Branching Logic Research Articles

Development and content validity of the behavioral assessment screening tool (BASTβ)

Purpose: Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTβ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury.Methods: This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BASTβ.Results: The BASTβ initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTβ included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BASTβ had a high Content Validity Index of 89.3%.Conclusion: The BASTβ is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST.Implications for RehabilitationBehavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury.Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term.The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries.The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.

SPORTS PHYSICAL THERAPY CURRICULA IN PHYSICAL THERAPIST PROFESSIONAL DEGREE PROGRAMS

The specialty niche of sports physical therapy has grown at a significant rate over the past 40 years. Despite this growth there is little information or direction from the physical therapy education accreditation body or professional association to guide academic programs on the interest or necessity of this type of practice content in physical therapy professional degree programs. The purpose of this survey study is to report on the prevalence, attitudes, barriers, resources, and faculty expertise in providing required or elective sports physical therapy course work. Cross-sectional descriptive survey. A 57-item questionnaire with branching logic was distributed via a web-based electronic data capture tool to survey all Commission on Accreditation for Physical Therapy Education (CAPTE) accredited and candidate schools in the United States. Response data was analyzed to describe typical educational program profiles, faculty demographics, and correlational factors consistent with the presence or absence of specific sports physical therapy curricular content. Thirty one percent of the schools responded to the survey and the program demographics were consistent with all currently accredited schools in regards to their geography, Carnegie classification, and faculty and student size. Forty three percent of programs offered a required or elective course distinct to the practice of sports physical therapy. Descriptive information regarding the sequencing, curricular make-up, resources, and assessment of content competence is reported. The odds of providing this content nearly doubles for programs that have faculty with sports clinical specialist credentials, accredited sports residency curriculums, or state practice acts that allow sports venue coverage. This survey provides an initial overview of sports physical therapy educational efforts in professional physical therapy degree programs. The data can used to spur further discussion on the necessity, structure, and implementation of education content that is inherent to a growing specialty practice in the physical therapy profession. 4, Cross-sectional descriptive survey design.

Evidence-Based App for the Evaluation and Treatment of OSA: Development of a Mobile App by Two Medical Residents

SESSION TITLE: Sleep 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Obstructive sleep apnea is a disorder that holds great significance since patients with the disorder are at an increased risk for a broad range of cardiovascular morbidities including systemic hypertension, pulmonary arterial hypertension, coronary artery disease, cardiac arrhythmias, heart failure, and stroke. American Academy of Sleep Medicine (AASM) developed a number of evidence-based peer-reviewed guidelines for the evaluation and management of OSA in adults. However, practical utilization of the guidelines has been a challenge due to the complexity of the algorithms. To increase access and engagement with the guidelines, we created a native smartphone application that allows users to interact with the algorithms in a more engaging manner. METHODS: We converted the peer-reviewed guidelines into multiple interactive diagrams featured on a native smartphone app. The users are provided with diagnoses and treatment options based on the choices that they make. At the point of care, it can be overwhelming and time-consuming for the users to navigate through the entire treatment algorithm themselves. Therefore, we designed the app in a way to help users navigate into relevant questions that are generated by using the conditional branching logic. (e.g. the questions regarding high-risk comorbidities will be asked only if the patient snores.) We chose the Apple operating system (iOS) platform and used XCODE8 as the software development tool. The app design is consistent with the iOS Human Interface Guideline (Apple Inc, 2015). We have distributed the app to sleep specialists and medical residents at Englewood Hospital and Medical Center and collected their feedback in order to further improve the app. RESULTS: Early feedback has been positive so far. We are planning to receive a more systematically designed feedback regarding the usability and satisfaction from our users by the time we present our posters at the CHEST Annual Meeting. We will also offer live demonstrations of the app during the poster session and help users access and download the app for free of charge. Of note, the app is non-commercial and designed to be a free tool for everyone to access and use. CONCLUSIONS: We converted the peer-reviewed, evidence based guidelines for OSA into an interactive mobile application. CLINICAL IMPLICATIONS: As physicians are beginning to rely more on digital resources such as mobile apps for decision making, it is also increasingly important that high quality, evidence based, and peer reviewed materials are available in a mobile app format. By extending The AASM OSA Guidelines into a practical user-friendly app, we hope to inspire others to come up with useful practical tools for patient care. DISCLOSURE: The following authors have nothing to disclose: Joongheum Park, Hwan Kim No Product/Research Disclosure Information

The effect of Using Buxton in the achievement of the scientific branch students fourth class and logic Intelligence

