Fictitious Patients Research Articles

Impact of a Case-Based Sleep Apnoea Education on the Knowledge, Attitudes and Confidence of Dental Hygiene Students-A Multicentre Intervention Study.

This pilot study aimed to explore knowledge, attitudes and confidence levels of Obstructive Sleep Apnoea (OSA) before and after case-based education among dental hygiene students. Moreover, to give an international perspective, this study included students from the US and Scandinavia. A longitudinal multicentre study assessed dental hygiene students' OSA knowledge, attitudes and confidence through a case-based education model. Students from six dental hygiene programmes in the US, Norway and Sweden participated from 2021 to 2022. The intervention group (N = 89) received preview material, live synchronous OSA lecture, case-based screening of fictitious patients and clinical practice using the STOP-Bang screening tool. Controls (N = 70) followed the standard curriculum. The Obstructive Sleep Apnoea Knowledge and Attitudes (OSAKA) questionnaire, comprising 18 knowledge and five attitude/confidence questions, was used. Reliability was assessed and nonparametric tests determined OSAKA knowledge score differences among the baseline, 6 months and 12 months intervals. The intervention increased OSA knowledge with the largest increase in proportions of correct responses occurring between the baseline and 6 months and all single items showing a higher proportion of correct answers at 12 months compared to the baseline. Students' attitudes regarding the importance of OSAKA and confidence in managing patients increased from the baseline to both 6 months and 12 months. The case based educational intervention increased OSA knowledge and improved attitudes and confidence among dental hygiene students. The results also determined that the OSAKA questionnaire can be used in a setting with dental hygiene students to provide an overview of their knowledge, attitudes and confidence toward OSA. Current sleep medicine education in dental hygiene programmes is limited, suggesting the need for enhanced and sustained educational interventions to address this knowledge gap.

Statistical refinement of patient-centered case vignettes for digital health research.

Digital health research often relies on case vignettes (descriptions of fictitious or real patients) to navigate ethical and practical challenges. Despite their utility, the quality and lack of standardization of these vignettes has often been criticized, especially in studies on symptom-assessment applications (SAAs) and self-triage decision-making. To address this, our paper introduces a method to refine an existing set of vignettes, drawing on principles from classical test theory. First, we removed any vignette with an item difficulty of zero and an item-total correlation below zero. Second, we stratified the remaining vignettes to reflect the natural base rates of symptoms that SAAs are typically approached with, selecting those vignettes with the highest item-total correlation in each quota. Although this two-step procedure reduced the size of the original vignette set by 40%, comparing self-triage performance on the reduced and the original vignette sets, we found a strong correlation (r = 0.747 to r = 0.997, p < .001). This indicates that using our refinement method helps identifying vignettes with high predictive power of an agent's self-triage performance while simultaneously increasing cost-efficiency of vignette-based evaluation studies. This might ultimately lead to higher research quality and more reliable results.

Leveraging Large Language Models for Precision Monitoring of Chemotherapy-Induced Toxicities: A Pilot Study with Expert Comparisons and Future Directions.

