Reimbursement Incentives to Improve Adherence to Follow-Up of Cervical Cancer Cytology Screening Results in Peru.

OBJECTIVE: The purpose of this study was to determine Peruvian women's attitudes toward novel reimbursement incentives used to improve adherence to obtaining cervical cytology test results. MATERIALS AND METHODS: Women presenting for cervical cancer screening in Peru completed a 34-item Investigational Review Board-approved questionnaire. The questionnaire determined their attitudes toward various reimbursement incentives to improve adherence to obtaining cervical cytology results. Descriptive statistics, generalized linear models, and Kruskal-Wallis tests were used in the analyses. RESULTS: Completed questionnaires were available for 997 women. Most women (51%) would be more likely to return for their Pap result if an incentive was provided, 79% (759/956) agreed that they would pay for the Pap test, and 51% (402/859) would be willing to pay 10 Soles or less. Quechua-speaking women considered follow-up more difficult (p < .0001) but were less likely to return for their Pap results (p < .0001), pay for the Pap test (p < .0001), and afford paying more than 5 Soles (p < .0001) than women who spoke Spanish or both languages. More women who earn 1000 Soles/year or less would likely return if incentivized (p < .0001), felt the incentive would help them remember to return (p = .0047), and would be willing to pay whether there was a rebate (p = .010) as compared with women earning more money. CONCLUSIONS: A reimbursement incentive program designed to improve follow-up of cervical cytology test results was acceptable to most Peruvian women. Such a behavioral-modifying program may improve patient follow-up after cervical cytology testing. Implementation may reduce the morbidity and mortality of cervical cancer in remote regions of the country.

Neuronal injury in the motor cortex after chronic stroke and lower limb motor impairment: a voxel-based lesion symptom mapping study.

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuronal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults.

BACKGROUND AND PURPOSE: Walking speed is associated with several health-related outcomes. Research examining how differences in test walking distance affect walking speed reliability and validity is limited. The primary purpose of this study was to examine the reliability and concurrent validity of gait speed measurements obtained from a 4-Meter Walk Test compared with the commonly used 10-Meter Walk Test. A second objective was to similarly examine 2 different timing methods: stopwatch and automatic timers. METHODS: Forty-three healthy, older adults (mean age = 84.3 ± 6.9 years) performed 3 consecutive walking trials on the 4- and 10-Meter Walk Tests at their self-selected walking speed. RESULTS: Gait speed measurements for both tests were shown to have excellent test-retest reliability (ICC values of 0.96-0.98), with similar results for stopwatch and automatic timer assessments (ICC values of 0.99-1.00). Standard error of the measurement (SEM) values were small (0.004-0.008 m/s) across measurement methods. While the ICC value for gait speed measurements between the 2 walk tests was 0.93, the Bland-Altman analysis revealed a discrepancy of ±0.15 to ±0.17 m/s between measurement methods. DISCUSSION: Both 4- and 10-m gait speed assessments had excellent test-retest reliability with similar SEM and minimal detectable change values. There was little difference in SEM values between the 2 timing methods. While the mean difference in gait speed between the 4- and 10-Meter Walk Tests was small, the range of the measurement differences was large enough to potentially mask meaningful changes in gait speed over time if both methods were used interchangeably. CONCLUSIONS: While the reliability of both walking tests is excellent, the 4-Meter Walk Test does not exhibit a high enough degree of concurrent validity with the 10-Meter Walk Test to be used interchangeably for gait speed assessments in healthy, older adults. We therefore recommend using the 10-Meter Walk Test to obtain the most valid clinical assessment of walking speed when using it as a 1-time indicator of health status.

Geriatricians' interest to learn bedside portable ultrasound (GEBUS) for application in the clinical practice and in education.

BACKGROUND: Technological advances have allowed ultrasound machines to become portable, pocket-size aids to diagnosis and clinical examination. As technology becomes more available, physicians are challenged to educate themselves and new generations of health providers in the usage of bedside portable ultrasonography. OBJECTIVES/DESIGN: The aim of this study was to survey a representative sample of geriatricians in South Carolina to evaluate their current knowledge about the use of ultrasound machines in the primary care of the elderly, to determine their willingness to adopt the technology and willingness to educate physicians and medical students, and to identify hurdles for the implementation in the clinical and educational environment. PARTICIPANTS: Fourteen physicians and geriatricians participated in the survey. SETTING: Outpatient geriatric practice, Program of All-inclusive Care for the Elderly, inpatient geriatric practice, home-based care, Veterans Affairs hospital program. SURVEY: A 22-item survey regarding geriatric bedside ultrasound (GEBUS) in the clinical setting and in education. RESULTS: Most physicians (92.8%) had heard of GEBUS performed by primary care physicians, and 21.4% had previous formal training. That same percentage also had some training in interpreting ultrasound. Only one physician felt comfortable using the machine and none felt ready to instruct other medical staff and students. Most of the participating group of physicians (71%-85%) expressed an interest in learning this new skill to apply in clinic, research, and medical education. Challenges for wide implementation were identified. CONCLUSIONS: GEBUS is a technology that is now available to the practitioner. Participating geriatricians are ready to embrace this technology in clinical practice and in medical education. Challenges to current implementation include cost, training, liability, credentialing, and lack of reimbursement.