A mHealth application for the training of caregivers of children with developmental disorders in South Africa: rationale and initial piloting.

Background: Evidence-based mobile health (mHealth) interventions have been successful for an array of physical and mental health conditions. Children with developmental disorders (DD) often have secondary speech and language disorders. The lack of high-quality medical and educational services in low- and middle-income countries limits the opportunities for children with DD to succeed in life. South Africa currently offers limited access to education, social, and health services. Methods: Twelve caregivers of twelve children with DD between the ages of 3 and 6 years who already received monthly early childhood therapy participated in this study. A mHealth app, called Nna'Le'wena, a Setswana phrase meaning "Me and You", was designed, developed, installed, and tested on tablets. The app provided a systematic framework and guidance to the caregivers in order to use evidence-based communication interaction strategies with the children over a twelve-week period. The app could be used offline and provided audio instructions in English and Setswana, two dominant languages in South Africa. The app automatically generated log files and collected answers to weekly surveys. At the end of the study, caregivers were asked to evaluate the app by using relevant portions of the Mobile App Rating Scale (MARS). Results: Caregivers were able to successfully interact and use the app. The app was well-received and liked by the caregivers. Caregivers listened to the instructional audios in English and Setswana during the 12-week period. They were able to provide communication opportunities to their children during daily living activities, especially during play- and mealtime activities. Conclusions: The Nna'Le'wena app was successfully deployed and used by caregivers of children with DD. mHealth solutions can be effective and are relatively affordable solutions that can enhance health care and educational delivery in different settings, including in low-and middle-income countries with limited Internet capabilities.

Interprofessional education in US radiologic technologist programs: Results of a national survey.

BACKGROUND: Interprofessional Education (IPE) prepares students to work in healthcare teams while promoting multidisciplinary learning. The Interprofessional Education Collaborative is a national organization committed to advancing interprofessional learning experiences and promoting team-based care. Previous studies of several allied health disciplines have explored faculty attitudes and beliefs about interprofessional education, but none have investigated program directors of radiologic sciences education programs. Because of their impact on radiologic sciences (technology) programs, it becomes necessary to analyze the attitudes and beliefs of program directors. To this end, this project investigated how program directors ranked the four IPE core competencies, how IPE is currently implemented in their program, and the differences between program directors who have implemented IPE in their curriculum and those that have not yet implemented IPE. METHODS: An online survey was distributed via email to 701 radiological science program directors of programs accredited by the JRCERT. The quantitative data was evaluated by crosstabulations, descriptive statistics, and Mann-Whitney U tests. RESULTS: We found most program directors believe that IPE should not be a separate accreditation standard. The majority of program directors with over five years in academia had already implemented IPE in their curricula (n = 68, 91%). Program directors with 11-15 years in academia had the highest rate of IPE implementation (n = 22, 81.48%). Approximately half of the programs without IPE in their curriculum would like to see a greater emphasis on IPE in their programs (n = 36, 55.38%). Most program directors (n = 114, 80.90%) somewhat or strongly agreed that interprofessional education will increase the student's ability to understand problems. Less than half of respondents agreed that their program had the resources and personnel to teach IPE (n = 59, 43.3%). Program directors ranked the IPE competency Communication (n = 42, 32.60%) first, followed by Ethics (n = 39, 30.20%), Teams and Teamwork (n = 31, 24.00%), and Roles and Responsibilities (n = 17, 13.20%). CONCLUSION: There is strong support from program directors for IPE to be implemented within radiological sciences programs. Radiologic Technology program directors reported active collaborations with other health-care related programs, similar to collaborations noted in previous research studies. Many program directors that had not yet implemented IPE reported investigating ways to incorporate an IPE activity into their curricula. However, barriers that can affect IPE implementation have been identified.

Design and development of a Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters.