Large Language Models (LLMs), such as the GPT model family from OpenAI, have demonstrated transformative potential across various fields, especially in medicine. These models can understand and generate contextual text, adapting to new tasks without specific training. This versatility can revolutionize clinical practices by enhancing documentation, patient interaction, and decision-making processes. In oncology, LLMs offer the potential to significantly improve patient care through the continuous monitoring of chemotherapy-induced toxicities, which is a task that is often unmanageable for human resources alone. However, existing research has not sufficiently explored the accuracy of LLMs in identifying and assessing subjective toxicities based on patient descriptions. This study aims to fill this gap by evaluating the ability of LLMs to accurately classify these toxicities, facilitating personalized and continuous patient care. This comparative pilot study assessed the ability of an LLM to classify subjective toxicities from chemotherapy. Thirteen oncologists evaluated 30 fictitious cases created using expert knowledge and OpenAI's GPT-4. These evaluations, based on the CTCAE v.5 criteria, were compared to those of a contextualized LLM model. Metrics such as mode and mean of responses were used to gauge consensus. The accuracy of the LLM was analyzed in both general and specific toxicity categories, considering types of errors and false alarms. The study's results are intended to justify further research involving real patients. The study revealed significant variability in oncologists' evaluations due to the lack of interaction with fictitious patients. The LLM model achieved an accuracy of 85.7% in general categories and 64.6% in specific categories using mean evaluations with mild errors at 96.4% and severe errors at 3.6%. False alarms occurred in 3% of cases. When comparing the LLM's performance to that of expert oncologists, individual accuracy ranged from 66.7% to 89.2% for general categories and 57.0% to 76.0% for specific categories. The 95% confidence intervals for the median accuracy of oncologists were 81.9% to 86.9% for general categories and 67.6% to 75.6% for specific categories. These benchmarks highlight the LLM's potential to achieve expert-level performance in classifying chemotherapy-induced toxicities. The findings demonstrate that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM achieved 85.7% accuracy in general categories and 64.6% in specific categories. While the model's general category performance falls within expert ranges, specific category accuracy requires improvement. The study's limitations include the use of fictitious cases, lack of patient interaction, and reliance on audio transcriptions. Nevertheless, LLMs show significant potential for enhancing patient monitoring and reducing oncologists' workload. Future research should focus on the specific training of LLMs for medical tasks, conducting studies with real patients, implementing interactive evaluations, expanding sample sizes, and ensuring robustness and generalization in diverse clinical settings. This study concludes that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM's performance in general toxicity categories is within the expert range, but there is room for improvement in specific categories. LLMs have the potential to enhance patient monitoring, enable early interventions, and reduce severe complications, improving care quality and efficiency. Future research should involve specific training of LLMs, validation with real patients, and the incorporation of interactive capabilities for real-time patient interactions. Ethical considerations, including data accuracy, transparency, and privacy, are crucial for the safe integration of LLMs into clinical practice.

Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD-11 (CAL-CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study.

The ICD-11 classification of chronic pain comprises seven categories, each further subdivided. In total, it contains over 100 diagnoses each based on 5-7 criteria. To increase diagnostic reliability, the Classification Algorithm for Chronic Pain in the ICD-11 (CAL-CP) was developed. The current study aimed to evaluate the CAL-CP regarding the correctness of assigned diagnoses, utility and ease of use. In an international online study, n = 195 clinicians each diagnosed 4 out of 8 fictitious patients. The clinicians interacted via chat with the virtual patients to collect information and view medical histories and examination findings. The patient cases differed in complexity: simple patients had one chronic pain diagnosis; complex cases had two. In a 2 × 2 repeated-measures design with the factors tool (algorithm/standard browser) and diagnostic complexity (simple/complex), clinicians used either the algorithm or the ICD-11 browser for their diagnoses. After each case, clinicians indicated the pain diagnoses and rated the diagnostic process. The correctness of the assigned diagnoses and the ratings of the algorithm's utility and ease of use were analysed. The use of the algorithm resulted in more correct diagnoses. This was true for chronic primary and secondary pain diagnoses. The clinicians preferred the algorithm over the ICD-11 browser, rating it easier to work with and more useful. Especially novice users benefited from the algorithm. The use of the algorithm increases the correctness of the diagnoses for chronic pain and is well accepted by clinicians. The CAL-CP's use should be considered in routine care and research contexts. The ICD-11 has come into effect in January 2022. Clinicians and researchers will soon begin using the new classification of chronic pain. To facilitate clinicians training and diagnostic accuracy, a classification algorithm was developed. The paper investigates whether clinicians using the algorithm-as opposed to the generic tools provided by the WHO-reach more correct diagnoses when they diagnose standardized patients and how they rate the comparative utility of the diagnostic instruments available.

Putting ICU triage guidelines into practice: A simulation study using observations and interviews.