The aim of this study is to identify the effect of Using Buxton - logic Intelligence and fourth class in physics find determined by fourth grade students the average of the province of Baghdad for the academic year 2015- 2016 , the four chapters of the first semester of physics textbook for Grade Average Total sample (62) female students in the secondgrade as(31) studentsfor the experimental group and (31) for the control group. the researcher formulated (125) behavioral objectives within the levels (remembering.understanding .application .analysis.) according to blooms classification of the cognitive field . the researcher adopted an achievement test made from (40) items the type the multiple choice. She also prepared test of motivation toward physics logic Intelligence stage made up of (35) andfor the purpose of verifying the equivalence of research groups have been ,( the previous –information , age in monthes , intellingence ,testreflective – logic Intelligence) the use of study f Using Buxton in the achievement of the scientific branch students fourth class and logic Intelligence

Seeing the Future: Predicting a Patient’s Need for Shoulder Surgery before the First Encounter

Objectives:The aim of this study was to determine the likelihood of shoulder surgery based on a pre-visit branching questionnaire implemented prospectively at the time of initial visit scheduling.Methods:Patients calling a large regional sports health institution with shoulder complaints between Jan 2015 and June 2016 were asked a series of questions according to a branching logic algorithm at the time of initial appointment scheduling (Fig. 1). All patients had appointments scheduled regardless of their responses. In July 2016, a retrospective chart review was conducted to determine which patients were recommended for shoulder surgery. Multivariate regression models were constructed to determine the combination of questions that were asked, or could be asked, that would lead to the highest and most accurate predictive value of recommended surgery. Patient records were excluded if the patients were younger than 13 or over 75, if the appointment was cancelled or scheduled after April 2015, and if the treatment was not yet determined at the time of chart review.Results:After chart review of included patients, 760 records were available for analysis. The multivariate regression model that best matched the data and produced the highest predictive value for surgery had a concordance index of 0.688, representing the rate at which the model correctly assigned a higher surgical risk to patients that were ultimately recommended for surgery against those who were not. Significant variables in this model were if a previous provider ordered an MRI for the patient, injury status, and patient sex. The odds ratios for a patient requiring surgery based on their status in those areas are shown in Table 1. Having an MRI ordered by a previous provider (OR=4.45) and male sex (OR=1.6) were both positive predictors of needing surgery. Indication of injury with a primary complaint of weakness or instability carried the strongest predictive effect of surgery. (OR=1, reference) The odds of surgery decreased if the patient’s primary complaint was pain or if the patient followed the answer pathway: Pain—Not Crushing Pain—Injury—No ER Visit—No Pain Raising Arm. The model can predict between a 7.5% and 95% chance of needing surgery (20% of the population required surgery). A nomogram was constructed from the model such that a patient’s response to each question correlated to a point value, and the total of those points correlated to a probability of needing surgery.Conclusion:Based on patient’s response to the questionnaire, we have constructed a model that can both quickly and easily estimate the probability that the patient will require surgery. Our model can predict up to a 95% likelihood of needing surgery and down to a 7.5% likelihood of needing surgery. We believe that this information can guide and improve future scheduling practices and will help patients see the appropriate provider sooner, reduce cost, and improve patient and physician satisfaction.Table 1.Odds Ratios, ModelPoints, and SurgicalRiskfor Predictive Model including Sex, MRI status, and Injury statusFactor/VariableOdds Ratio95% CI on Odds Ratiop-valuePoints from affirmative responseSurgical Risk Intercept ––0.733N/A MRI ordered by other provider 4.45(2.79, 7.10)<0.00153 Male (vs. Female) 1.6(1.05, 2.49)0.03117 Indicated Injury Indicated Injury on Weakness or Instability Branch1RefRef100Indicated injury on AP: Pain—Not Crushing Pain—Injury (excluding the AP below)0.167(0.033, 0.659)0.01636Did not encounter an injury question0.129(0.0243, 0.544)0.00827Indicated no injury0.0797(0.0161, 0.308)<0.00110Indicated injury on AP: Pain—Not Crushing Pain—Injury—No ER Visit—No Pain Raising Aim0.0603(0.011, 0.264)<0.0010 TotalPoints 20.075420.2910.51410.81960.95

Routine physical function assessment through a Branching Logic Electronic Symptom Survey (BLESS) vs. the 32-combined item HAQ-DI + WHODAS (HW) survey: A quality improvement controlled trial.

