Token economy to improve adherence to activities of daily living

Hickey, Victoria; Flesch, Laura; Lane, Adam; Pai, Ahna L. H.; Huber, John; Badia, Priscila; Davies, Stella M.; Dandoy, Christopher E.

doi:10.1002/pbc.27387

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…Patients in the SOC group continued to receive the prescribed 3 daily oral rinses of chlorhexidine gluconate and nystatin, as described previously [8,[28][29][30]. The xylitol group used oral xylitol wipes (with .7 g xylitol) to wipe the patient's teeth and gums once daily for a minimum of 30 seconds in addition to the standard of care.…”

Section: Study Interventionmentioning

confidence: 99%

Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial

Badia

Andersen

Nelson

et al. 2020

Biology of Blood and Marrow Transplantation

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Bloodstream infections (BSIs) from oral organisms are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. There are no proven strategies to decrease BSIs from oral organisms. The aim of this study was to evaluate the impact of daily xylitol wipes in improving oral health, decreasing BSI from oral organisms, and modulating the oral microbiome in pediatric HSCT recipients. This was a single-center 1:1 randomized controlled trial in pediatric HSCT recipients age >2 years. Age-matched healthy children were enrolled to compare the oral microbiome. The oral hygiene standard of care (SOC) group continued to receive the standard oral hygiene regimen. The xylitol group received daily oral xylitol wipes (with .7 g xylitol) in addition to the SOC. The intervention started from the beginning of the transplantation chemotherapy regimen and extended to 28 days following transplantation. The primary outcome was oral health at interval time points, and secondary outcomes included BSIs from oral organisms in the first 30 days following transplantation, oral microbiome abundance, and diversity and oral pathogenic organism abundance. The study was closed early due to efficacy after an interim analysis of the first 30 HSCT recipients was performed (SOC group, n = 16; xylitol group, n = 14). The xylitol group had a significantly lower rate of gingivitis at days 7, 14, and 28 following transplantation (P = .031, .0039, and .0005, respectively); oral plaque at days 7 and 14 (P = .045 and .0023, respectively); and oral ulcers >10 mm at day 14 (P = .049) compared with the SOC group. The xylitol group had no BSI from oral organisms compared with the SOC group, which had 4 (P = .04). The xylitol group had significantly lower abundance of potential BSI pathogens, such as Staphylococcus aureus (P = .036), Klebsiella pneumoniae (P = .033), and Streptococcus spp (P = .011) at the day after transplantation compared with the SOC group. Healthy children and young adults had significantly increased oral microbiome diversity compared with all HSCT recipients (P < .001). The addition of xylitol to standard oral care significantly improves oral health, decreases BSI from oral organisms, and decreases the abundance of pathogenic oral organisms in pediatric and young adult HSCT recipients.

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Section: Study Interventionmentioning

confidence: 99%

Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial

Badia

Andersen

Nelson

et al. 2020

Biology of Blood and Marrow Transplantation

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“…To examine the effectiveness of incentivization, one study [ 20 ] designed a token economy to encourage adherence to activities of daily living—bathing, physical activity, and oral hygiene—to reduce the risk of bloodstream infections, oral complications, and deconditioning in hematopoietic stem cell transplant for pediatric patients. Activities of daily living adherence rate increased from 0.51 to 2.5 after implementing the token economy [ 20 ]. In other studies [ 21 - 23 ], the preferred incentive methods were free parking, modest financial compensation, food coupons, guitar lessons, transportation, and donations to charity.…”