The COVID-19 pandemic has prompted many countries to formulate guidelines on how to deal with a worst-case scenario in which the number of patients needing intensive care unit (ICU) care exceeds the number of available beds. This study aims to explore the experiences of triage teams when triaging fictitious patients with the Dutch triage guidelines. It provides an overview of the factors that influence decision-making when performing ICU triage with triage guidelines. Eight triage teams from four hospitals were given files of fictitious patients needing intensive care and instructed to triage these patients. Sessions were observed and audio-recorded. Four focus group interviews with triage team members were held to reflect on the sessions and the Dutch guidelines. The results were analyzed by inductive content analysis. The Dutch triage guidelines were the main basis for making triage decisions. However, some teams also allowed their own considerations (outside of the guidelines) to play a role when making triage decisions, for example to help avoid using non-medical criteria such as prioritization based on age group. Group processes also played a role in decision-making: triage choices can be influenced by the triagists' opinion on the guidelines and the carefulness with which they are applied. Intensivists, being most experienced in prognostication of critical illness, often had the most decisive role during triage sessions. Using the Dutch triage guidelines is feasible, but there were some inconsistencies in prioritization between teams that may be undesirable. ICU triage guideline writers should consider which aspects of their criteria might, when applied in practice, lead to inconsistencies or ethically questionable prioritization of patients. Practical training of triage team members in applying the guidelines, including explanation of the rationale underlying the triage criteria, might improve the willingness and ability of triage teams to follow the guidelines closely.

Toward future triage regulations: Investigating preferred allocation principles of the German public

BackgroundWhen intensive care capacity is limited, triage may be required. Given that the German government started working on new triage legislation in 2022, the present study investigated the German public's preferences for intensive care allocation in two situations: ex-ante triage (where multiple patients compete for available resources) and ex-post triage (where admitting a new patient to intensive care means withdrawing treatment from another because ICU resources are depleted). MethodIn an online experiment, N=994 participants were presented with four fictitious patients who differed in age and pre- and post-treatment chance of survival. In a series of pairwise comparisons, participants were asked to select one patient for treatment or to opt for random selection. Ex-ante and ex-post triage situations were varied between participants and preferred allocation strategies were inferred from their decisions. ResultsOn average, participants prioritized better post-treatment prognosis ahead of younger age or treatment benefit. Many participants rejected random allocation (on the flip of a coin) or prioritization by worse pre-treatment prognosis. Preferences were similar for ex-ante and ex-post situations. DiscussionAlthough there may be good reasons for deviating from laypeople's preference for utilitarian allocation, the results can help to design future triage policies and accompanying communication strategies.

Training concept for personnel in auniversity outpatient clinic: development and evaluation of astructured introductory training concept

The training of new employees is crucial for effective interaction and commitment to the company. Development and evaluation of astructured induction into the process flows of auniversity outpatient clinic. We developed and tested atwo-stage model for getting to know staff, premises, nursing and medical process flows, and learning examination techniques: Participants went through all stages of an outpatient clinic visit as fictitious patients and subsequently evaluated learning success by self-assessment of general (process-related) and specific (examination-related) competencies in writing and in afeedback interview. In this study, 11residents, 8operating room nursing staff, and 6students underwent the training program. The self-assessed level of competence before and after the run-through as well as the extent of the increase in competence varied depending on the stage and professional group. Residents and students experienced aspecific increase in general competences (both 98%; nursing personnel 64%). Specific competence gains for residents were particularly evident in becoming familiar with important process-related interfaces between the occupational groups, in software and examination techniques, and in improved orientation in the outpatient clinic (competence gain at 83% of stages). Operating room nursing staff benefited most from improved communication with staff. An increase in general competence can be achieved by astructured training with little time expenditure for different professional groups and facilitates, especially the start for new residents. For maximum specific competence gain, an outpatient clinic run tailored to the employee's field of activity seems desirable.

