Background The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand’s Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants’ scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding.

BackgroundSocial media offers a new way to provide education, reminders, and support for patients with a variety of health conditions. Most of these interventions use one-way, provider-patient communication. Incorporating social media tools to improve postoperative (postop) education and follow-up care has only been used in limited situations.ObjectiveThe aim of this study was to determine the feasibility and efficacy of two-way social media messaging to deliver reminders and educational information about postop care to cataract patients.MethodsA total of 98 patients undergoing their first eye cataract surgery were divided into two groups: a no message group receiving usual pre- and postop care and a message group receiving usual care plus messages in a mobile social media format with standardized content and timing. Each patient in the message group received nine messages about hand and face hygiene, medication and postop visit adherence, and links to patient education videos about postop care. Patients could respond to messages as desired. Main outcome measures included medication adherence, postop visit adherence, clinical outcomes, and patients’ subjective assessments of two-way messaging. The number, types, content, and timing of responses by patients to messages were recorded.ResultsMedication adherence was better in the message group at postop day 7, with high adherence in 47 patients (96%, 47/49) versus 36 patients (73%, 36/49) in the no message group (P=.004), but no statistically significant differences in medication adherence between the groups were noted at preop and postop day 30. Visit adherence was higher at postop day 30 in the message group (100%, 49/49) versus the no message group (88%, 43/49; P=.03) but was 100% (49/49) in both groups at postop day 1 and 7. Final visual outcomes were similar between groups. A total of 441 standardized messages were sent to the message group. Out of 270 responses generated, 188 (70%) were simple acknowledgments or “thank you,” and 82 (30%) responses were questions that were divided into three general categories: administrative, postop care, and clinical issues. Out of the 82 question responses, 31 (11%) were about administrative issues, 28 (10%) about postop care, and 23 (9%) about clinical symptoms. All the messages about symptoms were triaged by nurses or ophthalmologists and only required reassurance or information. Patients expressed satisfaction with messaging.ConclusionsTwo-way social media messaging to deliver postop information to cataract patients is feasible and improves early medication compliance. Further design improvements can streamline work flow to optimize efficiency and patient satisfaction.

Purpose: To describe the pattern of vitreoretinal surgeries performed in Bhutan. This first national study informs policy making and resource development. Methods:We reviewed the surgical registers of the three hospitals in Bhutan providing VR operations or interventional procedures for VR diseases over three years. Patient demography, indications and types of vitreoretinal surgeries were logged and quantified. Comparisons of the expected and observed frequency used Chisquared tests.Results: A total of 214 patients received vitreoretinal surgeries, 36 paediatric cases received examination under anaesthesia for diagnostic confirmation followed by vitreoretinal surgery or retinal laser. Additionally, 381 cases received intravitreal anti-vascular endothelial growth factor injections in the operating theatres as mandated in Bhutan. The mean age was 56.2 ± 22.3 years. The majority, 375 cases (59.4%) were males (p<0.001). The common indications for VR surgery were retinal detachment (45.1%), vitreous haemorrhage (13.6%), and macular hole (7.7%). Retinal detachment surgery was the most common surgery performed, followed by silicon oil removal with cataract surgery. The common indications for anti-vascular endothelial growth factor injection were neovascular age-related macular degeneration (168 cases, 44.12%), retinal vein occlusion (132 cases, 34.6%), and diabetic macular oedema and retinopathy (50 cases, 13.1%). Conclusion:Performing high-tech vitreoretinal surgeries in a resource-limited setting is challenging. With an ever-increasing load of vitreoretinal diseases such as retinal detachment, age-related macular degeneration and macular hole, and the complications of systemic diseases such as retinal vein occlusion, vitreous haemorrhage, and diabetic macular oedema and retinopathy, there is a need to improve vitreoretinal services in Bhutan.

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Clinicians and engineers are improving medical practice and healthcare care delivery in low and middle-income countries (LMIC's) through research and innovation using data science and technology. One of the major barriers to translating their ideas into practice is the lack of financial resources. Without adequate funding, many of the critical issues regarding the development, implementation, and impact of technology innovations-including whether there is an actual improvement in clinical outcomes-cannot be adequately evaluated and addressed. While securing funding is a challenge for everyone, researchers and innovators in LMIC's often lack training and experience in proposal writing to support their work. Keywords LMIC • Funding • Funding strategy • Grants • Implementation research • Grant writing • Funding • Research • Technology • Innovation Learning Objectives This chapter is designed to provide clinicians and engineers with information on how to develop an idea into a fundable proposal. We will focus on understanding why research is an important strategy in the development and implementation of digital innovations such as mHealth and artificial intelligence (AI) technologies, developing a problem statement and research question, understanding the components of a research proposal, and learning about funding sources and strategies. We use research as a framework for developing a funding proposal because funding opportunities for health care technology development and implementation often are centered around research. Even if you are not planning to seek funding for research,