Laboratory testing is necessary when it contributes to the overall clinical management of the patient. Redundant testing, however, is often unnecessary and expensive and contributes to overall reductions in healthcare system efficiency. The purpose of this study is two-fold. First, to evaluate the frequency of ordering duplicate laboratory tests in hospitalized patients and the costs associated with this practice. Second, it was designed to determine if the use of a computerized alert or prompt will reduce the total number of unnecessarily duplicated Acute Hepatitis Profile (AHP) laboratory tests. This two-phase study took place in an inpatient facility that was part of a large tertiary care hospital system in Florida. A retrospective descriptive design was used during Phase 1 was to evaluate six laboratory tests and the frequency of ordering duplicate laboratory tests in hospitalized patients and to determine the associated costs of this practice for a 12-month time period in 2010. A test was considered a duplicate or an unnecessarily repeated test if it followed a previous test of the same type during the patient’s length of stay in the hospital and one in which any change in their values likely would not be clinically significant. A quasi-experimental pre- and post-test design was used during phase 2 was to determine the proportion of duplication of the AHP test before and after the implementation of a computerized alert intervention implemented as part of a system quality improvement process on January 5th, 2011. Data were compared for two 3-month time periods, pre- and post-alert implementation. The AHP test was considered redundant if it followed a previous test of the same type within 15 days of the initial test being final and present in the medical record. In phase 1, including each of the six tests examined, there were a total amount of 53, 351 test ordered, with 10, 375 (19.4%) of these cancelled. Out of the total amount of result final tests iv (n = 42,976), including each of the six tests examined, 4.6-8.7% were redundant. Results of the proportion of duplication of the six selected tests are as follows: AHP 196/2514 (7.8%), Antinuclear Antibody (ANA) 120/2594 (4.6%), B12/Folate level 396/5874 (6.7%), Thyroid Stimulating Hormone (TSH) 1893/21595 (8.7%), Ferritin 384/5171 (7.4%), and Iron/Total iron binding capacity (TIBC) 316/5155 (6.1%). The overall associated yearly cost of redundant testing of these six selected tests was an estimated $419, 218. The largest proportion of redundant tests was the Thyroid Stimulating Hormone level, costing a yearly estimated $300, 987. In Phase 2, prior to introduction of the alert, 674 AHP tests were performed. Of these, 53 (7.9%) were redundant. During the intervention period, 692 AHP tests were performed, of these 18 (2.6%) were redundant. The implementation of the computerized alert was shown to significantly reduce the proportion of AHP tests (Chi-Square: χ2 = df 1, p ≤ 0.001). The differences in the associated costs of duplicated AHP were $5238 dollars in 2010 as compared to $1746 in 2011 post-alert and these differences were significant (Mann Whitney U, Z = -4.04, p ≤ 0.001). Although the proportions of unnecessarily repeated diagnostic tests that were observed during Phase 1 of this study were small, the associated costs could adversely affect hospital revenue and overall healthcare efficiency. The implementation of the AHP computerized alert demonstrated a drop in the proportion of redundant AHP tests and subsequent associated cost savings. It is necessary to perform further research to evaluate computerized alerts on other tests with evidence-based test-specific time intervals, and to determine if such reductions postimplementation of AHP alerts are sustained over time.

Problem: A Major challenge for healthcare providers is the non-adherence of patients to prescrip- tions. One important area is hypertension treatment through medication. A treatment often starts with multiple adjustment cycles of medication type or dosage, which are based on regular at-home blood pressure measurements. Patients therefore need to adhere to regular medication intake and blood pressure measurements. Research Aim: The project first explored whether or not it is possible to develop a medication reminder system that checks patient adherence based on vital parameters. The project goal was adapted to the design and development of a reminder and data logging system for hypertension patients, based on the following research questions: 1) What are functional and non- functional requirements for the proposed artefact? 2) How can these requirements be implemented? Method: The project makes use of Design Science Research to create the system. The problem and requirement explication for the new artefact was achieved by working closely with a general prac- titioner who deals with hypertension patients. The artefact was evaluated by presenting it ex-post to a focus group of a hypertension patient, developers and founders in digital health. Results: The results of expert interviews concluded that the initial project aim is not feasible due to continuous vital monitoring being invasive and intrusive, lack of applicability for health conditions and medica- tions and other potential negative consequences. These insights led to the new research aim. The results address the question: ”What are functional and non-functional requirements for the proposed artefact?”. The envisioned product is a cross-platform application, illustrating the frequent medica- tion adjustments for hypertension patients. The treating doctor should configure all patient-specific parameters and the app should guide patients through daily tasks like measurements and medication intake. The patient should also be reminded of their tasks. The app should record, display, and export data for the doctor’s review, and ensure easy input of measurements. Future remote data exchange capabilities via servers were also considered. To address the research question ”How can these requirements be implemented?”, the researcher developed a cross-platform mobile application for iOS and Android with .NET Multi-Platform App UI (MAUI) that implements the desired features. A concept for remote data exchange and a system for scanning measured values of blood pressure devices were developed. The evaluation partially validated the problem area and discussed future implementations, such as remote data exchange, usage of patient data for research and adoption to other medication. The perceived high usability of the application was emphasized. Conclusions: The researcher concludes that the developed artefact addresses a relevant problem and extends existing solutions in the problem space. It is acknowledged that future research has to be conducted to prove the effectiveness of the tool as well as assess its usability and accuracy. Difficulties for accepting the artefact in real life settings are discussed.