CN50 Facing negative emotions: Evaluating the effects of training in affirmative communication for contact nurses in cancer care

In cancer care, contact nurses daily meet people who deal with strong, aversive emotions in relation to that they have or may have cancer where the risk of dying is constantly present. This places demands on the ability of contact nurses to master difficult conversations with strong emotional expressions. One communication method known for its regulating effects on emotions is affirmative communication, so called validation. The overall aim of the current study was to evaluate effects of a training in validating communication for contact nurses in cancer care, aimed to strengthen their ability to work in a person-centered way. This study had a within-group design with pre-, post- and follow-up measurements (2 months). Specifically, the study aimed to evaluate whether the validation training coincided with an increase in validation and a decrease in invalidation. Contact nurses from six regions (n = 17) with a generally long work experience as a nurse participated in a digital validation training for six weeks (three training sessions plus three pre-recorded theoretical lectures). Communicative behaviors were assessed through video-recordings of interactions between the nurses and fictitious patients. The videos were encoded by independent coders and analyzed with dependent MANOVA. The contact nurses showed a significant increase in validation and a significant decrease in invalidation after the training. These effects remained at the 2-month follow-up. Experienced healthcare professionals' affirmative communication skills can be improved after a brief training in validation.

Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study.

Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment for patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice. A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach. Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations, (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training. To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols. The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.

Who Should Get Vaccinated First? Limits of Solidarity during the First Week of the Danish Vaccination Programme

AbstractThe coronavirus disease 2019 (COVID-19) pandemic resulted in several acute shortages of healthcare provision and thereby posed a challenge to solidarity among citizens of welfare states. One example was the limited number of vaccine batches at the outset of European COVID-19 vaccination campaigns. This resulted in a rare constellation in which citizens faced both a unifying collective threat but also a scarcity of healthcare resources that necessitated the prioritization of certain groups for an early vaccination. On that premise, we conducted a survey experiment during the first week of the Danish vaccination programme. Our results demonstrate that citizens judged who deserves early access to preventive healthcare along established lines of welfare chauvinism. Fictitious diabetes patients with a Muslim name and those who recently immigrated were regarded as less deserving of an early vaccination. That said, concerns over responsibility for one’s hardship and anti-social free-rider behaviour drive citizens considerations, too. Contra our hypotheses, we find only weak evidence that immigrants or Muslims are penalized more harshly for an irresponsible lifestyle or free-rider behaviour. Compared with previous research, we study a unique moment in history and are the first to disentangle minority status from stereotypes about their anti-social free-riding behaviour and irresponsibly unhealthy lifestyles.

Reliability of Third Ventricle Assessment by Transcranial Ultrasound: A Computational Model of the Effect of Insonation Angle.

Transcranial sonography (TCS) is a bedside examination which is currently used in multiple neurocritical care settings. Third ventricle ultrasound is usually a simple technique, though a large insonation angle could lead to an overestimation of third ventricular diameter. The aim of this study was to use a mathematical model to evaluate the impact of probe inclination on the false positive rate when using TCS to evaluate third ventricle enlargement. Using R software, we simulated a pool of 100,000 fictitious patients with a normal third ventricle size (diameter from 0 to 9 mm) in daily follow-up for ventricle enlargement for 30 consecutive days using TCS. Each day, a different, random insonation angle (α) was generated and a corresponding measured diameter calculated as: measured diameter=real diameter/cos α. If the measured diameter was >9.0 mm, the simulation registered a "misdiagnosis" episode and the simulation loop was interrupted; otherwise, the simulation continued to its thirtieth iteration. Of the 100,000 "patient" simulations, 30,905 (30.9%) had an erroneous TCS diagnosis of ventricular enlargement. Angles of insonation >35 degrees contributed to 79.3% of the total misdiagnoses of ventricular enlargement (false positive rate, 3.71%), whereas misdiagnosis was rare when the insonation angle was ≤15 degrees (1.30% of the total misdiagnoses; false positive rate, 0.06%). Using probe inclinations <15 degrees, erroneous diagnosis of third ventricular enlargement was rare. Our results suggest that TCS has a low rate of false positives when the angle of insonation is minimized.

