The #PalliativeCare Conversation on Twitter: An Analysis of Trends, Content, and Caregiver Perspectives.

CONTEXT: Palliative care is known to improve patients' quality of life, but oftentimes these conversations occur outside of the health-care setting. OBJECTIVES: To characterize the #PalliativeCare Twitter network and evaluate the caregiver experience within palliative care. METHODS: In this cross-sectional study, a total of 182,661 #PalliativeCare tweets by 26,837 users from June 1, 2015 to June 1, 2019 were analyzed using Symplur Signals. Analysis included activity metrics, content analysis, user characteristics, engagement, and network analysis. Similar metrics were performed on tweets by self-identified caregivers (482), who wrote a total of 3952 tweets. Qualitative analysis was completed on a systematic sample of caregiver tweets. RESULTS: The number of #PalliativeCare tweets, users, and impressions has increased by an annual average of 18.7%, 16.4%, and 32.5%, respectively. Support, access, and patients were among the Trending Terms. About 39.4% of Trending Articles were scientifically valid, and information about palliative care and comorbidities had the greatest number of articles. The majority of users wrote five or less #PalliativeCare tweets. Network analysis revealed central hubs to be palliative care advocacy organizations and physicians. The five main themes from qualitative analysis of caregiver tweets were 1) advocacy and events, 2) care strategies, 3) resources, 4) public health issues, and 5) myths related to palliative care. CONCLUSION: The use of Twitter as a platform for palliative care conversations is growing rapidly. Twitter serves as a platform to facilitate #PalliativeCare conversation among patients, caregivers, physicians, and other healthcare providers.

Evaluating Medication Habits in Medical Mission Patients: A Cross-Sectional Study.

Background Short-term medical missions (STMMs) are a highly debated and largely understudied form of international volunteer work. With growing dedication to health care abroad, research evaluating their impact is crucial to ensure continued interventions are effective in improving medical care. STMM care varies in length, frequency, size, location, services offered, and country of origin and destination. This makes systematic evaluation of STMMs difficult. In addition, the transient nature of patient visits makes trending STMM's impact on long-term health outcomes complex. Despite intermittent availability, primary care missions offering pharmaceutical supplies have the unique opportunity to provide continued care to the community via free prescription supplies each visit. Given the challenges with measuring long-term outcomes in this population, it is unknown if these donated medications have any impact on patient health outcomes. As medication noncompliance is known to hinder health outcomes, our study chose to evaluate patient medication habits to see if these prescription supplies were being utilized appropriately. To our knowledge, no study has surveyed medical mission patients to explore their access and utilization of medication. Methods A cross-sectional study was conducted using a patient survey to identify risks and/or factors associated with medication noncompliance in patients visiting the medical mission, Waves of Health (WOH). For over 10 years, WOH has organized biannual seven-day trips to the Dominican Republic. The multi-question survey was translated into the native language, Spanish with Dominican dialect. Noncompliance was defined through the survey question "Did you run out of your prescription medication at all during the past year?" Spanish speaking participants, of both sexes and age ≥18 years old, who visited the mission clinic in November 2019 met inclusion for this study. Patients from Haiti or age <18 years old were excluded. Participation was voluntary. Survey items were dichotomized for univariate analysis to identify factors associated with running out of medication. To explore predictors of running out of medicine, we performed multivariate logistic regression analysis by ENTER method.  Results Of 127 patients, over half (58.3% [74]) reported running out of medication. Inadequate access to healthcare, daily medication use, and rationing personal medications were all significantly associated with running out of medicine. Frequency of WOH visits was not associated with running out of medication. Multivariate regression showed that being on daily medication and rationing personal medications were statistically significant predictors of running out of medicines. Access to healthcare, frequency of WOH visits, and WOH medication supply were not predictors of running out of medication. Conclusion  Mission interventions to improve medication practices should be explored due to the high number of patients who reported improper utilization of medication. In order to improve health outcomes in primary care settings, patients must play an active role in their care and understand the importance of taking their medication as prescribed for optimal disease management. Primary care STMMs may relieve short-term health concerns, but without proper utilization of chronic disease medications, it is unclear if STMMs role is impactful in long-term health outcomes.

48-Hour Hospice Home Immersion Encourages Osteopathic Medical Students to Broaden Their Views on Dying and Death.