Although the use of audiovisual telemedicine has grown in recent years especially during recent COVID-19-related lockdowns, evidence shows there is still a lack of tools that can be used for the assessment of telemedicine encounters. The few validated questionnaires that are available for assessing telemedicine encounters are not often used. Non-validated questionnaires dominate research, leading to results that cannot be compared or extrapolated to other research or medical sites. Development of standard measures for the assessment of telemedicine encounters has been advocated by stakeholders. The objective of this study is to provide a comprehensive set of measures by developing a conceptual approach and a preliminary Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters. A two-step conceptual approach was used to identify potential domains and sub-domains by qualitative analysis of a pool of questions from studies published from 2016 to 2021. Questions were adopted from validated questionnaires or generated to represent the underlying concept of each sub-domain, resulting in a core block of comprehensive questions. A toolkit is proposed with question-measures that cover the sub-domains relevant to the assessment of telemedicine encounters. This study recommended 11 domains to be used for the assessment of telemedicine encounters: "usability," "patient satisfaction," "patient-provider interaction," "patient perspectives," "telemedicine readiness," "qualitative feedback," "comparison to standard (in-person) care," "privacy," "technology," "patient feeling," and "patient costs." Of the 11 domains, 26 underlying sub-domains were created. From the subdomains, a 30-question core block was proposed. The core-block together with a precursor block aimed to retrieve demographic/patient characteristics and, together with a customizable clinical outcomes block, complete the comprehensive toolkit. The toolkit, upon testing and validation, would enable researchers and system owners to assess patient-oriented aspects of audiovisual telemedicine encounters more accurately and accelerate the adoption of common audiovisual telemedicine assessment measures.

A review of questionnaires used for the assessment of telemedicine.

INTRODUCTION: Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS: We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION: We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

Interprofessional Education in NAACLS MLT and MLS Programs: Results of a National Survey.

BACKGROUND: Interprofessional education is essential for students enrolled in health care professional programs. OBJECTIVES: We assessed the attitudes towards and the beliefs about interprofessional education (IPE) among program directors of medical laboratory science (MLS) and medical laboratory technician (MLT) programs accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). We also investigated the inclusion of IPE in the curricula of such programs. METHODS: We emailed the link to an anonymous 22-item cross-sectional survey to 468 program directors and tabulated the responses. RESULTS: Program directors who support the need to include IPE within the curricula of MLT and MLS programs showed a generally positive attitude towards IPE. The beliefs about IPE among our respondents were not homogeneous. Program directors who have not yet implemented IPE in the curriculum may not have had an opportunity to experience the practical benefits of IPE. CONCLUSION: Although barriers to IPE implementation exist, half of the respondents reported having already implemented IPE within their curricula.

Impact of the COVID-19 Pandemic on National Institutes of Health-Funded Researchers and Their Projects: The Role of Age, Sex, Experience, and Team Size.

OBJECTIVES: The COVID-19 pandemic has disrupted the social life, work environment, and well-being of millions of people. We examined COVID-19's impact on National Institutes of Health (NIH)-funded extramural principal investigators (PIs) affiliated with public health and preventive medicine departments across the country and their projects; assessed PIs' confidence in achieving project goals; and investigated the role of age, sex, experience, and team size on PIs' confidence in achieving project goals during the pandemic. METHODS: We sent an anonymous online survey in January 2021 to 1076 extramural PIs affiliated with public health and preventive medicine departments at US institutions; 133 (12.4%) responded. We examined the impact of COVID-19 on the PIs, their project team operations, and their confidence that project objectives would be met, using Likert scales based on age, sex, team size, and PI experience. RESULTS: Of 126 PIs, 94 (74.6%) felt that their day-to-day professional life was impacted a lot or a great deal by COVID-19. More female PIs than male PIs reported that their level of stress changed because of the COVID-19 pandemic. Of 125 PIs, 67 (53.6%) made major adjustments to research operations, 46 (36.8%) made minor adjustments, 5 (4.0%) halted research, and 7 (5.6%) reported not being affected. Of 123 PIs, 89 (72.4%) reported not using NIH COVID-19 accommodations. PIs who led projects 4 or 5 times felt more confident about meeting their research objectives than PIs who led projects 2 or 3 times. CONCLUSIONS: Future studies should investigate how to develop more engaging support and communication strategies to assist NIH researchers in mitigating the effects of pandemics or large-scale emergencies.