Caregiver development of activity-supporting services for smart homes

Older adults often need some level of assistance in performing daily living activities. Even though these activities are common to the vast majority of individuals (e.g., eating, bathing, dressing), the way they are performed varies across individuals. Supporting older people in performing their everyday activities is a major avenue of research in smart homes. However, because of its early stage, this line of work has paid little attention on customizing assistive computing support with respect to the specific needs of each older adult towards improving its effectiveness and acceptability. We propose a tool-based approach to allowing caregivers to define services in the area of home daily living, leveraging their knowledge and expertise on the older adult they care for. This approach consists of two stages: 1) a wizard allows caregivers to define an assistive service, which supports aspects of a daily activity that are specific to an older adult; 2) the wizard-generated service is uploaded in an existing smart home platform and interpreted by a dedicated component, carrying out the caregiver-defined service. Our approach has been implemented. Our wizard has been successfully used to define existing manually-programmed, activity-supporting services. The resulting services have been deployed and executed by an existing assisted living platform deployed in the home of community-dwelling individuals. They have been shown to be equivalent to their manually-programmed counterparts. We also conducted an ergonomics study involving five occupational therapists, who tested our wizard with clinical vignettes describing fictitious patients. Participants were able to successfully define services while revealing an ease of use of our wizard.

A Novel Case Study Approach to Undergraduate Research in Post‐COVID Times ‐ Mayhem in May

The COVID‐19 pandemic shut down laboratories across the nation for many months. Scientists at all academic levels had to think creatively and design, if possible, engaging remote projects for their students. Based on journal reviews from renowned educators, we decided to perform a systematic literature review of publicly available material to summarize information about SARS‐CoV‐2, the virus responsible for the current pandemic, which has affected 87.5 million people with 1.89 million deaths worldwide (as of Jan 7, 2021).Using the PubMed Central (PMC) advanced search builder, we were able to narrow the initial 93,999 results for COVID‐19 related articles published in the past year (Nov 2019 – Nov 2020) to 543 publications that were related to SARS‐CoV‐2, spike protein structure and its receptor. Relevant articles in peer‐reviewed journals were identified from this list and comprehensive analysis of ~40 research articles were conducted and summarized. This compilation was used in a case‐study model to narrate a story simplifying the complexities of COVID‐19 infection while providing detailed qualitative information, which would otherwise be difficult and sensitive to discuss. This model for summer research enhanced students’ critical thinking skills necessary to ponder questions related to COVID‐19 in preparation to enter the healthcare profession.This directed patient case study was designed by using data from real life situations and applying it to fictitious patients to maintain anonymity. The storyline follows three individuals (85‐year‐old male, 80‐year‐old female, and a 50‐year‐old male) and their families during the 2019–2020 coronavirus outbreak in the United States. The timeline of patients’ infections, testing, interventions, and outcomes are discussed. Additional sections on COVID‐19 gender disparities and atypical symptoms are also provided.Students in upper‐level biology and health science courses, such as physiology and pathophysiology, will research the symptoms, susceptibility, mechanism of action, progression of the infection, opportunistic infections, extrapulmonary complications and treatments. The case concludes with an assignment to discuss the most current information available regarding the progress made in designing novel treatments.This project was presented at the Natural Science Summer Research program and parts of it will be introduced to students in local high schools as part of Benedictine University's (BenU) outreach activity. We are in the process of submitting a detailed version of this case to the National Center for Case Study Teaching in Science. Working on the various aspects of the case, including instructor notes, answer key and presentations, honed the critical analysis and communication skills of the research students. Despite various tragedies and challenges, the pandemic offered the unique opportunity to identify novel topics and techniques to circumvent original project goals and traditional undergraduate research methods, as well as provide freedom for innovation that can ultimately benefit the academic community.

How do radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting? A vignette study.

Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs' ability to identify and manage patients' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety. A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants. Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)). RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.

Evaluating the influence of data collector training for predictive risk of death models: an observational study

BackgroundSeverity-of-illness scoring systems are widely used for quality assurance and research. Although validated by trained data collectors, there is little data on the accuracy of real-world data collection practices.ObjectiveTo evaluate...

Partnership between Primary Health and Social Care Services in the Long-Term Care of Older People with Dementia: A Vignette Study.