To augment learning about interprofessional palliative and end-of-life care, the University of New England College of Osteopathic Medicine immersed 2 second-year osteopathic medical students in an 18-bed acute care hospice home in Scarborough, Maine, for 48 hours. The students worked with an interprofessional staff and independently to provide patient care, family support, and postmortem care. For data collection, students wrote in journals before the immersion experience (prefieldwork), while living in the hospice home (fieldwork), and for 10 days following the immersion experience (postfieldwork). The students recorded their subjective and objective reporting of observations, experiences, feelings, and patient/family encounters. Data analyses included a review of the journals, identifying thematic categorizations, and coding through content analysis. Three themes identified in the students' journals reflected shared experiences: (1) shifting perspectives, (2) path to family acceptance, and (3) emotional journey. The students learned how to converse with patients and families about end-of-life care while ensuring attainment of patients' goals. They also learned about the importance of helping patients enjoy life's simple pleasures like taking them outside to enjoy the sunshine, and they learned to trust themselves when handling emotional and difficult situations. Each student gained confidence in her ability to help guide patients through this stage of life.

Mobile health applications for atrial fibrillation: A readability and quality assessment.

BACKGROUND: Mobile health applications may improve patient education and self-care for a complex condition such as atrial fibrillation (AF). Little is known about the accessibility of mobile health applications ("apps") and their readability. We evaluated the readability and quality of available apps for AF. METHODS: We searched the Apple and Google Play app stores with the terms "atrial fibrillation" and "afib." We downloaded English-language apps (up to n = 100 for each term) and categorized them by name, App store, cost, content, uploading agency (heath care associated [HCA] versus non-HCA), target audience (health care professional [HCP] versus non-HCP), scientific validity (i.e., citation of peer-reviewed or validated medical information), and user ratings. We analyzed the text of apps intended for a non-HCP target audience for readability with 10 established measures. RESULTS: Of the 206 downloaded apps, 50.5% were excluded as unrelated to AF, inaccessible, or non-English language. The majority of apps contained information about AF (63.2% Apple, 52.2% Google Play) and AF detection (52.6% Apple, 56.5% Google Play). A minority of non-HCP apps contained scientifically validated content (Apple, 15.8%; Google Play, 13.0%; P = NS). App mean readability was grade 12.1 ±â€¯2.6. CONCLUSIONS: Most AF apps lacked scientific validation and were written at excessively high reading-grade levels. Our results suggest caution with mobile health apps, particularly for users with limited health literacy. There is potential opportunity for a multi-disciplinary effort by regulatory agencies, healthcare organizations, and app stores to improve relevance, scientific validity, and readability of AF apps for patients with this complex and morbid disease.

A New Test for the Detection of Direct Oral Anticoagulants (Rivaroxaban and Apixaban) in the Emergency Room Setting.

Determining whether a patient has taken a direct oral anticoagulant (DOAC) is critical during the periprocedural and preoperative period in the emergency department. However, the inaccessibility of complete medical records, along with the generally inconsistent sensitivity of conventional coagulation tests to these drugs, complicates clinical decision making and puts patients at risk of uncontrollable bleeding. In this study, we evaluate the utility of inhibitor-II-X (i-II-X), a novel, microfluidics-based diagnostic assay for the detection and identification of Factor Xa inhibitors (FXa-Is) in an acute care setting. DESIGN: First-in-human, 91-patient, single-center retrospective pilot study. SETTING: Emergency room. PATIENTS: Adult patients admitted into the emergency department, which received any clinician-ordered coagulation test requiring a 3.2% buffered sodium citrate blood collection tube. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Plasma samples from patients admitted to the emergency department were screened for the use of FXa-Is, including apixaban and rivaroxaban, within the past 24 hours using our new i-II-X microfluidic test. i-II-X results were then compared with results from conventional coagulation tests, including prothrombin time (PT) and international normalized ratio (INR), which were ordered by treating clinicians, and an anti-Xa assay for rivaroxaban. The i-II-X test detected DOACs in samples collected from the emergency department with 95.20% sensitivity and 100.00% specificity. Unlike PT and INR, i-II-X reliably identified patients who had prolonged clotting times secondary to the presence of a FXa-I. CONCLUSIONS: The i-II-X test overcomes the limitations of currently available coagulation tests and could be a useful tool by which to routinely screen patients for DOACs in emergency and critical care settings. Our new diagnostic approach is particularly relevant in clinical situations where medical records may be unavailable, or where precautions need to be taken prior to invasive interventions, such as specific reversal agent administration.