Factors Associated with Controlled Glycemic Levels in Type 2 Diabetes Patients: Study from a Large Medical Center and Its Satellite Clinics in Southeast Region in the USA.

Diabetes, including type 1, type 2, and gestational, is a significant public health issue responsible for various clinical, economic, and societal issues. Most of the consequences, if uncontrolled, can result in serious health problems, such as heart disease, vision loss, and kidney disease. Approximately 37.3 million Americans have diabetes, including 37.1 million adults 18 years or older, with 90-95% type 2 diabetes (T2D). The purpose of this study is (1) to explore the profile of patients with T2D and (2) to identify the associated factors of diabetic status. Examined factors included sociodemographic characteristics, social factors, and comorbidities. The study analyzed a primary dataset from a retrospective chart review of adult patients with T2D who were seen at a large medical center and its satellite clinics in the southeast region of the United States in 2019. Sex, dyslipidemia, and the number of concordant comorbidities were found to be significant associated factors of diabetic status. In the era of intertwined patient-centered approach and public health, the study's findings can guide treatment plans and interventions targeting individuals and communities.

Faculty Perspective on Interprofessional Education Competencies: Respiratory Therapy Compared to Other Allied Health Professions.

BACKGROUND: Interprofessional Education (IPE) provides a framework for collaborative education between health care specialties to improve patient care. In 2010, the Interprofessional Education Collaborative Expert Panel established the competencies of communication, ethics, roles and responsibilities, and teams and teamwork. Studies have assessed knowledge and attitudes about IPE in several allied health educational programs including respiratory therapy (RT). METHODS: We compared RT faculty to athletic training (AT), nutrition (NT), occupational therapy (OT), physical therapy (PT), and dental hygiene (DH) faculty. Faculty were asked to rank the IPE competencies according to importance. RESULTS: RT faculty ranked communication first, then teams and teamwork, roles and responsibilities, and last ethics. A Kruskal-Wallis Dwass-Steel-Chritchlow-Fligner pairwise analysis showed statically significant differences among allied health faculty rankings of IPE competencies. In communication, RT faculty responded statistically higher than AT (P < .001), DH P < .001), NT P < .001), and OT (P = .003). In ethics, RT faculty responded statistically lower than DH (P < .001), NT (P = .01), and PT (P < .001). In roles and responsibilities, RT faculty responded statistically higher than AT (P = .007) and OT (P < .001). In teamwork, RT faculty responded statistically higher than AT (P = .02), DH (P < .001), OT (P = .002), and PT (P < .001). CONCLUSIONS: RT faculty who teach at different degree levels (associate's degree programs vs bachelor's and master's degree programs) had the same ranking of competencies, but they had a statistically significant difference for teamwork, with associate's degree faculty ranking teamwork lower than bachelor's and master's degree faculty.

A review of audiovisual telemedicine utilization and satisfaction assessment during the COVID-19 pandemic.

INTRODUCTION: The use of telemedicine has broadened as technology that both restores continuity of care during disruptions in healthcare delivery and routinely provides primary care alone or in combination with in-person care. During the Covid-19 outbreak, the use of telemedicine as a routine care modality further accelerated. METHODS: A review of scientific studies that used telemedicine to provide care from December 2019 to December 2020 is presented. From an initial set of 2,191 articles, 36 studies are analyzed. Evidence is organized and evaluated according to the country of study, the clinical specialty, the technology platform used, and satisfaction and utilization outcomes. RESULTS: Thirty-one studies reported high patient satisfaction scores. Eight studies reported satisfaction from both providers and patients with no uniformly accepted assessment instrument. Eight studies conducted a descriptive analysis of telemedicine use and patient adoption patterns. Less than one-third of studies were controlled before/after studies. Most studies were conducted in the USA followed by Europe. CONCLUSIONS: Reported satisfaction rates are high, consistent with previously documented research, whereas utilization rates increased significantly compared with the prepandemic period. Future work in developing standardized uniform assessment instruments, embedded with each telemedicine system, would increase versatility and agility in the assessment, boosting statistical power and the interpretation of results.

Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians' Competence: A Delphi Consensus from the United States.

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs' NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach's alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and >0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings.

Nutrient composition of preterm mother's milk and factors that influence nutrient content.

BACKGROUND: Breast milk feedings are the optimal feeding choice for premature infants. Clinicians depend on accurate nutrient profiles of the breast milk in order to make informed decisions regarding the need for nutrient supplementation. Existing data for nutrient composition of preterm breast milk are dated and not representative of the current population of women delivering prematurely in the United States. OBJECTIVES: The purpose of this prospective, longitudinal, single-center observational study was to measure the macronutrient and micronutrient composition of breast milk expressed by mothers, including women who self-identify as black, delivering preterm infants at ≤33 completed weeks of gestation. METHODS: We collected breast milk samples from mothers of preterm infants admitted to the neonatal intensive care unit at Augusta University Medical Center from January 2019 through November 2019. Mother's milk samples were collected on postpartum days 7, 14, 21, and 28 and analyzed for macronutrients (energy, fat, protein, and carbohydrates) and micronutrients (sodium, potassium, chloride, calcium, phosphorus, magnesium, vitamin D, and zinc). RESULTS: Thirty-eight mothers, mean age 27 ± 5.1 y and majority black (66%), provided milk for the study. The mean estimated gestational age and birth weight were 28.2 ± 2.8 weeks of gestation and 1098 ± 347 g, respectively, with 42% of mothers in the cohort delivering before week 28 of pregnancy. Differences in protein, sodium, potassium, calcium, phosphorus, and zinc concentrations based on race, day, and milk volume were identified. Dilution effects for protein, sodium, chloride, and vitamin D concentrations over time were identified. CONCLUSIONS: Our study is among the first to characterize breast milk composition from women who delivered extremely preterm infants and adds to the evidence that race, gestational age, and volume influence the composition of preterm mother's milk. These factors should be considered when designing mother's milk-based feeds for premature infants.

Item Generation in the Development of an Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT): A Qualitative Study Utilizing Technology-Based Focus Groups in the United States.

An alarming 30% to 50% prevalence rate of disease-related malnutrition among hospitalized patients compels the need for early diagnosis and treatment of malnutrition. Registered Dietitian Nutritionists (RDNs) can utilize the nutrition-focused physical examination (NFPE) as one of the nutrition assessment criteria to accurately diagnose malnutrition. Although RDNs are striving to employ NFPE in practice, a lack of experience and adequate training impedes full utilization of this technique. This results in wide skill variations requiring continuous evaluation of RDNs' NFPE competency. However, a standardized, validated competency tool is not widely available and hence this study aims to develop a standardized, interactive nutrition-specific physical exam competency tool (INSPECT). As a first step in the development of INSPECT, a qualitative, technology-based focus group approach with 7 content and practice experts was utilized to generate appropriate tool items. A total of 70 NFPE items under 9 areas including 12 items for muscle loss, 4 items for subcutaneous fat loss, 31 items for micronutrient deficiencies, 1 item for fluid status, 2 items for handgrip strength, 5 items for initial preparation, 4 items for bedside manner, 8 items for swallowing, and 3 items for abdominal evaluation were generated. This study successfully utilized technology-based focus groups to generate appropriate NFPE items for the competency tool development. Using the items, an initial version of INSPECT has been developed, which is presently being investigated for content and face validity. The final version will undergo field tests and will be examined for reliability, validity, and item-level psychometric properties.

Attitudes and Behavior towards Interprofessional Collaboration among Healthcare Professionals in a Large Academic Medical Center.