136 Background: Routine outpatient physical function assessment can improve quality of care by prioritizing supports for specific patients. However, conventional research surveys including the 32-combined item HAQ-DI + WHODAS (HW) may be burdensome to patients. To streamline this process, we have developed BLESS, an electronic patient reported outcomes software program that utilizes PRO-ECOG and EQ-5D-3L items to screen for physical dysfunction symptoms, with follow-up questions from HW; BLESS has been demonstrated to have high sensitivity and specificity for the complete HW survey. We compared completion times and patient acceptability of BLESS vs. HW. Methods: Adult oncology outpatients of all stages at Princess Margaret Cancer Centre were allocated prospectively and alternately to receive either BLESS or HW on touchscreen tablets. Completion times were recorded and a patient acceptability survey was administered. Results: Of 225 patients analyzed from breast (19%), GI (22%), GU (12%), gynecology (16%), head/neck (12%), skin (6%) and thoracic (13%) cancer clinics, 118 (52%) patients completed BLESS and 107 (47%) completed HW. Median age was 61 (range: 18-97) years; 60% were female, 68% were Caucasian, 44% were stage IV, and 57% were treated with a curative intent. There were no statistically significant differences in demographic and clinical characteristics between the arms analyzed. Median EQ-5D-3L utility was 0.83 (0.28-1.00), median HAQ-DI was 0.13 (0-3.00) and median WHODAS was 8.3% (0-83.3%). Compared to HW, BLESS resulted in a median completion time reduction of 3.9 minutes (32% decrease; p &lt; 0.001). Although most patients in both arms did not find the survey time-consuming nor caused the clinic visit to be more difficult, a greater proportion of BLESS patients held a stronger conviction in their answers (p = 0.02 for both comparisons). Conclusions: In comparison to traditional research tools of HW for assessing physical function,BLESS was associated with shorter administration times and improved patient acceptability, rendering BLESS more suitable for routine clinical use.

Reducing the burden of patient reporting of physical function in the chronic care of cancer survivors through a branching logic electronic symptom survey (BLESS).

5 Background: A patient’s functional status is a key outcome variable used to both measure and improve quality of care in cancer survivors. However, comprehensive research tools such as the HAQ-DI and WHODAS instruments pose 35 questions altogether, increasing patient reporting burden. We evaluated whether a BLESS could be developed with high sensitivity of screening questions followed by questions relevant to specific physical function domain, through a branching logic algorithm. Methods: Adult cancer clinic outpatients at Princess Margaret Cancer Centre used tablet technology to complete the HAQ-DI, WHODAS, EQ-5D-3L and PRO-ECOG. BLESS was developed as an algorithm that used PRO-ECOG/EQ-5D-3L to screen for appropriate domains of HAQ-DI/WHODAS to query. Sensitivity/specificity of BLESS screeners to HAQ-DI/WHODAS items were reported. BLESS derived physical function scores were also compared to scores generated by the full version of WHODAS/HAQ-DI. Results: Of 407 patients,median age was 62 (range 20-93) years, 51% female, 75% Caucasian, with a median EQ-5D-3L index score of 0.83 (0.31-1.00), and WHODAS of 6.0 (0-37). Of cancer sites, 14% had breast, 11% GI, 11% GU, 18% head/neck, 10% thoracic, 18% hematologic, and 15% gynecologic cancers. 34% were stage III-IV; 72% were treated for curative intent. Using the sum of mobility, self-care, and usual activities dimensions of the EQ-5D-3L to dichotomize patients as with or without difficulty, we found an area under the receiver operating curves that was &gt; 90% when comparing to recommended WHODAS and HAQ cut-offs for significant physical dysfunction. Using BLESS, 38% of our clinic outpatients need answer only 5 questions, generating derived-WHODAS scores with no median difference when compared to reported scores; sensitivity of screeners for each WHODAS/HAQ-DI item ranged from 92-100%. Overall, median number of questions asked was 9. Conclusions: By focusing on relevance, BLESS maintained high sensitivity with a dramatic decrease in question burden compared to traditional research surveys for physical function. BLESS is suitable for use in immediate, routine screening of chronic care outcomes.

