Sex Ed to Go: A Content Analysis of Comprehensive Sexual Education Apps.

Mobile applications ("apps") designed for sexual health education have the potential to reach teens and young adults that are hard to reach through traditional platforms; however, little is known about availability of these apps and their adherence to existing guidelines. Following a search on the two major app stores, data from 2,693 apps were analyzed. Only 697 (25%) addressed sexual health, and only 15 (1%) of apps met inclusion criteria for comprehensive programs and their content was further analyzed. The content of most of these apps narrowly focused on sexually transmitted infections and pregnancy prevention and lacked information on puberty, sexual identity, and personal safety. Theoretically grounded strategies including self-efficacy and modeling behavior to strengthen behavior change efforts were largely absent. Last, we identified significant shortcomings in the literate design of these apps, including limited use of interactive features, such as videos, quizzes, or games. These findings indicate that the potential of apps as sexual health promotion tools has not yet been fully realized. We outline recommendations for developing theory- and evidence-based sexual education apps and provide suggestions for health educators on how to select relevant apps when working for youth.

Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis.

BACKGROUND: Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps. OBJECTIVE: This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price. METHODS: Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM). RESULTS: The most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms. CONCLUSIONS: Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities.

The practice of simulation-based assessment in respiratory therapy education.

Clinical simulation has gained prominence as an educational approach in many Canadian respiratory therapy programs and is strongly associated with improved learning, clinical and nonclinical skill, future performance, and patient outcomes. Traditionally, the primary assessment approach employed in clinical simulation has been formative debriefing for learning. Contextual factors, such as limited opportunities for learning in clinical practice and technologically oriented perspectives on learning in clinical simulation, are converging to prompt a move from using formative debriefing sessions that support learning in simulation to employing high-stakes testing intended to measure entry-to-practice competencies. We adopt the perspective that these factors are intricately linked to the profession's regulatory environment, which may strongly influence how simulation practices become embedded with respiratory therapy educational programs. Through this discussion we challenge the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments.

Towards an enhanced conceptualization of fidelity for instructional design in simulation-based respiratory therapy education.

Despite the apparent centrality of fidelity to clinical simulation instructional design and practice in respiratory therapy education, it remains one of most contested constructs in the simulation literature. Fidelity has been described as educationally under-theorized resulting in an emphasis often being placed on technological sophistication rather than theory-informed design, particularly in respiratory therapy. This article critically examines various conceptualizations of fidelity in the field of clinical simulation in an effort to inform its instructional design practices. We adopt the perspective that a shift in the theoretic lens from individualistic to a more socio-cultural orientation may better support our understanding of learning in simulation environments. The instructional design framework (IDF) developed by the Canadian Network for Simulation in Healthcare provides a solid pedagogical foundation on which to base clinical simulations design. The IDF has also been a platform upon which designers can frame the characteristics of simulation environments. We propose an enhanced IDF informed by contemporary education theory describing the joint learning relationship that exists between learners and technology-enhanced learning environments. The enhanced IDF includes each of the interdependent design elements in the original model and incorporates a socio-culturally informed conceptualization of fidelity. The framework will be useful in fostering the relationships that support an effective clinical simulation learning environment. This will be of particular value to practitioners, researchers, and theorists in the clinical simulation-based respiratory therapy education field.

Staffing patterns of respiratory therapists in critical care units of Canadian teaching hospitals.

BACKGROUND: The optimal level of respiratory therapy staffing in Canadian intensive care units (ICUs) has not been described in the literature. An examination of practice patterns is an essential first step in developing an understanding of the contribution of respiratory therapists (RTs) to both short- and long-term patient outcomes in this context. OBJECTIVE: To identify the ratio of mechanically ventilated patients to respiratory therapist (Vent:RT ratio) in the ICUs of Canadian teaching hospitals and the factors that influence this ratio. METHODS: The present observational study investigated all adult ICUs (n=38) of the primary teaching hospital associated with each Canadian medical school. An electronic survey was administered at three intervals over a period of three months to control for seasonal variation. Data collected included the hours worked by all RTs, the number of mechanically ventilated patients receiving care, ICU characteristics and the practice patterns of the RTs. Data were used to calculate the Vent:RT ratio, and repeated measures ANOVA examined for variation between findings of each of the data collection points. Correlation analyses between key variables were performed and identified associations were further explored using the t test. Approval for the study was granted by the University of Manitoba Research Ethics Board (Winnipeg, Manitoba). RESULTS: A mean (± SD) Vent:RT ratio of 5.1:1±2.818 was determined. Repeated measures ANOVA demonstrated no significant differences between findings of the three data collection points (F [1.7,30.5]=0.695; P=0.492). Several variables were associated with a significant difference in the Vent:RT ratio including ICUs where RTs insert arterial monitoring lines (4.05±2.89 versus 6.97±2.85; t[17.6]=-2.64; P=0.02), neurological ICUs (4.04±2.76 versus 6.40±3.35; t[30]=-2.092; P=0.04) and coronary care units (5.72±2.80 versus 3.10±1.88; t[35]=2.72; P=0.01). Significant differences were also identified in the mean number of RT hours worked in ICUs where RTs intubated (31.40±9.71 versus 60.54±47.20; t(13)=-2.17; P=0.049) and procured arterial blood gases (41.68±30.85 versus 77.33±46.22; t[35]=-2.79; P=0.01). CONCLUSIONS: The present study is the first to report the Vent:RT ratio and RT practice patterns in Canadian adult ICUs. The results serve as a baseline for comparison of staffing norms and will enlighten future research on the impact of RT staffing and practice patterns on patient outcomes.