No description available.

Weighted granular best matching algorithm is proposed for the operation of context matching in context-aware computing systems. New algorithm deals with the subjective, fuzzy and multidimensional characteristics of contextual information by using weights and a granular structure for contextual information. The proposal is applied on a case: CAPRA &ndash / Context-Aware Personal Reminder Agent tool to show the applicability of the new context matching algorithm. The obtained outputs showed that proposed algorithm produces the results which are more sensitive to the user&rsquo / s intention, more adaptive to the characteristics of the contextual information and applicable to a current Context-aware system.

Thesis (Ph.D. in Clinical Science) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 86-91). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Context. Reminder system offers flexibility in daily life activities and assists to be independent. The reminder system not only helps reminding daily life activities, but also serves to a great extent for the people who deal with health care issues. For example, a health supervisor who monitors people with different health related problems like people with disabilities or mild dementia. Traditional reminders which are based on a set of defined activities are not enough to address the necessity in a wider context. To make the reminder more flexible, the user’s current activities or contexts are needed to be considered. To recognize user’s current activity, different types of sensors can be used. These sensors are available in Smartphone which can assist in building a more contextual reminder system. Objectives. To make a reminder context based, it is important to identify the context and also user’s activities are needed to be recognized in a particular moment. Keeping this notion in mind, this research aims to understand the relevant context and activities, identify an effective way to recognize user’s three different activities (drinking, walking and jogging) using Smartphone sensors (accelerometer and gyroscope) and propose a model to use the properties of the identification of the activity recognition. Methods. This research combined a survey and interview with an exploratory Smartphone sensor experiment to recognize user’s activity. An online survey was conducted with 29 participants and interviews were held in cooperation with the Karlskrona Municipality. Four elderly people participated in the interview. For the experiment, three different user activity data were collected using Smartphone sensors and analyzed to identify the pattern for different activities. Moreover, a model is proposed to exploit the properties of the activity pattern. The performance of the proposed model was evaluated using machine learning tool, WEKA. Results. Survey and interviews helped to understand the important activities of daily living which can be considered to design the reminder system, how and when it should be used. For instance, most of the participants in the survey are used to using some sort of reminder system, most of them use a Smartphone, and one of the most important tasks they forget is to take their medicine. These findings helped in experiment. However, from the experiment, different patterns have been observed for three different activities. For walking and jogging, the pattern is discrete. On the other hand, for drinking activity, the pattern is complex and sometimes can overlap with other activities or can get noisy. Conclusions. Survey, interviews and the background study provided a set of evidences fostering reminder system based on users’ activity is essential in daily life. A large number of Smartphone users promoted this research to select a Smartphone based on sensors to identify users’ activity which aims to develop an activity based reminder system. The study was to identify the data pattern by applying some simple mathematical calculations in recorded Smartphone sensors (accelerometer and gyroscope) data. The approach evaluated with 99% accuracy in the experimental data. However, the study concluded by proposing a model to use the properties of the identification of the activities and developing a prototype of a reminder system. This study performed preliminary tests on the model, but there is a need for further empirical validation and verification of the model. / +46707560843