The Use of a Novel CME Format to Ellicit and Develop True Competence in Hematologist Ability to Risk Stratify Patients with Hodgkin Lymphoma

Introduction/Background: Novel approaches for the post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation treatment now exist for patients with classical Hodgkin lymphoma (HL) at high risk of relapse or progression. This advancement can potentially reduce the frequency of disease progression following autologous stem cell transplantation (ASCT) for certain patients at high risk. However, before such treatment can be administered, hematologists must appropriatelyrecognize and apply prognostic factors to identify patients at risk who would benefit from such treatment.Materials and Methods: We developed an online CME initiative that aimed to match each leaner with needed education as determined by his/her baseline competency and skill level. This tailored-learning approach used a single case-based screening question to segment the participants based on their knowledge regarding risk stratification of patients with HL. Hematologists who incorrectly answered the screening question were directed to Activity 1 - Interpreting Risk Factors for Post-Transplantation Relapse in Hodgkin Lymphoma (http://www.medscape.org/viewarticle/842624). Those who correctly identified a patient at risk for post-ASCT relapse were directed to Activity 2 - Post-Autologous Transplantation Therapy for Hodgkin Lymphoma (http://www.medscape.org/viewarticle/842640). . Online survey instruments using knowledge- and case-based, multiple-choice questions were administered to compare the same participants' responses to identical questions before and after each activity. McNemar's chi-squared test was used to determine statistical significance between responses. The initiative launched on June 1, 2015 and data collected through October 23, 2015.Results: 1600 hematologists answered the case-based screening question; 74% of hematologists answered incorrectly and were directed to Activity 1, indicating a deficit in understanding which patients would benefit from consolidation treatment in HL. Among hematologists who participated in Activity 1 and completed all pre- and post-assessment questions during the study duration (n=272), comparison of individually linked pre-assessment question responses to the respective post-assessment question responses demonstrates statistically significant improvements in knowledge (P <.05) on appropriate treatments for patients with HL who have received HDT/ASCT, and ways to optimize outcomes for those receiving consolidation/maintenance therapy. Correct responses on post-assessment questions were up to 48% higher after CME completion (compared with the pre-assessment question responses) with an overall medium effect size of d=0.621 [Figure 1]. Among those who were directed to Activity 2 (26% of learners) and completed all pre- and post-assessment questions (n=37), there was 26% increase in recognition that treatment with brentuximab vedotin consistently improved progression-free survival across all prespecified subgroups [Figure 2].Conclusions: This study demonstrated the success in using online branching logic to segment the participants based on a screening question to identify presence or absence of a specific knowledge gap in hematologist learners. Participation in this initiative led to the identification of large group of learners who benefited from segmented learning. Recognizing that individual hematologists are at various stages of understanding of best practices in managing HL, this approach may be used to maximize translation of evidence-based recommendations into clinical decisions. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Development of a Mobile Tool That Semiautomatically Screens Patients for Stroke Clinical Trials.

Despite several national coordinated research networks, enrollment in many cerebrovascular trials remains challenging. An electronic tool was needed that would improve the efficiency and efficacy of screening for multiple simultaneous acute clinical stroke trials by automating the evaluation of inclusion and exclusion criteria, improving screening procedures and streamlining the communication process between the stroke research coordinators and the stroke clinicians. A multidisciplinary group consisting of physicians, study coordinators, and biostatisticians designed and developed an electronic clinical trial screening tool on a HIPAA (Health Insurance Portability and Accountability Act)-compliant platform. A web-based tool was developed that uses branch logic to determine eligibility for simultaneously enrolling clinical trials and automatically notifies the study coordinator teams about eligible patients. After 12 weeks of use, 225 surveys were completed, and 51 patients were enrolled in acute stroke clinical trials. Compared with the 12 weeks before implementation of the tool, there was an increase in enrollment from 16.5% of patients screened to 23.4% of patients screened (P<0.05). Clinicians and coordinators reported increased satisfaction with the process and improved ease of screening. We created a semiautomated electronic screening tool that uses branch logic to screen patients for stroke clinical trials. The tool has improved efficiency and efficacy of screening, and it could be adapted for use at other sites and in other medical fields.

Overt hepatic encephalopathy: development of a novel clinician reported outcome tool and electronic caregiver diary.