La dotation en thérapeutes respiratoires dans les unités de soins intensifs des hôpitaux universitaires canadiens. HISTORIQUE: Les publications ne décrivent pas le taux de dotation optimal des thérapeutes respiratoires dans les unités de soins intensifs (USI) canadiennes. À cet effet, il est essentiel de commencer par examiner les profils d'exercice pour comprendre l'apport des thérapeutes respiratoires (TR) aux résultats cliniques des patients à court et à long terme. OBJECTIF: Déterminer le ratio entre les patients sous ventilation mécanique et les TR (ratio Vent:TR) dans les USI des hôpitaux universitaires canadiens et les facteurs qui influent sur ce ratio. MÉTHODOLOGIE: La présente étude d'observation a porté sur toutes les USI pour adultes (n=38) de l'hôpital universitaire de soins de première ligne associé à chaque faculté de médecine canadienne. Les chercheurs ont envoyé un sondage virtuel à trois reprises sur une période de trois mois pour controller la variation saisonnière. Ils ont recueilli les heures travaillées par tous les TR, le nombre de patients sous ventilation mécanique traités, les caractéristiques des USI et les profils d'exercice des TR. Ils ont utilisé les données pour calculer le ratio Vent:TR et examiné les mesures de variance répétées pour établir la variation entre les observations à chaque moment de la collecte des données. Ils ont effectué des analyses de corrélation entre les principals variables et examiné de manière plus approfondie les associations établies au moyen du test t. Le comité d'éthique de la recherche de l'université du Manitoba, à Winnipeg, a approuvé l'étude. RÉSULTATS: Un ratio Vent:TR moyen (± ÉT) de 5,1:1±2,818 a été établi. Les mesures de variance répétées n'ont démontré aucune différence significative entre les observations à trois moments de la collecte de données (F [1,7, 30,5]=0,695; P=0,492). Plusieurs variables s'associaient à une différence importante du ratio Vent:TR, y compris les USI où les TR insèrent les cathéters intra-artériels (4,05±2,89 par rapport à 6,97±2,85; t[17,6]=−2,64; P=0,02), les USI en neurologie (4,04±2,76 par rapport à 6,40±3,35; t[30]=−2,092; P=0,04) et les unités de soins coronariens (5,72±2,80 par rapport à 3,10±1,88; t[35]=2,72; P=0,01). Les chercheurs ont également constaté des différences significatives en matière de nombre moyen d'heures-TR travaillées dans les USI où les TR procédaient à des intubations (31,40±9,71 par rapport à 60,54±47,20; t(13)=−2,17; P=0,049) et celles où ils effectuaient des gaz artériels (41,68±30,85 par rapport à 77,33±46,22; t[35]=−2,79; P=0,01). CONCLUSIONS: La présente étude est la première à rendre compte du ratio Vent:TR et des profils d'exercice des TR dans les USI pour adultes canadiennes. Les résultats sont un point de départ pour comparer les normes de dotation en personnel et pour éclairer les futures recherches sur les répercussions du nombre de TR et des profils d'exercice sur les résultats cliniques des patients.

Advisory workgroup recommendations on the use of clinical simulation in respiratory therapy education.

Clinical simulation has become established as a commonly used educational approach in respiratory therapy, though questions remain with regards to the evidence basis for its use in some contexts. In conjunction with the development of a new iteration of the National Competency Framework (NCF), the National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) reaffirmed its desire to continue to recognize the use of simulation as an educational tool. Given the expressed uncertainty as to best practices in the use of clinical simulation in entry-to-practice respiratory therapy education programs, the NARTRB requested the creation of an expert workgroup to develop a list of recommendations from which an implementation plan could be developed for the next iteration of the NCF. The resulting advisory workgroup recommendations are intended to inform the application of simulation in education programs relative to the attainment of entry-to-practice competencies as outlined in the current National Competency Profile. The recommendations presented focus on the use of clinical simulation for formative and summative assessment of respiratory therapy competencies. The recommendations indicate that the use of formative assessment in clinical simulations along with deliberate practice has been clearly shown to improve learning outcomes for which the simulations are designed. However, it is advised that the use of clinical simulation for the summative assessment of competency (e.g., to assess readiness for practice) be exercised cautiously in the context of respiratory therapy education. A number of requisite instructional design factors that should be considered before implementing summative simulation-based assessments are identified, including the validation of summative assessment tools.