Detta examensarbete har ägnats åt att undersöka FMI:s påföljdsystem och tillsynsmetoder under  tidsperioden  2007  till  2016.  Utifrån  FMI:s  statistik  har  orsaker  till  disciplinära  påföljder, orsaker till anmälningar, antal hanterade ärende samt antal disciplinära åtgärder kartlagts. Den  nya  fastighetsmäklarlagen  infördes  2011.  Lagändring  innebar  bland  annat  att  en  ny  disciplinär  påföljd,  erinran,  togs  i  bruk.    Förändringen  av  statistiska  data  under  åren analyserades för att utvärdera eventuell inverkan på fastighetsmäklarbranschen.  Det läggs extra blickfång på förändringen i påföljdsystemet och dess effekter. Tidsperioden som granskats delades upp i två femårs perioder, det vill säga 2007 till och med 2011 samt 2012 till och med 2016. Diverse analytiska data över jämförelser på de två femårsperioderna har presenterats för att kunna identifiera skillnader mellan de olika perioderna. FMI:s  tillsynsmetoder  har  framställts  och  fördelning  mellan  de  olika  tillsynsmetoderna  har  redogjorts. FMI:s och andra myndigheternas hantering av anonyma anmälningar har utretts och presenterats i rapporten. / In this thesis has FMIs sanction system and regulatory methods between 2007 and 2016 has examined.  Distribution  of  different  reasons  for  disciplinary  actions,  different  reasons  for  notifications, quantity of handled cases and quantity of disciplinary actions has charted by utilizing statistics since 2007. Evolution of statistic data under those years has explored and possible  influence  on  them  has  been  investigated.  Those  values  before  and  after  law  amendment at 2011 has also been examined in order to analyze the influence of the new laws effect on sanction system and regulatory methods. A new discipline sanction called reminder has introduced thru the new real estate agent law (FML 2011:666). It imposed extra focus on the change at sanction system and its effect for the branch. Time period has been divided in two five years periods, 2007-­‐2011 and 2011-­‐2016.  Various  analytical  data  for  the  comparison  of  those  five  years  periods  has  been presented in order to identify the difference between those periods. FMIs  regulatory  methods  have  been  produced  and  distributions  between  those  different  regulatory  methods  have  been  narrated.  The  management  of  anonymous  notification  by FMI and other government bodies has been investigated and presented in the report.

No description available.

Adherence to guideline-recommended secondary cardiovascular prevention therapy (statins and cardiac rehabilitation) has been demonstrated to reduce the risk of all-cause mortality (Statins RRR 0.25, 95% CI 0.19-0.30; Cardiac Rehabilitation RRR 0.26, 95% CI 0.14-0.36) and secondary events.1,2 Yet, ≥50% of patients discontinue statin use within 12-month after an initial prescription and completion of cardiac rehabilitation is ≤20% in Ontario.3,4 Low statin adherence and cardiac rehab completion limits patients from realizing the full benefits of therapy. A meta-analysis of randomized controlled trials of adherence to statins for secondary prevention reported that nonadherence to statins was greater in non-white ethnicities compared to white ethnicities (OR 1.28, 95% CI 1.04-1.59) with geographical variation in outcomes.5 In respect to cardiac rehabilitation, the literature suggests that non-white ethnicities are less likely to complete cardiac rehabilitation compared to white participants.6,7 However, a gap remains in our knowledge of cardiac rehabilitation completion among immigrants due to lack of outcome reporting across clinical trials. The literature suggests that immigrants have improved health profiles relative to Canadian-born patients. Specifically, immigrants with ≤10 years of Canadian residency have greater medication adherence than immigrants with >10 of Canadian residency when compared to Canadian-born participants.6-9 This thesis was a planned sub-study of the Interventions Supporting Long-Term Adherence and Decreasing Cardiovascular Events (ISLAND) randomized control trial. The ISLAND study was a pragmatic, randomized controlled trial investigating the effect of educational reminders on adherence to guideline-recommended therapy post-myocardial infarction. Study participants were allocated in a 1:1:1 ratio to one of three groups: i) usual care, ii) educational reminders sent via post, or iii) combination post and interactive voice response educational reminders. Investigators were blinded to the allocation sequence, participant allocation, and outcome assessment. Medication adherence and completion of cardiac rehabilitation were assessed 12-months from baseline. This sub-study of ISLAND focused on participants who completed a 12-month outcome assessment with a recorded response to the following question, “Were you born a Canadian citizen?”. Immigrants experienced greater odds of statin adherence at 7-days (OR 1.36, 95% CI 1.00-1.85) and 30 days (OR 1.36, 95% CI 0.96-1.94) at one-year post-myocardial infarction, after adjusting for age, diabetes, sex, and smoking status. We found no evidence that immigration status was associated with cardiac rehabilitation completion (OR 0.91, 95% CI 0.72-1.14) after adjusting for age, diabetes, sex, smoking status, average neighborhood income quintile, education, and marital status. The odds of statin adherence at 7-days (OR 1.33, 95% CI 0.89-2.18) and 30-days (OR 1.39, 95% CI 0.89-2.18) was greater in visual minorities than white patients, however the difference was not statistically significant. We found no evidence of an association between ethnicity and cardiac rehabilitation completion (OR 0.98, 95% CI 0.75-1.29). Our analysis could not fully evaluate the healthy immigrant effect due to an insufficient sample size of immigrants with <10 years of Canadian residency exposure (n=29). In conclusion, we report a statistically significant 36% increase in the odds of 7-day and 30-day statin adherence in immigrants compared to Canadian-born patients. We also report that the odds of cardiac rehabilitation decreased by 9% in immigrants compared to Canadian-born patients at 12-months post-myocardial infarction but this was not statistically significant. Our findings offer support for the “healthy immigrant effect” continuing in immigrants with >10 years of Canadian residency exposure. We were unable to evaluate outcomes in immigrants with <10 years Canadian residency exposure due to a lack of sample size (n=29). / Thesis / Master of Science (MSc) / The primary purpose of this research project was to assess whether immigrants, individuals who reside in Canada but were born outside of the country, who have experienced a previous heart attack were adhere to heart health therapies better than Canadian-born patients. The heart health therapies of interest to our investigation are two guideline-recommended heart attack prevention therapies, statins and cardiac rehabilitation. The study design of our research project was a cohort sub-study of the ISLAND randomized control trial which investigated adherence to heart health therapies in patients residing in Ontario, Canada. Our major finding was that immigrants who lived in Canada for >10 years were more adherent to statin therapy for a previous heart attack compared to Canadian-born participants. Our findings support the hypothesis that immigrants tend to demonstrate behaviours associated with improved outcomes compared to their Canadian-born counterparts.