Clinical management and clinical trials of patients with overt hepatic encephalopathy (OHE) are compromised by lack of standardized and reproducible tools for its clinical diagnosis or for caregiver (CG) identification of OHE manifestations which merit medical evaluation. Using an iterative Delphi method, Steering Committee and international hepatologist panel, the West Haven (WH) scale was modified to develop and operationalize a clinician tool for OHE identification and grading (HE Grading Instrument, HEGI™). Major diagnostic criteria included disorientation to time, place, and person, asterixis, lethargy, and coma. Minimum HEGI requirements for OHE diagnosis included: (1) disorientation, or (2) presence of both lethargy and asterixis, or (3) coma. Inter- and intra-rater HEGI reproducibility were 97% and 98%, respectively. When applied to a phase II clinical trial population of 178 patients with 388 OHE episodes, HEGI demonstrated excellent concordance with investigator judgement. Additionally, a multi-stage study was conducted to develop a daily CG e-diary, based on OHE manifestations recognizable by CG including speech difficulties, unusual behavior, forgetfulness, confusion, disorientation and level of consciousness. The e-diary was designed for use on smart phone, laptop or desktop, utilized branching logic and skip patterns, incorporated automatic daily completion reminders and real time alerts to clinical sites to facilitate daily standardized CG input and was found to be user friendly and understandable. The HEGI and e-diary, which were developed using methodology accepted by regulatory authorities, are designed to facilitate the design and interpretation of clinical trials for OHE and improve outcomes for OHE patients in clinical practice.

Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey

V IEW F ROM THE A SSOCIATION OF P EDIATRIC P ROGRAM D IRECTORS Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey Geoffrey M. Fleming, MD; Michael M. Brook, MD; Bruce E. Herman, MD; Chris Kennedy, MD, PhD; Kathleen A. McGann, MD; Katherine E. Mason, MD; Pnina Weiss, MD; Angela L. Myers, MD, MPH From the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Fleming); University of California San Francisco, San Francisco, Calif (Dr Brook); Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah (Dr Herman); Children’s Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Mo (Drs Kennedy and Myers); Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr McGann); Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio (Dr Mason); and Department of Pediatrics, Yale University, New Haven, Conn (Dr Weiss) The authors declare that they have no conflict of interest. Address correspondence to Geoffrey M. Fleming, MD, Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, 5112 DOT, 2200 Children’s Way, Nashville, TN 37232 (e-mail: geoffrey.fleming@vanderbilt.edu). A CADEMIC P EDIATRICS 2016;16:415–418 core program requirements: “The program director must devote a minimum of 0.5 FTE regardless of the size of the program.” 14 Core pediatric residency programs have recommendations for additional effort support in a graded increase on the basis of the size of the program and includes PDs, associate PDs, residency coordinators, and liaisons. Currently the “ACGME Program Requirements for Graduate Medical Education in the Subspecialties of Pediatrics” do not delineate any specific required time allotment for fellowship PDs but requires “sufficient pro- tected time.” 2 The goal of this study was to describe current time allotted for PDs in pediatric subspecialty fellowship training programs and to delineate the minimum time required for program administration to meet the regula- tions outlined by the ACGME. P EDIATRIC FELLOWSHIP TRAINING programs are the primary source of subspecialty practitioners who care for our nation’s children. There are 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited pe- diatric subspecialties made up of 837 individual training programs that graduated over 8500 trainees from 2004 to 2013 in addition to those who graduated from combined board specialty programs that include a pediatric training component. 1 Explicit in the requirements for graduate medical education (GME) accreditation is the key role of the program director (PD), who is responsible for over- seeing all educational activities, assessing all trainee and faculty performance, maintaining and distributing all pro- gram policies and procedures, directing programmatic evaluation and process improvement, and monitoring compliance with all ACGME regulations. 2 Prior study has identified inadequate PD time as a barrier to complying with ACGME requirements in the nonpediatric subspe- cialties. 3 Dedicated administrative time has been identified as necessary for innovation and curricular design, and has been linked to ongoing accreditation by the ACGME. 4–12 The ACGME program requirements for core residency programs and many nonpediatric subspecialties now delin- eate program administration time requirements for PDs, associate PDs, and other support staff. The time allotted differs by specialty and varies in specification from hours per week to a percentage of total effort. 13 Current require- ments set forth by the ACGME range from 10% to 50% full-time equivalent (FTE) staff for the core medical and surgical specialties and for many of the subspecialty fel- lowships accredited by the American Board of Medical Specialties. For core pediatric residency programs, support of administrative efforts are specifically delineated in the A CADEMIC P EDIATRICS Copyright a 2016 by Academic Pediatric Association M ETHODS The study was conducted in 2 phases through the use of an anonymous national survey of fellowship PDs. An initial survey was created by the author group using a modified Delphi technique through 5 iterations and con- sisted of 23 items, including demographic data, definition of an FTE in the respondent’s institution, time allotted to administer the program, and the time needed by the respondent to administer their program. The survey was created in REDCap hosted by Vanderbilt University Med- ical Center. 15 This survey was distributed from August 20, 2013, to October 16, 2013, using the Association of Pediatric Program Directors (APPD) Fellowship Program Director (FPD) e-mail list. As a result of an initial low response rate, these data were considered pilot data. Volume 16, Number 5 July 2016