Dementia is considered to be a significant cause of disability and dependency for older people worldwide and it raises difficulties in providing adequate formal and informal assistance. Research on the experience of long-term care (LTC)services for older people with dementia is scarce in Eastern European countries. This study aimed to understand the system of care for older people with dementia from the perspective of health and social care workers providing LTC services in Lithuania. A total of 72 primary health care and social care professionals from public and private institutions in Kaunas city participated in this study. One-to-one interviews were conducted with family physicians, community nurses, psychiatrists, psychiatric nurses, and social workers. A vignette situation of 2 fictitious patients with dementia and their informal caregiver was discussed during the interviews. Data were analyzed using thematic analysis by induction approach. The data revealed 2 main themes: LTC provision trajectory, and three-dimensional relationship perception in realization of LTC activities. LTC provision trajectory reflected activities performed as a response to the described situation embracing formal procedures for the endorsement of LTC needs as well as the range of LTC services. The three-dimensional perception of relationships in LTC services’ implementation reflected the participants’ personal approach toward LTC, relationship with different specialists, and the informal caregiver. Our study revealed the potential of complex measures that could be instrumental for the refinement of the caregiving process. First, a change in the additional care requirements endorsement logic is needed, shifting focus from medical diagnosis to functional abilities assessment. Second, to establish clear procedures for formal cooperation between the health and social care sectors in the trajectory of LTC service provision. Finally, to find an adequate balance between LTC and institutional care by creating a more comprehensive range of LTC services. A more consistent and coordinated delivery of services by both health and social care sectors seems to be an untapped resource for the improvement of the LTC potential.

Differences in Access to Outpatient Care in the State of Ohio for an Orthopaedic Sports Medicine Patient

PurposeTo evaluate the impact of either Medicaid or private insurance on securing an appointment in an outpatient orthopaedic clinic and to determine waiting periods until an appointment as well as the relationship between population metrics and access to care.MethodsA total of 88 clinics were called. There were 2 fictitious patients, one with an anterior cruciate ligament (ACL) injury and the other with a medial meniscus injury, with each calling as having Medicaid or private insurance. Clinic responses were recorded for whether an appointment could be made, when it was scheduled, and with what provider.ResultsA total of 32 of 88 (36.4%) of the clinics scheduled an appointment for the Medicaid patient reporting an ACL injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. A total of 34 of 88 (38.6%) of the clinics scheduled an appointment for the Medicaid patient reporting a medial meniscus injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. Mean waiting period for ACL patients with Medicaid was 8.6 days and 4.5 days for patients with private insurance, whereas medial meniscus patients with Medicaid was 7.7 days and 5.4 days for patients with private insurance. In total, 60 of the 66 (90.9%) patients with Medicaid who received an appointment were scheduled to see the orthopaedic surgeon (30 in both ACL and medial meniscus groups). In total, 126 (71.6%) patients with Medicaid and 34 (19.3%) patients with private insurance of the 176 encounters faced barriers to scheduling an appointment. Rural communities were associated with appointment acceptance for patients with Medicaid (P < .05), and patients with private insurance had successful appointment scheduling in all community types (P < .05).ConclusionsThis study suggests that patients with Medicaid are less likely to receive orthopaedic care for multiple sports medicine injuries, are more likely to encounter barriers, and endure longer waiting periods. There are different patterns of insurance acceptance according to population metrics.Clinical RelevanceServes as a baseline evaluation of the difference in access to health care that may be impacted by increases in Medicaid coverage and/or changes in government policies.

Effect of an Educational Program on Healthcare Professionals' Readiness to Support Patients with Asthma, Allergies, and Chronic Obstructive Lung Disease for Improved Medication Adherence.

