The Roles of Trust and Its Antecedent Variables in Healthcare Consumers' Acceptance of Online Medical Consultation during the COVID-19 Pandemic in China.

Online medical consultation (OMC) is generating considerable interest among researchers and practitioners due to the mandatory quarantine measures implemented during the COVID-19 pandemic in China. However, the acceptance rate of OMC has declined over time. This paper aims to empirically investigate OMC acceptance using a proposed research model by integrating the technology acceptance model (TAM) with trust and its antecedent variables. A quantitative self-administered cross-sectional survey was conducted to collect data from 260 healthcare consumers. A partial least squares structural equation modeling method was used to examine the data. Results revealed that healthcare consumers' behavioral intention was influenced by attitudes, while perceived usefulness and trust significantly influenced behavioral intention through attitude as a mediator. In addition, perceived risk, perceived privacy protection, network externalities, cognitive reputation, and interactivity directly influenced trust. Overall, the research model explained 50% of the variance in attitude and 71% of the variance in behavioral intention. The study's findings should provide useful insights into making effective design, development, and implementation decisions for OMC services.

Myeloid sarcoma with ulnar nerve entrapment: A case report.

BACKGROUND: Myeloid sarcoma (MS) is relatively rare, occurring mainly in the skin and lymph nodes, and MS invasion of the ulnar nerve is particularly unusual. The main aim of this article is to present a case of MS invading the brachial plexus, causing ulnar nerve entrapment syndrome, and to further clinical understanding of the possibility of MS invasion of peripheral nerves. CASE SUMMARY: We present the case of a 46-year-old man with a 13-year history of well-treated acute nonlymphocytic leukaemia who was admitted to the hospital after presenting with numbness and pain in his left little finger. The initial diagnosis was considered a simple case of nerve entrapment disease, with magnetic resonance imaging showing slightly abnormal left brachial plexus nerve alignment with local thickening, entrapment, and high signal on compression lipid images. Due to the severity of the ulnar nerve compression, we surgically investigated and cleared the entrapment and nerve tissue hyperplasia; however, subsequent pathological biopsy results revealed evidence of MS. The patient had significant relief from his neurological symptoms, with no postoperative complications, and was referred to the haemato-oncology department for further consultation about the primary disease. This is the first report of safe treatment of ulnar nerve entrapment from MS. It is intended to inform hand surgeons that nerve entrapment may be associated with extramedullary MS, as a rare presenting feature of the disease. CONCLUSION: MS invasion of the brachial plexus and surrounding tissues of the upper arm, resulting in ulnar nerve entrapment and degeneration with significant neurological pain and numbness in the little finger, is uncommon. Surgical treatment significantly relieved the patient's nerve entrapment symptoms and prevented further neurological impairment. This case is reported to highlight the rare presenting features of MS.

What shapes people's willingness to wear a face mask at the beginning of a public health disaster? A qualitative study based on COVID-19 in China.

COVID-19 should not be the world's last public health disaster, so there is an urgent need to learn from COVID-19 to prepare better for the next public health disaster. This study aims to understand the factors that make people wear a face mask at the beginning of an outbreak of public health disaster. Semi-structured interviews were conducted during April 2020 in China, one month after the COVID-19 was declared a pandemic. The respondents were members of the public living in China, covering two age groups: young adults and older adults. They were recruited using a convenient sample and snowball sampling strategy. The results were analysed using content analysis. Seventeen subjects were recruited, among which nine were young adults (average age = 26.4; SD = 10.5), and eight were older adults (average age = 60.4; SD = 12.1). This study found that environmental factors, personal factors, factors concerning wearing masks, specific circumstances, and development of the pandemic were the common factors considered by both young adults and older adults. This study should help the authority formulate prevention policies better to reduce the risk of an outbreak if there is a new virus outbreak in the future, unfortunately.

Effects of Text Enhancement on Reduction of Look-Alike Drug Name Confusion: A Systematic Review and Meta-analysis.