Building a scalable mobile library orientation activity with Edventure Builder

Purpose – The purpose of this paper is to discuss the technical aspects of using the Edventure Builder platform to create UC San Diego’s scalable, interactive, online library orientation activity, which was designed for the university’s new First Year Experience program. Design/methodology/approach – This paper examines a case study using a successive approximation model for the build process of a mobile library scavenger hunt. Findings – The Edventure Builder software is intuitive, scalable and provides a variety of options to users, including flexibility in question format, a WYSIWYG interface, and branching logic. The main limitation is that analytics is still in beta testing and users must request that data be sent in an Excel spreadsheet via e-mail. Originality/value – This paper is of interest to information professionals who would like to create a mobile library orientation activity using the Edventure Builder platform.

Development of the TabacoQuest app for computerization of data collection on smoking in psychiatric nursing.

ABSTRACTObjective: to develop a mobile app for research on the use of tobacco among psychiatric patients and the general population. Method: applied research with the technological development of an app for data collection on an Android tablet. For its development, we considered three criteria: data security, benefits for participants and optimization of the time of researchers. We performed tests with twenty fictitious participants and a final test with six pilots. Results: the app collects data, stores them in the database of the tablet and export then to an Excel spreadsheet. Resources: calculator, stopwatch, offline operation, branching logic, field validation and automatic tabulation. Conclusion: the app prevents human error, increases the quality of the data by validating them during the interview, allows the performing of automatic tabulation and makes the interviews less tiring. Its success may encourage the use of this and other computational resources by nurses as a research tool.

Mobile application of cognitive behavioral therapy for anxiety and advanced cancer.

220 Background: We previously demonstrated the efficacy of a brief, in-person cognitive behavioral therapy (CBT) program for alleviating anxiety in patients with advanced cancer. The aim of the current study was to adapt this program to an interactive, patient-centered mobile tablet application (CBT app) for self-delivery, ideally to enhance dissemination and patient access to the CBT intervention. Methods: Development of the CBT app proceeded in two phases. First, we enrolled five patients with advanced cancer and anxiety (HADS-Anxiety subscale score ≥ 8) to review a preliminary CBT app prototype and to provide qualitative feedback regarding intervention acceptability and utility. Using content analysis of the recorded data, we identified key themes in patient feedback and refined the CBT app content and design accordingly. Finally, a multidisciplinary team of clinical researchers (n=7) specializing in healthcare technology, psychiatry, and psychology conducted an extensive iterative review process to vet and finalize the CBT app intervention. Results: Patients reported that the CBT app content was comprehensible, easily navigated, and helpful in addressing a breadth of concerns relevant to patients with anxiety and advanced cancer. Specifically, patients reported that case examples, tailored feedback, accessible interactive features, and content summaries were important for engagement with the program. The multidisciplinary study team used patient feedback to adapt the CBT app prototype to a tablet design consisting of six modules that teach skills for practicing relaxation, staying present-focused, coping with fears related to cancer, and pacing activities. To enhance patient engagement, features also included homework assignments, symptom distress tracking, and tailored algorithms and branching logic based on patient responses. Conclusions: Patient interviews confirmed acceptability of the CBT app content. Expert clinician feedback also supported the tablet design for self-administration of the intervention to reduce patient burden. We are currently conducting a randomized controlled trial to assess the efficacy of the CBT app for improving anxiety symptoms in patients with advanced cancer. Clinical trial information: NCT02286466.

Innovating to enhance clinical data management using non-commercial and open source solutions across a multi-center network supporting inpatient pediatric care and research in Kenya.

Objective To share approaches and innovations adopted to deliver a relatively inexpensive clinical data management (CDM) framework within a low-income setting that aims to deliver quality pediatric data useful for supporting research, strengthening the information culture and informing improvement efforts in local clinical practice. Materials and methods The authors implemented a CDM framework to support a Clinical Information Network (CIN) using Research Electronic Data Capture (REDCap), a noncommercial software solution designed for rapid development and deployment of electronic data capture tools. It was used for collection of standardized data from case records of multiple hospitals’ pediatric wards. R, an open-source statistical language, was used for data quality enhancement, analysis, and report generation for the hospitals. Results In the first year of CIN, the authors have developed innovative solutions to support the implementation of a secure, rapid pediatric data collection system spanning 14 hospital sites with stringent data quality checks. Data have been collated on over 37 000 admission episodes, with considerable improvement in clinical documentation of admissions observed. Using meta-programming techniques in R, coupled with branching logic, randomization, data lookup, and Application Programming Interface (API) features offered by REDCap, CDM tasks were configured and automated to ensure quality data was delivered for clinical improvement and research use. Conclusion A low-cost clinically focused but geographically dispersed quality CDM (Clinical Data Management) in a long-term, multi-site, and real world context can be achieved and sustained and challenges can be overcome through thoughtful design and implementation of open-source tools for handling data and supporting research.