Purpose The aim of this study was to strengthen the healthcare professionals' readiness to support patients who have asthma, an allergy, and COPD for better medication adherence. Methods The design was an educational intervention in a study population (n = 70) consisting of 66 nurses and four other allied healthcare professionals working in primary care with patients diagnosed with asthma, allergy, or COPD in a county in southern Sweden. As part of two training days, an educational intervention—consisting of lectures and workshops—was conducted. Both qualitative and quantitative data were collected. The qualitative data were collected during the workshops when the participants worked with fictitious patient cases. They documented in writing how they, based on the theoretical content in the educational intervention in combination with their clinical experiences, reasoned that the fictitious patients could be supported for better adherence. This documentation constituted qualitative data. The quantitative data were collected through questionnaires, which the participants completed before and after the intervention. Data from the questionnaires were statistically analyzed using descriptive statistics and paired t-tests. The qualitative data collected from the workshops were analyzed with content analysis. Results The intervention increased the participants' knowledge of adherence (pre mean 3.95 versus post mean 4.18, p=0.001) and how to better support patients' adherence to medication (pre mean 3.71 versus post mean 3.98, p=0.001). Moreover, their knowledge of how to measure patients' adherence behavior (pre mean 3.02 versus post mean 3.54, p=0.001) and how to communicate with patients effectively about adherence was heightened (pre mean 3.92 versus post mean 4.13, p=0.011). Furthermore, participants felt that their readiness to support patients for better adherence had strengthened (pre mean 3.78 versus post mean 4.13, p=0.001). Individual adherence support for three fictitious patients with different adherence issues was developed. Conclusion An educational intervention focusing on adherence and communication equipped healthcare professionals with tools to support patients with asthma, an allergy, or COPD for better medication adherence.

When Success Is Not Enough: The Symptom Base-Rate Can Influence Judgments of Effectiveness of a Successful Treatment.

Patients’ beliefs about the effectiveness of their treatments are key to the success of any intervention. However, since these beliefs are usually formed by sequentially accumulating evidence in the form of the covariation between the treatment use and the symptoms, it is not always easy to detect when a treatment is actually working. In Experiments 1 and 2, we presented participants with a contingency learning task in which a fictitious treatment was actually effective to reduce the symptoms of fictitious patients. However, the base-rate of the symptoms was manipulated so that, for half of participants, the symptoms were very frequent before the treatment, whereas for the rest of participants, the symptoms were less frequently observed. Although the treatment was equally effective in all cases according to the objective contingency between the treatment and healings, the participants’ beliefs on the effectiveness of the treatment were influenced by the base-rate of the symptoms, so that those who observed frequent symptoms before the treatment tended to produce lower judgments of effectiveness. Experiment 3 showed that participants were probably basing their judgments on an estimate of effectiveness relative to the symptom base-rate, rather than on contingency in absolute terms. Data, materials, and R scripts to reproduce the figures are publicly available at the Open Science Framework: https://osf.io/emzbj/.

Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system

BackgroundDrug-laboratory (lab) interactions (DLIs) are a common source of preventable medication errors. Clinical decision support systems (CDSSs) are promising tools to decrease such errors by improving prescription quality in terms of lab values. However, alert fatigue counteracts their impact. We aimed to develop a novel user-friendly, evidence-based, clinical context-aware CDSS to alert nephrologists about DLIs clinically important lab values in prescriptions of kidney recipients.MethodsFor the most frequently prescribed medications identified by a prospective cross-sectional study in a kidney transplant clinic, DLI-rules were extracted using main pharmacology references and clinical inputs from clinicians. A CDSS was then developed linking a computerized prescription system and lab records. The system performance was tested using data of both fictitious and real patients. The “Questionnaire for User Interface Satisfaction” was used to measure user satisfaction of the human-computer interface.ResultsAmong 27 study medications, 17 needed adjustments regarding renal function, 15 required considerations based on hepatic function, 8 had drug-pregnancy interactions, and 13 required baselines or follow-up lab monitoring. Using IF & THEN rules and the contents of associated alert, a DLI-alerting CDSS was designed. To avoid alert fatigue, the alert appearance was considered as interruptive only when medications with serious risks were contraindicated or needed to be discontinued or adjusted. Other alerts appeared in a non-interruptive mode with visual clues on the prescription window for easy, intuitive notice. When the system was used for real 100 patients, it correctly detected 260 DLIs and displayed 249 monitoring, seven hepatic, four pregnancy, and none renal alerts. The system delivered patient-specific recommendations based on individual lab values in real-time. Clinicians were highly satisfied with the usability of the system.ConclusionsTo our knowledge, this is the first study of a comprehensive DLI-CDSS for kidney transplant care. By alerting on considerations in renal and hepatic dysfunctions, maternal and fetal toxicity, or required lab monitoring, this system can potentially improve medication safety in kidney recipients. Our experience provides a strong foundation for designing specialized systems to promote individualized transplant follow-up care.