Section: Introductionmentioning

confidence: 99%

Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios

Jung¹,

Kim²,

Hwang³

et al. 2021

J Med Internet Res

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Background Despite the fact that the adoption rate of electronic health records has increased dramatically among high-income nations, it is still difficult to properly disseminate personal health records. Token economy, through blockchain smart contracts, can better distribute personal health records by providing incentives to patients. However, there have been very few studies regarding the particular factors that should be considered when designing incentive mechanisms in blockchain. Objective The aim of this paper is to provide 2 new mathematical models of token economy in real-world scenarios on health care blockchain platforms. Methods First, roles were set for the health care blockchain platform and its token flow. Second, 2 scenarios were introduced: collecting life-log data for an incentive program at a life insurance company to motivate customers to exercise more and recruiting participants for clinical trials of anticancer drugs. In our 2 scenarios, we assumed that there were 3 stakeholders: participants, data recipients (companies), and data providers (health care organizations). We also assumed that the incentives are initially paid out to participants by data recipients, who are focused on minimizing economic and time costs by adapting mechanism design. This concept can be seen as a part of game theory, since the willingness-to-pay of data recipients is important in maintaining the blockchain token economy. In both scenarios, the recruiting company can change the expected recruitment time and number of participants. Suppose a company considers the recruitment time to be more important than the number of participants and rewards. In that case, the company can increase the time weight and adjust cost. When the reward parameter is fixed, the corresponding expected recruitment time can be obtained. Among the reward and time pairs, the pair that minimizes the company’s cost was chosen. Finally, the optimized results were compared with the simulations and analyzed accordingly. Results To minimize the company’s costs, reward–time pairs were first collected. It was observed that the expected recruitment time decreased as rewards grew, while the rewards decreased as time cost grew. Therefore, the cost was represented by a convex curve, which made it possible to obtain a minimum—an optimal point—for both scenarios. Through sensitivity analysis, we observed that, as the time weight increased, the optimized reward increased, while the optimized time decreased. Moreover, as the number of participants increased, the optimization reward and time also increased. Conclusions In this study, we were able to model the incentive mechanism of blockchain based on a mechanism design that recruits participants through a health care blockchain platform. This study presents a basic approach to incentive modeling in personal health records, demonstrating how health care organizations and funding companies can motivate one another to join the platform.

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“…When children with serious diagnoses need long-term treatment, paediatrics usually face two major difficulties: (i) sustainable adherence to curative programmes and satisfactory compliance and (ii) adverse impact of disease experiences, hospitalisation and medical interventions on the child's mental development and self-image. Various approaches such as token economy can improve compliance and many of them are based on behavioural conditioning and/or extrinsic motivation [1]. Nonetheless, paediatric paradigms such as empowerment, e.g.…”

Section: Introduction and Backgroundsmentioning

confidence: 99%

Music Rhythmic Therapy - A Novel Versatile Add-On Support in Paediatrics

Mastnak¹

2020

J Pediatr Res Rev Rep

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Music rhythmic therapy is a novel discipline and a contribution to integrative paediatrics. Based on an interdisciplinary systemic meta-synthesis involving medicine, neuropsychology, cultural anthropology, philosophy of arts and aesthetics, music rhythmic therapy focuses on the health promoting and curative power of music and movement as well as the artistic and creative nature of the child. Considered an efficient and versatile add-on therapy, it contributes to paediatric psychiatry (e.g. childhood trauma therapy, communication disorders and internet gaming disorder), paediatric neuro-rehabilitation (e.g. cerebral palsy, foetal alcohol spectrum disorder and poly-lingual withdrawal syndrome), paediatric psychosocial oncology, and treatment of the metabolic syndrome in children. Music rhythmic therapy was developed at the Beijing Normal University Research Centre for Arts Therapies and comprises elements of Chinese music rhythmic education, which was founded by Lele Kremer. Intersections between music rhythmic therapy and arts education in schools also apply to health education. Further research is needed to substantiate its models and enhance related clinical practice and public health measures

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Token economy to improve adherence to activities of daily living

Cited by 8 publications

References 38 publications

Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial

Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial

Mechanism Design of Health Care Blockchain System Token Economy: Development Study Based on Simulated Real-World Scenarios

Music Rhythmic Therapy - A Novel Versatile Add-On Support in Paediatrics

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