Innovation in respiratory therapy and the use of three-dimensional printing for tracheostomy management.

Technological advances have influenced practice patterns and innovation in many health disciplines, including respiratory therapy. Collaborative approaches and knowledge-sharing environments are vital in addressing problems and adopting emerging technology. This article illustrates how the emergence of low-cost three-dimensional printing technology to physically reproduce the results of computed tomography imaging data can provide ways to assess airway abnormalities and symptomology not explained by traditional diagnostic methods.

Improving survival outcomes in lung transplant recipients through early detection of bronchiolitis obliterans: Daily home spirometry versus standard pulmonary function testing.

BACKGROUND: Long-term lung transplant success is limited by bronchiolitis obliterans syndrome (BOS), a form of chronic allograft rejection that manifests in the majority of patients by five years post-transplant. Frequent monitoring of pulmonary function measurements through the use of daily home spirometry may have the capability to detect the onset of BOS sooner than standard pulmonary function testing. Early detection of BOS would confer a treatment advantage that may improve survival outcomes for lung transplant recipients. METHODS: A systematic review of current evidence was used to determine the effectiveness of daily home spirometry as a BOS detection tool, in addition to its impact and survival outcomes. Articles were included in the present systematic review if they were randomized control studies and if their purpose(s) included investigation of spirometry as a BOS detection tool in lung transplant patients. RESULTS: A primary search of databases yielded 115 unique citations, with an additional four citations identified through a secondary review of the reference lists of retrieved articles. After application of all inclusion and exclusion criteria through abstract and full-text review, eight randomized controlled trials were included in the review. DISCUSSION: Forced expiratory volume in 1 s (FEV1) has been identified as the most reliable diagnostic tool for detecting the onset of BOS. Two studies compared the use of traditionally scheduled pulmonary function testing with daily home spirometry and found BOS stage 1 to appear 341 days earlier with home spirometry (P<0.001). Other studies that investigated the impact early detection had on survival showed a positive trend toward freedom from BOS and reduced rates of retransplantation, although these results did not reach statistical significance (P<0.07). CONCLUSION: Daily home spirometry has been shown to lead to earlier detection and staging of BOS when compared with standard pulmonary function testing. Although FEV1 has been shown to be the most sensitive and reliable marker of BOS onset, the impact of earlier staging via home spirometry on survival has not been reliably determined.

HISTORIQUE: La réussite à long terme des transplantations pulmonaires est limitée par le syndrome de bronchiolite oblitérante (SBO), une forme de rejet chronique de l'allogreffe qui se manifeste chez la majorité des patients dans les cinq ans suivant la transplantation. La surveillance fréquente des mesures de fonction pulmonaire par la spirométrie quotidienne à domicile pourrait déceler l'apparition du SBO plus rapidement que l'exploration fonctionnelle respiratoire standard. Le dépistage précoce du SBO confère un avantage thérapeutique qui peut améliorer la survie des greffés pulmonaires. MÉTHODOLOGIE: Les chercheurs ont procédé à l'analyse systématique des données probantes à jour pour déterminer l'efficacité de la spirométrie quotidienne à domicile comme outil de détection du SBO, ainsi que son effet sur la survie. Les articles étaient retenus s'il s'agissait d'études aléatoires et contrôlées dont l'un des objectifs consistait à évaluer la spirométrie comme outil de dépistage du SBO chez les greffés pulmonaires. RÉSULTATS: Les chercheurs ont obtenu 115 citations uniques au moyen d'une recherche primaire des bases de données, et quatre autres après un examen secondaire des listes de références des articles extraits. Après l'application de tous les critères d'inclusion et d'exclusion par l'analyse des résumés et des textes intégraux, ils ont retenu huit essais aléatoires et contrôlés. EXPOSÉ: Il a été établi que le volume expiratoire maximal par seconde (VEMS) est l'outil diagnostique fiable pour dépister l'apparition du SBO. Deux études comparant l'utilisation de l'exploration fonctionnelle respiratoire habituelle à la spirométrie quotidienne à domicile ont décelé que le SBO de stade 1 était décelé 341 jours plus tôt grâce à la spirométrie quotidienne (P<0,001). D'autres études sur l'effet du dépistage précoce sur la survie ont révélé une tendance positive vers la guérison du SBO et une diminution du taux de retransplantation, même si ces résultats n'étaient pas statistiquement significatifs (P<0,07). CONCLUSION: L'analyse a révélé que la spirométrie quotidienne à domicile assure un dépistage et l'établissement du stade du SBO plus rapidement que l'exploration fonctionnelle respiratoire. Même si le VEMS est le marqueur le plus sensible et le plus fiable d'apparition du SBO, l'effet sur la survie de l'établissement du stade de la maladie par la spirométrie à domicile n'a pas été établi avec fiabilité.