BACKGROUND AND OBJECTIVES: Drug name confusion induced by look-alike drug names represents a serious health care management problem in practice. Text enhancement by changing visual attributes of look-alike drug names has been proposed and widely applied in practice to mitigate drug name confusion. However, the effectiveness of text enhancement on reducing drug name confusion is yet to be determined. This study aimed to explore the effects of text enhancement on reduction of confusion caused by look-alike drug names through systematic review and meta-analysis. METHODS: We searched 5 databases (from database inception to January 2020) for empirical studies that examined the effects of text enhancement on reduction of look-alike drug name-induced drug name confusion. The pooled outcome data were analyzed using either meta-analysis or a narrative synthesis approach. RESULTS: From the 351 identified articles, 11 articles representing 20 individual trials were included. Five basic text enhancement methods were revealed, including Tall Man, red, boldface, contrast, and size enhancement, from which 4 Tall Man variants and 6 text enhancement combinations were derived. The meta-analysis results showed significant reduction in omission errors when using Tall Man (standardized mean difference [SMD] = -0.628, 95% confidence interval [CI]: -1.018 to -0.238, P = .002), red (SMD = -0.516, 95% CI: -1.002 to -0.030, P = .038), boldface (SMD = -1.027, 95% CI: -1.240 to -0.814, P < .001), and contrast (SMD = -0.437, 95% CI: -0.869 to -0.004, P = 0.048), as compared with lowercase. This finding was also supported in our subgroup analysis by task type for name differentiation tasks. No other significant effects of text enhancement were found for either commission errors or response time. CONCLUSIONS: Using Tall Man, red, boldface, or contrast could help reduce omission errors (ie, wrong medication selection) caused by look-alike drug names, particularly in name differentiation tasks. However, no text enhancement could shorten name search and/or differentiation time. Our findings could facilitate the understanding of the effects of text enhancement in the prevention of confusion errors caused by look-alike drug names and promote the application of text enhancement in practice.

An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension.

BACKGROUND: Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence. METHODS: We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression. RESULTS: Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes. CONCLUSIONS: Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.

Gracillin inhibits apoptosis and inflammation induced by lipopolysaccharide (LPS) to alleviate cardiac injury in mice via improving miR-29a.

Sepsis induces critical myocardial dysfunction, resulting in an increased mortality. Gracillin (GRA) is a natural steroidal saponin, showing strong capacities of anti-inflammation, but its pharmacological effects on lipopolysaccharide (LPS)-induced acute cardiac injury still remain unclear. In this study, we attempted to explore if GRA was effective to attenuate cardiac injury in LPS-challenged mice and the underlying mechanisms. First, we found that GRA treatments markedly up-regulated the expression of miR-29a in cardiomyocytes. LPS-induced cytotoxicity in cardiomyocytes was significantly alleviated by GRA treatment, as evidenced by the improved cell viability and reduced lactate dehydrogenase (LDH) release. In addition, LPS-triggered apoptotic cell death was clearly ameliorated in cardiomyocytes co-treated with GRA. Notably, LPS-exposed cells showed significantly reduced expression of miR-29a, while being rescued by GRA treatment. In vivo, LPS apparently impaired cardiac function in mice, which was, however, alleviated by GRA administration. In addition, GRA markedly attenuated apoptosis in hearts of LPS-challenged mice by decreasing the expression of cleaved Caspase-3. LPS-triggered inflammatory response in cardiac tissues was also suppressed by GRA through blocking nuclear factor κB (NF-κB) signaling pathway. We also found that miR-29a expression was highly reduced in hearts of LPS-treated mice but was rescued by GRA pretreatment. Besides, miR-29a mimic alleviated LPS-induced apoptosis and inflammation in cardiomyocytes; however, LPS-caused effects were further accelerated by miR-29a. Of note, the protective effects of GRA on LPS-injured cardiac tissues were significantly abrogated by miR-29a suppression. In conclusion, our findings demonstrated that GRA exerted an effective role against LPS-induced acute cardiac injury through impeding apoptosis and inflammation regulated by miR-29a.

Integrating usability and social cognitive theories with the technology acceptance model to understand young users' acceptance of a health information portal.

The past decade has seen the proliferation of health information portals; however, consumer acceptance of the portals has proven difficult and rate of use has been limited. This study developed a consumer acceptance model by integrating usability and social cognitive theories with the technology acceptance model to explain young Internet users' acceptance of health information portals. Participants (n = 201) completed a self-report questionnaire measuring model constructs after attending a usability testing with a typical health information portal. Results showed that the hypothesized model accounted for 56 percent of the variance in behavioral intention to use the portal and explained consumer acceptance well. Both subjective usability and application-specific self-efficacy served as significant antecedents in the model, while application-specific self-efficacy also moderated the effect of subjective usability on perceived ease of use. The findings can help practitioners with the design and implementation of health information portals and other health informatics applications in support of consumer acceptance.