The background and problem statement focuses on antiretroviral therapy (ART) and the use of mobile technology to improve compliance within a primary health care (PHC) context in South Africa. South Africa is one of the countries, globally, with the highest HIV incidence and prevalence and ART enrolled patients visiting PHC facilities. Compliance to ART plays an integral part in effective HIV/AIDS management. HIV/AIDS management entails a complex process of patient education and pharmacological control to improve ART compliance in South Africa. Studies were done in South Africa on reminder messages as most studies focused on chronic conditions in general. A literature review explored what is known about ART and mobile technology to improve compliance. Literature confirmed that compliance through reminder messages were done worldwide and in Sub-Saharan countries. Previous research indicated that the compliance rate of the patients increased through reminder messages. Yet there is a gap in the literature regarding reminder messages combined with health education on ART compliance. The aim of the study was to determine the impact of reminder messages combined with health education on ART compliance among patients receiving ART at a PHC facility Methodology: The study followed a quantitative, experimental, intervention, randomised multi-group, pre- and post measurement design (Creswell, 2012:1, Welman et al., 2012:80). The research design is experimental because the researcher applied an intervention (reminder messages) to two experimental groups. Random sampling was applied and participants were grouped into three groups: Group A, (control group), Group B, (reminder messages only) and Group C (reminder messages combined with health education). A preand post-measurement design is followed as each participant’s pill count and return date were measured before and after the reminder messages with/without health education were given. The sample size was 202 eligible patients receiving Regime 1 and 2 ART’s (Lamuvidine, Tenofovir, Efavirenz, Nevirapine, Alluvia® and Zidovudine) at a PHC facility in the North West, South Africa (N=202). The sample size was determined with guidance of statistical services to ensure that results obtained from the study would be reliable and significant. Data collection was done in three phases. Phase one (1) consisted of collecting the biographical data and a pre-measurement of pill count and return dates for participants in Groups A, B and C. Phase two (2) consisted of sending bi-weekly messages (Group B) via WinSMS and with health education (Group C) for three (3) months. Phase three (3) consisted of post-measurement of participants’ pill count and return date for Groups A,B and C. Data collection stretched over six months (October 2013-March 2014), namely three months pre-measurement, then activation of intervention combined with another three months post-measurement. Descriptive and inferential statistical analysis was conducted through SPSS (SPSS Inc., 2013). Descriptive statistics indicated that more female patients visited the PHC facility for ART on a more regular basis. It was concluded that the experimental group proved a slight increase in compliance with regards to return date after the SMS intervention. No difference was noted in compliance to pill counts. It can also be concluded that pill counts is a complex monitoring procedure with room for error from the patients’ aspect. / MCur, North-West University, Potchefstroom Campus, 2015