Nonconvulsive seizures and status epilepticus in pediatric head trauma: A national survey.

Objectives:It remains uncertain whether nonconvulsive seizures and nonconvulsive status epilepticus in pediatric traumatic brain injury are deleterious to the brain and/or impact the recovery from injury. Consequently, optimal electroencephalographic surveillance and management is unknown. We aimed to determine specialists’ opinion regarding the detection and treatment of nonconvulsive seizures or nonconvulsive status epilepticus in pediatric traumatic brain injury, regardless of their practice.Methods:In 2012, 183 surveys were sent to all 93 neurologists, 27 neurosurgeons, and 63 intensivists in the14 tertiary pediatric hospitals across Canada. The survey included an initial scenario of pediatric TBI that evolved into three further scenarios. Each scenario had required responses and an embedded branching logic algorithm ascertaining clinical management. The survey instrument assimilated data about the importance of nonconvulsive status epilepticus and nonconvulsive seizures detection and treatment, and whether they are a cause of brain injury that adversely affects neurologic outcomes.Results:Of the 79 specialists who replied (43% response rate), 68%–78% elected to order an electroencephalographic across all four scenarios, and one-third (31%–36%; scenario dependent) would request an urgent electroencephalographic (within the hour) in the comatose pediatric traumatic brain injury patient. In the absence of pharmacologic paralysis or intracranial pressure spikes, half-hour electroencephalographic (41%–55%) was preferred over ⩾24-h continuous electroencephalographic monitoring (29%–40%). Finally, nonconvulsive status epilepticus (81%–87%) and nonconvulsive seizures (61%–73%) were considered to be a cause of poor neurologic outcomes warranting aggressive pharmacologic management.Conclusion:The Canadian specialists’ opinion is that nonconvulsive seizures and nonconvulsive status epilepticus are biomarkers of brain injury and contribute to worsened outcomes. This suggests the urgency of future outcome-oriented research in the identification and management of nonconvulsive seizures or nonconvulsive status epilepticus.

Impact of a health information exchange on resource use and Medicare-allowable reimbursements at 11 emergency departments in a midsized city.

IntroductionUse clinician perceptions to estimate the impact of a health information exchange (HIE) on emergency department (ED) care at four major hospital systems (HS) within a region. Use survey data provided by ED clinicians to estimate reduction in Medicare-allowable reimbursements (MARs) resulting from use of an HIE.MethodsWe conducted the study during a one-year period beginning in February 2012. Study sites included eleven EDs operated by four major HS in the region of a mid-sized Southeastern city, including one academic ED, five community hospital EDs, four free-standing EDs and 1 ED/Chest Pain Center (CPC) all of which participated in an HIE. The study design was observational, prospective using a voluntary, anonymous, online survey. Eligible participants included attending emergency physicians, residents, and mid-level providers (PA & NP). Survey items asked clinicians whether information obtained from the HIE changed resource use while caring for patients at the study sites and used branching logic to ascertain specific types of services avoided including laboratory/microbiology, radiology, consultations, and hospital admissions. Additional items asked how use of the HIE affected quality of care and length of stay. The survey was automated using a survey construction tool (REDCap Survey Software © 2010 Vanderbilt University). We calculated avoided MARs by multiplying the numbers and types of services reported to have been avoided. Average cost of an admission from the ED was based on direct cost trends for ED admissions within the region.ResultsDuring the 12-month study period we had 325,740 patient encounters and 7,525 logons to the HIE (utilization rate of 2.3%) by 231 ED clinicians practicing at the study sites. We collected 621 surveys representing 8.25% of logons of which 532 (85.7% of surveys) reported on patients who had information available in the HIE. Within this group the following services and MARs were reported to have been avoided [type of service: number of services; MARs]: Laboratory/Microbiology:187; $2,073, Radiology: 298; $475,840, Consultations: 61; $6,461, Hospital Admissions: 56; $551,282. Grand total of MARs avoided: $1,035,654; average $1,947 per patient who had information available in the HIE (Range: $1,491 – $2,395 between HS). Changes in management other than avoidance of a service were reported by 32.2% of participants. Participants stated that quality of care was improved for 89% of patients with information in the HIE. Eighty-two percent of participants reported that valuable time was saved with a mean time saved of 105 minutes.ConclusionObservational data provided by ED clinicians practicing at eleven EDs in a mid-sized Southeastern city showed an average reduction in MARs of $1,947 per patient who had information available in an HIE. The majority of reduced MARs were due to avoided radiology studies and hospital admissions. Over 80% of participants reported that quality of care was improved and valuable time was saved.

