Initial Pilot Phase Research Articles

Implementation of an extended scope of practice speech-language pathology allied health practitioner service: An evaluation of service impacts and outcomes

Purpose: Extended scope of practice roles can address health service challenges and enhance patient services; however there has been limited research of extended scope roles in the discipline of speech-language pathology (SLP). The aim of this study was to examine the clinical outcomes and service impacts of a Speech-Language Pathology Allied Health Practitioner (SLP AHP) led dysphagia and dysphonia service within an Integrated Specialist Ear Nose and Throat (ENT) Service.Method: Low risk referrals were triaged by ENT from the waiting list into the SLP AHP dysphagia and dysphonia clinic. Outcomes from an initial 6-month pilot phase (n = 43) and 6-month implementation phase (n = 158) were evaluated.Result: Approximately 70% of patients managed in the SLP AHP clinic in both phases were discharged without requiring separate ENT appointments. There were no adverse events. In the pilot phase, only 4.3% of medium priority and 10% of low priority referrals were seen within clinically recommended time frames. This improved to 90% in the final three months of the implementation phase.Conclusion: With appropriate governance and risk management, an extended scope SLP AHP service for low risk dysphagia and dysphonia can achieve safe, effective and beneficial changes to ENT service delivery.

Viral mHealth​

ABSTRACTThousands of mHealth applications are developed every year, but few of these spread or ‘go viral’. Even clinical applications that provide health benefits and social value often linger after an initial pilot phase. An examination of common hindrances in low-income countries suggests that more subsidies and education of health care personnel are insufficient solutions. Instead we propose better a priori screening of mHealth applications based on four criteria that may largely determine whether an mHealth application will spread. Further, we illustrate how using these criteria forms a good basis for involving ‘impact investors’ in the development of mHealth applications. This can reduce risks for public health care providers and increase the likelihood of success.

Toward evidence-based diagnosis of myocarditis in children and adolescents: Rationale, design, and first baseline data of MYKKE, a multicenter registry and study platform

After an initial 6-month pilot phase, MYKKE was opened in June 2014 as a prospective multicenter registry for patients from pediatric heart centers, university hospitals, and community hospitals with pediatric cardiology wards in Germany. Inclusion criteria consisted of age<18 years and hospitalization for suspected myocarditis as leading diagnosis at the discretion of the treating physician. By December 31, 2015, fifteen centers across Germany were actively participating and had enrolled 149 patients. Baseline data reveal 2 age peaks (<2 years, >12 years), show higher proportions of males, and document a high prevalence of severe disease courses in pediatric patients with suspected myocarditis. Severe clinical courses and early adverse events were more prevalent in younger patients and were related to severely impaired leftventricular ejection fraction at initial presentation. MYKKE represents a multicenter registry and research platform for children and adolescents with suspected myocarditis that achieve steady recruitment and generate a wide range of real-world data on clinical course, diagnostic workup, and treatment of this group of patients. The baseline data reveal the presence of 2 age peaks and provide important insights into the severity of disease in children with suspected myocarditis. In the future, MYKKE might facilitate interventional substudies by providing an established collaborating network using common diagnostic approaches.

Addressing health care to geriatric patients in nursing homes in Barcelona and its metropolitan area

