviewed, 31 claimed to sense prodromal symptoms at least 30 minutes before seizure onset. Eleven of them agreed to participate in a 4-week study to objectively measure their prospective prediction performance. In 9 patients returning data, the majority of prodrome entries were not followed by seizures or were identified only retrospectively. Statistical analysis revealed that no patient could outperform a nonspecific random predictor when predicting seizures based on the occurrence of prodromes, and that the group performance matched precisely the expected result for a by-chance prediction. These results question the predictive value of "prodromes" and the specificity of their occurrence in the preictal period.


Assuntos
Computadores de Mão , Convulsões/diagnóstico , Convulsões/fisiopatologia , Adulto , Viés , Computadores de Mão/provisão & distribuição , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
14.
Crit Care Nurs Clin North Am ; 17(1): 45-50, x, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15749401

RESUMO

Emergencies happen everyday in the acute care environment and demand nurses to make decisions quickly that can have serious, if not potentially fatal, ramifications. Being prepared to make decisions is partly the results of experience, but having access to ready resources can provide even the newest nurse with the potential to make critical decisions accurately. Handheld devices, such as personal digital assistants, can provide access to resources that can improve patient safety and, ultimately, patient care delivery.


Assuntos
Computadores de Mão/estatística & dados numéricos , Cuidados Críticos/organização & administração , Emergências/enfermagem , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Doença Aguda/enfermagem , Atitude do Pessoal de Saúde , Comportamento de Escolha , Computadores de Mão/provisão & distribuição , Tomada de Decisões , Humanos , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Gestão da Segurança/organização & administração
15.
J Oncol Manag ; 13(2): 18-25, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15180114

RESUMO

Handheld technology has grown in both popularity and capabilities. Studies continue to be done on their impact in numerous fields. At The Ohio State University Medical Center, a handheld program was started in 2001, initially involving third- and fourth-year medical students and residents. The presence of these digital devices presented the opportunity to examine their use in taking traditional materials and delivering them in a personal digital assistant-friendly format. The objective was to offer these materials within an "anytime anywhere" set-up, thereby positively affecting the learning experience while also laying the foundation for other such uses.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Estágio Clínico , Computadores de Mão/estatística & dados numéricos , Educação a Distância/métodos , Atitude do Pessoal de Saúde , Computadores de Mão/provisão & distribuição , Currículo , Apresentação de Dados , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Ohio , Inovação Organizacional , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Integração de Sistemas
17.
Home Healthc Nurse ; 21(12): 797-800, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14665965

RESUMO

This article focuses how clinical staff can use personal digital assistants (PDAs) to become more organized, expand quick reference libraries, and have some fun! If you've been wondering if a PDA will help maximize your work efficiently, this article is for you!


Assuntos
Enfermagem em Saúde Comunitária , Computadores de Mão , Serviços de Assistência Domiciliar , Computadores de Mão/classificação , Computadores de Mão/provisão & distribuição , Serviços de Informação sobre Medicamentos , Sistemas de Informação Geográfica , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Obras de Referência , Software , Tradução
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