Small business technology transfer (STTR) phase I study (1 R41 MD006148-01) of an automated voice response (AVR) system to improve symptom management in neuro-oncology patients.

e12500 Background: This STTR Phase 1 study focused on enhancing and improving the technology of a prior AVR system (Grant #R01 CA30724) to manage symptoms in cancer patients. Neuro-Oncology patients were enrolled to test our proof of concept (POC). Methods: Previous AVR function was replicated using Asterisk software enhancing the branching logic, configurability and operational capacity on multiple operating systems; limitations of the previous AVR. Eligibility criteria: access to a telephone; actively on chemotherapy. Nurse recruiters provided detailed information about the study and answered questions. Following signed consent patients provided a preferred phone number and chose a day and time of the week to receive AVR calls. Patients received a Symptom Management Guide (SMG) at time of consent. Patients were contacted a total of 4 times over a 4 week period by the AVR. At each contact patients were asked to rate 17 symptoms on a scale of 1-9 for severity and interference with 4 domains of quality of life on a 1-5 scale. Patient’s reporting a 4 or higher severity level were directed by the AVR to reference their SMG for self-care strategies to manage their symptoms. At the end of the study patients completed a satisfaction survey. Results: Ten patients were enrolled. The AVR placed 38 of 40 scheduled calls. No errors in survey branching were evident with confirmation. Patient satisfaction surveys were completed with 70% of patients. One patient did not complete any scheduled calls and was not contacted, two patients were unreachable. All patients reported satisfaction. 86% reported they would recommend this system to their oncology provider. 71% felt it was helpful in individualized monitoring of symptoms between visits. 57% liked knowing their symptom(s) were being checked regularly. One indicated the system was too overwhelming. Complaints included: not being able to change responses (1) and not allowing them to answer questions as fast as they wanted (2). Conclusions: Patient satisfaction results and system performance confirmed that the POC was feasible and that this system should be studied in larger groups of oncology patients.

Evaluation of retention protocols among members of the American Association of Orthodontists in the United States

Little research has been conducted to evaluate protocols and trends in orthodontic retention. The purpose of this study was to identify the general retention protocols used by orthodontists in the United States. Additionally, our goal was to identify trends in these orthodontic retention protocols by evaluating how they have changed over the past 5 years and how they might continue to change in the next 5 years. The study was conducted via a 36-question electronic survey (REDCap, Nashville, Tenn) with branching logic on certain questions. The survey was sent to all 9143 practicing members of the American Association of Orthodontists in the United States, and 1632 (18%) responded. Mean retention protocols of the surveyed population showed predominant use of Hawley or vacuum-formed retainers in the maxillary arch and fixed retention in the mandibular arch. For both arches, there is a current shift away from Hawley retainers and toward vacuum-formed retainers and fixed retention. Respondents who extract fewer teeth reported increased use of fixed retention in the maxillary (P = 0.041) and mandibular (P = 0.003) arches. Respondents who extract fewer teeth and use removable retainers were more likely to tell their patients to wear their retainers at night for the rest of their lives (P = 1.63 × 10(-6)).

Development of a hand-held computer platform for real-time behavioral assessment of physicians and nurses

We developed a hand-held data collection tool to facilitate real-time collection of data on the factors that affect hospital staff performance. To assure high-yield of data from busy clinicians, the design objectives included low response burden, the ability to collect complex real-time data in dynamic work environments, and automated data integration. Iterative user-centered design of custom interfaces resulted in a dynamic intuitive platform where branching logic was applied to present a series of survey questions dependent on the participant’s responses. Over a 12-month period, 304 inpatient physicians and nurses completed (with minimal initial training) a total of 11,381 survey responses. For randomly timed repeated survey prompts, complete (73%) or partial (12%) responses were obtained in a median time of 96 s.