The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas.

The increased prevalence, morbidity, mortality, and health costs associated with asthma among children suggest the need for accessible asthma education. This study examined the effect of telepharmacy counseling, using interactive compressed video, on metered-dose inhaler (MDI) technique and patient satisfaction among adolescents with asthma in rural Arkansas. The telepharmacy counseling provided accessible education regarding MDI technique for adolescents in this study. Twenty percent of the adolescents who participated had never been shown the appropriate use of an MDI. The study used an experimental design with random assignment of participants to a telepharmacy counseling group (n = 15) or a control group (n = 21). Both groups participated in pre-test, post-test, and 2- to 4-week follow-up assessments for MDI technique and patients satisfaction (follow-up assessment only) via interactive compressed video. Results indicated that from pre-test to follow-up the telepharmacy counseling group showed more improvement in MDI technique than participants in the control group (p < 0.001). There was no significant difference between the telepharmacy counseling group and control group in satisfaction with the instructional sessions (p = 0.132). Both groups had high levels of satisfaction with the telepharmacy sessions. The study findings demonstrated that patient education provided by pharmacists via interactive compressed video was superior to education provided via written instructions on an inhaler package insert. Interactive compressed video is an effective medium for teaching and improving MDI technique in this rural, adolescent, predominantly African-American population.

Enamel de/remineralization on teeth adjacent to fluoride releasing materials without dentifrice exposure.

Interproximal caries presents a continual clinical concern. The purpose of this study was to evaluate the ability of fluoride-releasing materials to remineralize incipient caries lesions on adjacent teeth, at the interproximal site with and without exposure to a fluoridated dentifrice. Thirty extracted teeth had Class II preparations placed, then equal numbers were restored with amalgam (Tytin (3-Kerr), glass ionomer (Ketac Fil-ESPE) or composite (Heliomolar-Ivoclar). Thirty additional teeth had 1 x 5 mm artificial caries lesions formed at the interproximal contact point. One hundred mu thick sections were obtained at the caries sites and polarized photomicrographs were taken. The sections had varnish placed, leaving only the external section site exposed, and were situated back into the original tooth. These teeth were then mounted with the artificial lesion having an interproximal contact with the adjacent tooth restoration. Specimens were placed in closed environments of artificial saliva for two weeks; the saliva was changed every forty-eight hours. All teeth were cycled through an artificial caries system for thirty minutes, three times per day. Half the specimens in each group were brushed with Crest (Procter and Gamble) for two minutes, twice per day. The same sections were again photographed under polarized light and areas of the lesions were digitized quantitatively. Results demonstrated the mean (+/- S.D.) percent change in lesion size (water imbibition) for each material nonexposed and exposed to fluoridated dentifrice to be: Amalgam -64.1 +/- 22.0, -1.0 +/- 8.5; Glass Ionomer 2.2 +/- 10.6, 14.0 +/- 7.2; Composite -28.1 +/- 11.7, 18.2 +/- 6.7. Negative numbers represent demineralization and positive numbers represent remineralization. Duncan's analysis indicated the nonbrushed fluoride-releasing glass ionomer and composite resin to have significantly greater demineralization inhibition compared to the nonbrushed amalgam group and remineralization enhancement effects on adjacent interproximal lesions (p < 0.05) compared to the brushed amalgam group.

Rural Arkansas physicians and telemedicine technology: attitudes in communities receiving equipment.

OBJECTIVE: To assess physician attitudes toward the usefulness, effectiveness, and expected use of telemedicine, as well as interest in learning about the technology. METHODS: A survey instrument assessing attitudes toward each of the four objective domains was mailed to 46 physicians at six hospitals affiliated with the Rural Hospital Program of the University of Arkansas for Medical Sciences. Binomial probability methods were used to analyze the responses. RESULTS: The survey achieved a response rate of 59% (27/46). Physician responders agreed that telemedicine would be useful in improving patient care quality but would not be useful in improving the financial position of the hospital or in lowering patient-borne costs. Physicians were evenly split on the effectiveness and expected utilization of telemedicine for patient consults. There was significant interest in learning more about telemedicine applications. CONCLUSION: Barriers to utilization of telemedicine by physicians may remain even under a new reimbursement system unless referring physicians are convinced of the benefits to the community as well the clinical effectiveness of the technology.