Nurse-led protocols are an effective, safe, and sustainable method for achieving early antibiotic administration in patients with suspected febrile neutropenia. This is a key component of ensuring improved outcomes for this cohort of patients.

Background Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood. Objective This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature. Methods A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study. Results A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13%), Parkinson disease (3/30, 10%), and chronic lower back pain (3/30, 10%). The results were mixed when assessing the impact on a predefined primary outcome, with 50% (15/30) of studies finding a positive influence on the studied outcome and 50% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A1c, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7%) addressed the health care outcomes component. This included pain (11/155, 7.5%), quality of life (7/155, 4.8%), and physical function (5/155, 3.4%). Approximately 7.7% (12/155) of outcome measures represented the patient experience component, with 1.3% (2/155) addressing the clinician experience and cost. Conclusions Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care Smartwatches can count every step towards a predict-prevent health care system, but clinical regulation is the first leap A ustralia is struggling with the ever-increasing burden of chronic disease. Over $38 billion per year is spent on care for people with chronic diseases, such as cardiovascular disease, type 2 diabetes, and cancer. 1 The majority of this funding is dedicated to acute care, and just 9.6% of health care investment supports disease prevention. 1 Perversely, Australia's health system is rewarded for increasing acute care activity (activity-based funding) to manage disease, which perpetuates inefficient break-fix models of care. 2 The strain on acute care service provision has been accelerated by the COVID-19 pandemic 3 and Australia's ageing population, and is forecast as unsustainable. 2 Ageing increases total expenditure on hospitalisations, pathology provision, medical imaging, and cost to the Pharmaceutical Benefits Scheme. 1 This burden of chronic diseaseassociated with disability and premature death -is becoming less and less sensitive to further extensions in health care spending on treatment. Prevention (as defined in the Supporting Information) is urgently needed; however, dedicated funding, policies and models of preventive care for chronic diseases in communities are minimal, especially for priority populations and high risk social and environmental settings. Digital medicine can enable efficient predictprevent models of health care

The Northern Territory of Australia has an exceptionally high prevalence of sexually transmitted infections (STIs), particularly in remote areas. In contrast there are few notified cases of HIV at present. This study describes HIV testing rates in both primary care and sexual health clinics in the Top End region. In 2010, medical records were reviewed for a random sample of patients from a sexual health clinic and three remote primary care clinics. Among sexual health clinic patients 51.4% overall, and 59.7% of those with an STI, were tested for HIV. In people diagnosed with an STI in remote primary care clinics 19.1% were tested for HIV. HIV testing rates in the Top End of the Northern Territory do not meet the standard of national and international guidelines, with implications both for the early initiation of therapy and the accuracy of surveillance in a region with very high rates of STIs.

BACKGROUND Chronic disease contributes to high rates of disability and death. Patient engagement in chronic disease self-management is an essential component of chronic disease models of healthcare. Wearables provide patient-centred health data in real-time that can help inform self-management decision-making. Despite the perceived benefits of wearables to improve chronic disease self-management, their influence on healthcare outcomes remains poorly understood. OBJECTIVE To examine the influence of wearables on healthcare outcomes in people with chronic disease through systematic review of the literature METHODS A narrative systematic review was conducted by searching six databases for randomised and observational studies published between January 1st 2016 – July 1st 2021 that included the use of a wearable intervention in a chronic disease group to assess impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or healthcare outcome as a result of the wearable intervention. Data from included studies were extracted from six key extraction themes, from which a narrative qualitative synthesis was performed. All outcomes were mapped against each component of the Quadruple Aim of Healthcare. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. RESULTS A total of 31 articles were included. Studies reported a total of 2,512 participants with a mean age range of 10.1 to 74.4 years, in which the influence of 15 types of wearables on 19 chronic diseases were presented. The most studied chronic diseases were Type 2 diabetes (n = 4), Parkinson’s disease (n = 3) and chronic lower back pain (n = 3). Results were mixed when assessing the impact on a predefined primary outcome, with 16 studies finding a positive influence on the studied outcome and 15 demonstrating nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in two studies evaluating two distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity, weight and biomarkers of disease such as HbA1c in diabetes. In total, 164 outcomes were studied. The majority (n = 147; 89.6%) addressed the “healthcare outcomes” component, which included pain (n = 11; 7.5%), quality of life (n = 7; 4.8%) and physical function (n = 5; 3.4%). Thirteen (7.9%) outcome measures represented the “patient experience” component, with two (1.2%) addressing the “clinician experience” and “cost” respectively. CONCLUSIONS Given their popularity and capabilities, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base behind their safe, effective implementation. CLINICALTRIAL The protocol for this review was registered in the International Prospective Register for Systematic Reviews (PROSPERO) on April 22nd 2021 - CRD42021244562.