The increasing rates of comorbidities among patients and the complexity of care have warranted interprofessional collaboration (IPC) as an important component of the healthcare structure. An initial step towards assessing the effectiveness of collaboration requires the exploration of the attitudes and experience of healthcare professionals towards IPC. This online survey aimed to examine the attitudes of healthcare professionals working in a large public academic medical center toward IPC in patient care and the healthcare team, and their behavior and experience regarding IPC. The rankings, according to the perceived importance among the respondents, of the four Interprofessional Education Collaborative (IPEC) core competencies (values/ethics, roles/responsibilities, interprofessional communication, teams/teamwork) were assessed. There were strong but varying levels of consensus among healthcare professionals (N = 551) that IPC facilitates efficient patient care, improves patient problem-solving ability, and increases better clinical outcomes for patients. They acknowledged that IPC promotes mutual respect within the healthcare team and providers' ability to make optimal patient care decisions. However, overall more than 35% of the respondents did not attend multidisciplinary education sessions (grand rounds, seminars, etc.), and about 23% did not participate in bedside patient care rounds. Interprofessional communication was ranked as the most important IPEC core competence. Although the attitude towards IPC among healthcare professionals is strongly positive, many healthcare professionals face challenges in participating in IPC. Institutional policies that facilitate interprofessional learning and interactions for this group of healthcare professionals should be formulated. Online distance learning and interactions, and simulation-enhanced interprofessional education, are options for addressing this barrier. Hospital administrators should facilitate conducive work environments that promote IPC, based on IPEC core competencies, and promote programs that address the challenges of IPC.

A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study.

BACKGROUND: Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. OBJECTIVE: This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. METHODS: Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. RESULTS: This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. CONCLUSIONS: The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/18098.

Knowledge, Use, and Perceptions of Metaphors Among Allied Health Faculty.

Allied health professionals spend a considerable amount of time listening to and communicating with patients while providing care. The inclusion of appropriate communication skills as a part of the core curriculum for allied health professions is crucial. Metaphorical representations are used by both patients and healthcare providers when communicating. Patients express their symptoms using metaphors and health professionals may use metaphors to facilitate the provider-patient interaction. It is reasonable to expect that allied health faculty would intentionally train their students in the use of metaphor. However, research on knowledge, use, and perception of metaphors among allied health faculty is absent. To address the gap, our study, by using a 13-question online anonymous survey, aimed to: 1) assess how well faculty of nutrition, respiratory therapy, athletic training, and occupational therapy programs recognize metaphors, and 2) determine if faculty use metaphors when they have to explain a clinical concept. A total of 366 participants completed the survey. Participants agreed on the value of metaphorical communication and showed a willingness to use metaphors in educational settings to teach a clinical concept. Participants were often not able to correctly identify metaphors when used in sentences.

Interprofessional Education in Dental Hygiene: Attitudes, barriers and practices of program faculty.

Purpose: Interprofessional education (IPE) experiences are an essential component in preparing dental hygiene students to participate in future interprofessional (IP) collaborations to support comprehensive patient care. The purpose of this study was to determine the attitudes, barriers and IPE practices in a national sample of dental hygiene faculty.Methods: A 25-item, researcher-designed, electronic survey was sent to 1,800 dental hygiene faculty members to determine attitudes, collaboration and practices involving interprofessional education (IPE). Descriptive statistics, Mann Whitney U and the Kruksal Wallis Test of Independent Samples were used to analyze and compare data.Results: The response rate was 22% (n=449). Results suggest faculty have positive attitudes toward IPE and most faculty (73%) incorporated IPE in their programs; however, time constraints were reported as the greatest barrier to IPE participation. A majority (85%) of respondents indicated a desire for greater emphasis on IPE in the curricula. Ethics (37%) was ranked as the most important IPE competency and teamwork the least (19%). Respondents from bachelor's degree programs were more likely to agree that learning with students in other health professions helps students become more effective members of a healthcare team than those from associate's degree programs (p = 0.025). Additionally, respondents from bachelor's degree programs were less likely to agree that clinical problem solving can only be learned when students are taught within their individual schools than those from associate degree programs (p = 0.022).Conclusion: Most of the dental hygiene faculty surveyed considered IPE important, incorporated it into student experiences, and wanted greater curricular emphasis on IPE. Time and institutional support may limit expansion of IPE activities and more collaboration amongst program faculty may be needed.

Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital.

BACKGROUND: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. DATA AND METHODS: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. RESULTS: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. CONCLUSIONS: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.

New Frontiers for Cognitive Assessment: An Exploratory Study of the Potentiality of 360° Technologies for Memory Evaluation.

One of the most recent trends in technology field is the 360° technology. In order to investigate its potentiality for the evaluation of memory function, we compared participants' performance in two memory tasks between an encoding delivered through an immersive 360° environment and a non-immersive 360° one. Specifically, we investigated if the immersive 360° environment would facilitate memory encoding in comparison to the non-immersive 360° one. Forty-two participants visualized two 360° pictures of a bedroom containing specific items and items shared by the two rooms, either in the "non-immersive → immersive" order or in the "immersive → non-immersive" one. Results showed that the immersive set-up was able to strengthen the mnestic trace only when participants performed the tasks in the "non-immersive → immersive" order. A possible explanation is a potential familiarity with the technologies used to explore the 360° environments. Overall, these results only partially supported the effectiveness of immersive 360° technology in facilitating episodic memory encoding; future studies should further explore the potentiality of this innovative technology.

Use of a web portal by adult patients with pre-diabetes and type 2 diabetes mellitus seen in a family medicine outpatient clinic.

BACKGROUND: There has been increasing interest in the use of web portals by patients with type 2 diabetes mellitus (T2DM). Studies of web portal use by patients with pre-diabetes have not been reported. To plan studies of web portal use by adult clinic patients seen for pre-diabetes and T2DM at an academic medical center, we examined characteristics of those who had or had not registered for a web portal. METHODS: Electronic records were reviewed to identify web portal registration by patients treated for pre-diabetes or T2DM by age, sex, race and ethnicity. RESULTS: A total of 866 patients with pre-diabetes and 2,376 patients with T2DM were seen in a family medicine outpatient clinic. About 41.5% of patients with pre-diabetes and 34.7% of those with T2DM had registered for the web portal. In logistic regression analysis, web portal registration among patients with T2DM was significantly associated with age 41-45 years, and with Hispanic ethnicity. Similar results were obtained for pre-diabetes except that the positive association with age 41-45 years and inverse association with Hispanic ethnicity were not statistically significant. Among patients with pre-diabetes or T2DM, Black men and Black women were less likely to have registered than their white counterparts. Patients who were aged 18-25 and >65 years were less likely to have registered for the web portal than those 26-65 years. CONCLUSIONS: Additional research is needed to identify portal design features that improve health outcomes for patients with pre-diabetes and T2DM and interventions that will increase use of patient portals by pre-diabetic and diabetic patients, especially among Black patients and older patients.

Health literacy and patient web portals.

OBJECTIVES: There is limited evidence about the association between health literacy and use of patient web portals in patients with chronic illnesses. The objective of this review was to learn more about health literacy and use of patient web portals. METHODS: Bibliographic searches were conducted in PubMed and CINAHL using relevant MeSH search terms and Boolean algebra commands. RESULTS: Qualitative studies and studies with a cross-sectional, cohort, or pre-/post-test design have shown that persons with limited health literacy are less likely to use patient web portals, although there is inconsistency in the association across studies. CONCLUSIONS: The conflicting findings may be partially due to racial and ethnic differences in health literacy or level of comfort in sharing private health information using mobile technologies. Several opportunities exist to improve the usability and acceptability of web portals for patients with limited health literacy including enhancements in the design of the portals, patient and provider education and training, and engagement of proxies such as caregivers and close family members.