A 12-week pilot study of acceptance of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension.

This study tested a structural model examining the effects of perceived usefulness, perceived ease of use, attitude, subjective norm, perceived behavioral control, health consciousness, and application-specific self-efficacy on the acceptance (i.e. behavioral intention and actual usage) of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension. The model was tested using partial least squares structural equation modeling, with 119 observations that were obtained by pooling data across three time points over a 12-week period. The results indicate that all of the seven constructs examined had a significant total effect on behavioral intention and explained 74 percent of the variance. Also, application-specific self-efficacy and behavioral intention had a significant total effect on actual usage and explained 17 percent of the variance. This study demonstrates that technology acceptance is determined by patient characteristics, technology attributes, and social influences. Applying the findings may increase the likelihood of acceptance.

Factors in the 4-week Acceptance of a Computer-Based, Chronic Disease Self-Monitoring System in Patients with Type 2 Diabetes Mellitus and/or Hypertension.

BACKGROUND: Health information technology (HIT) interventions developed to support patients' self-care for chronic diseases have become popular, but people may not always accept and sustain their use. INTRODUCTION: This study examined factors that affected patients' acceptance of a computer-based, chronic disease self-monitoring system over a 4-week period. MATERIALS AND METHODS: A research model was developed to test the relationships between the perceived usefulness, perceived ease of use, attitude, and subjective norm and the patients' behavioral intention to use the system (i.e., acceptance). Data were collected with surveys of 42 patients with type 2 diabetes mellitus and/or hypertension at baseline, 2 weeks after implementation, and 4 weeks after implementation. Path analysis was used for model testing. RESULTS: Perceived usefulness affected behavioral intention indirectly at 2 weeks and directly at 4 weeks; perceived ease of use affected behavioral intention indirectly at 2 and 4 weeks; attitude directly affected behavioral intention at 2 weeks; and subjective norm affected behavioral intention indirectly at 2 weeks and directly at baseline and at 4 weeks. CONCLUSIONS: Patients' acceptance of HIT is affected by the factors proposed in our research model. It is suggested that healthcare stakeholders consider and address the effects of these factors and their variations over time before implementing HIT.

[Clinical significance of abnormal protein bands in multiple myeloma treated with bortezomib-based induction regimen and autologous stem cell transplantation].

OBJECTIVE: To study the clinical significance of abnormal protein bands (APB) in multiple myeloma (MM) patients treated with bortezomib-based induction regimen and autologous stem cell transplantation (ASCT). METHODS: Sixty-eight MM patients submitted to bortezomib-based induction therapy and ASCT from January 2007 to July 2012 were retrospectively studied. Monoclonal protein was detected by immunofixation electrophoresis (IFE). RESULTS: Of all 68 patients, 33 (48.5%) patients had APB. At the first emergence of an APB, two patients with light chain type achieved CR and before transplantation, and thirty-one patients were after transplantation with median time of 104 (ranged 33-404) days. The median duration of APB appearance was 105 (ranged 35-801) days. Patients who developed APB compared with those without APB, had a significantly higher CR plus very good partial response (VGPR) rates (100.0% vs 85.7%%, P=0.017) and CR rates (87.9% vs 62.9%) (P=0.03). There were no significant differences in gender, age, HGB, ALB, ß2-microglobulin, M protein type, Durie-Salmon and ISS stages, the case number of first line or second line treatment, induction courses of bortezomib-based regimen, and the mode of ASCT. With a median follow-up of 33.4 (ranged 7.0-71.7) months, patients with APB tended to have a longer overall survival (OS) versus non-APB patients, although no significant difference obtained (P＞0.05). Among APB patients, OS was longer in patients whose appearance of APB occurred ＜6 months after transplantation than those ≥ 6 months, but the significant difference was not obtained yet (P＞0.05). CONCLUSIONS: Patients who developed APB had a significantly better response to bortezomib-based induction regimen followed ASCT. APB emergence has a good prognostic significance.