Privacy and security of patient data in the pathology laboratory.

Data protection and security are critical components of routine pathology practice because laboratories are legally required to securely store and transmit electronic patient data. With increasing connectivity of information systems, laboratory work-stations, and instruments themselves to the Internet, the demand to continuously protect and secure laboratory information can become a daunting task. This review addresses informatics security issues in the pathology laboratory related to passwords, biometric devices, data encryption, internet security, virtual private networks, firewalls, anti-viral software, and emergency security situations, as well as the potential impact that newer technologies such as mobile devices have on the privacy and security of electronic protected health information (ePHI). In the United States, the Health Insurance Portability and Accountability Act (HIPAA) govern the privacy and protection of medical information and health records. The HIPAA security standards final rule mandate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and security of ePHI. Importantly, security failures often lead to privacy breaches, invoking the HIPAA privacy rule as well. Therefore, this review also highlights key aspects of HIPAA and its impact on the pathology laboratory in the United States.

Public health in Canada: Evolution, meaning and a new paradigm for respiratory therapy.

Chronic disease burden in Canada poses an imminent public health threat. The impact of respiratory disease in Canada alone is significant, affecting one in five and leading any other cause of repeat hospitalization in all age groups. Public health action is considered to be an important means of addressing these issues. Historical understanding of health has evolved to support the adoption of paradigms by professions that recognize the limitations of medical intervention in addressing the fundamental basis of disease when compared with the broader public health perspective. Several key historical events have shaped this understanding in the Canadian context including the Lalonde and Epp reports, and public health emergencies such as the severe acute respiratory syndrome outbreak in 2003. The profession of respiratory therapy has historically existed within a medicalized paradigm of practice; however, forces both internal and external to the profession are pressuring it to consider adopting broader social-and population-based approaches. As a rapidly evolving profession, there is a need to explore emerging areas of practice opportunities in the discipline. Investigating alternative knowledge and ideology can ensure that effective strategies for addressing the contemporary respiratory heath needs of Canadians are undertaken. The present article explores the rationale for a public health- and population-based approach to health in general, and its applicability to the respiratory therapist's role in addressing respiratory health-related issues in Canada.

Le fardeau de la maladie chronique au Canada constitue une menace imminente pour la santé publique. Les conséquences des seules maladies pulmonaires au Canada sont considérables, car elles touchent une personne sur cinq et sont supérieures à toute autre cause de réhospitalisation dans tous les groupes d'âge. Les mesures de santé publique sont considérées comme un moyen important d'aborder le problème. La compréhension historique de la santé a évolué pour soutenir l'adoption de paradigmes par les professions, lesquels conviennent des limites des interventions médicales pour aborder les aspects fondamentaux des maladies selon la perspective plus vaste de la santé publique. Plusieurs événements historiques clés ont favorisé cette évolution dans le contexte canadien, y compris le rapport Lalonde et le rapport Epp, ainsi que des urgences de santé publique comme l'éclosion du syndrome respiratoire aigu en 2003.La profession d'inhalothérapeute a toujours existé dans un paradigme de pratique médicalisée, mais des forces internes et externes s'exercent pour qu'au sein de la profession, on envisage d'adopter des approches plus vastes sur le plan social et en population. Puisque la profession évolue rapidement, il faut explorer les possibilités de pratique émergentes dans la discipline. En explorant d'autres connaissances et idéologies, on peut s'assurer d'adopter des stratégies efficaces pour répondre aux besoins de santé pulmonaire contemporains des Canadiens. Le présent article traite de la raison d'être d'une approche de santé publique et en population et de son applicabilité au rôle de l'inhalothérapeute qui veut se pencher sur les problèmes liés à la santé pulmonaire au Canada.

Effectiveness of primary angioplasty for acute myocardial infarction in patients on dialysis.

We sought to characterize the outcome in patients who were on long-term dialysis and who underwent primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction. Of 2,831 consecutive patients who underwent primary PTCA for acute myocardial infarction from 1993 to 2001, 15 patients on long-term dialysis were identified. This small cohort had a 40% incidence of cardiogenic shock on admission. Despite the angiographic success rate for primary PTCA of 80%, in-hospital mortality was 53%.