The increase in life expectancy of the population suggests a scenario for the next few decades with an aging population and exponential increase in multimorbidity. These factors determine a high risk of health and social complexity. In recent years, there has been a general movement toward implementing alternative care models. We must respond to new arising needs from this population that has become more fragile, suffering a higher level of physical and / or psychological dependence, and is highly consumer of health and social resources. The geriatric population living in a nursing home keep their allocation to primary care team (public health) in the geographical area where it belongs. Nursing homes are required to provide enough staff to adequately care for residents (mostly private management). Mainly action from the primary care team becomes reactive to the demands of urgent attention and the resulting administrative processes, without any proactive action scheduled. And regarding the health teams of the nursing homes, these are a heterogeneous group with a high number of professionals who do not belong to the public health system and therefore do not make use of the tools it has to ensure the continuity of care for residents. In 2009 the CatSalut (Catalonia Department of Public Health) detects the need to strengthen care for this population. It creates a public competition to develop this program of care for institutionalized patients and Mutuam provider ends up being responsible for its implementation, and they creates the residential care teams (EAR). The main objective is to contribute to integrated care, resolute, efficient, adequate intensity and person centered of reference population. Always according to the frailty and morbidity of this population, adapting their care and treatment plans to existing needs. The EAR works in coordination and cooperation with both the direct care staff in nursing homes as primary care and hospitals in the area. In an initial pilot phase two basic indicators are monitored: the adequacy of prescription pharmaceuticals and the number of referral hospital emergency services. It creates a control and an intervention group and assessed the situation pre and post intervention. The chosen area is the area north of the city of Barcelona (n=1025). The first results are rated as very good and it was decided to extend it to the entire city of Barcelona, making a progressive deployment phases. Deployment further extends the area of Valles Occidental and Oriental Est (2013) and in the area of Baix Llobregat Litoral i Centre (2014). All EAR that are in these areas are managed by Mutuam. Actually the EAR are managing a population of 21.045, who are distributed in 322 nursing homes. The service model is based on comprehensive geriatric assessment and planning approach specific to each case. Following the lines that mark the last Health Plan (2011-2015), the corrent one (2016-2020) and the PPAC (program of prevention and chronic care). In this sense, once valued residents, we identify them with the criteria PCC/MACA (high complexity /terminal illness) and we developed a plan of individualized intervention (PIIC). The team is active all year round from 8 to 20 hours to provide scheduled service, acute care and urgent attention. It has a call-center reception where adequate resources are activated on demand. The main results are: decrease 13.1% in overall spending pharmacy in the intervention group (according to case-control study evaluation of the pilot in 2009) and variation in emergency referrals in the Hospital Tauli Sabadell from nursing homes in the opening hours of EAR is a reduction of 27.14% (p What we’ve learnt from this experience is that the EAR program offers institutionalised people the most appropriate resources in the right place, avoiding inadequate transitions in health and social system. At the same time, these results are a reflection of personalized attention focused on the person and the decisions agreed with him and / or his family, to secure the quality and continuity of care and clinical safety, when it is made appropriate use of social and health resources. In the near future we must improve our results by identifying areas of improvement, ensuring quality and safety care, and sustainability. The model discussed, with minor adaptations to local conditions, we believe that is transferable to other areas with high / medium concentration of nursing homes.

Why do entrepreneurial mHealth ventures in the developing world fail to scale?

Telemedicine is an increasingly common approach to improve healthcare access in developing countries with fledgling healthcare systems. Despite the strong financial, logistical and clinical support from non-governmental organisations (NGOs), government ministries and private actors alike, the majority of telemedicine projects do not survive beyond the initial pilot phase and achieve their full potential. Based on a review of 35 entrepreneurial telemedicine and mHealth ventures, and 17 reports that analyse their operations and challenges, this article provides a narrative review of recurring failure modes, i.e. factors that lead to failure of such venture pilots. Real-world examples of successful and failed ventures are examined for key take-away messages and practical strategies for creating commercial viable telemedicine operations. A better understanding of these failure modes can inform the design of sustainable and scalable telemedicine systems that effectively address the growing healthcare disparities in developing countries.

Statistical lessons learned for designing cluster randomized pragmatic clinical trials from the NIH Health Care Systems Collaboratory Biostatistics and Design Core.

Pragmatic clinical trials embedded within health care systems provide an important opportunity to evaluate new interventions and treatments. Networks have recently been developed to support practical and efficient studies. Pragmatic trials will lead to improvements in how we deliver health care and promise to more rapidly translate research findings into practice. The National Institutes of Health (NIH) Health Care Systems Collaboratory was formed to conduct pragmatic clinical trials and to cultivate collaboration across research areas and disciplines to develop best practices for future studies. Through a two-stage grant process including a pilot phase (UH2) and a main trial phase (UH3), investigators across the Collaboratory had the opportunity to work together to improve all aspects of these trials before they were launched and to address new issues that arose during implementation. Seven Cores were created to address the various considerations, including Electronic Health Records; Phenotypes, Data Standards, and Data Quality; Biostatistics and Design Core; Patient-Reported Outcomes; Health Care Systems Interactions; Regulatory/Ethics; and Stakeholder Engagement. The goal of this article is to summarize the Biostatistics and Design Core's lessons learned during the initial pilot phase with seven pragmatic clinical trials conducted between 2012 and 2014. Methodological issues arose from the five cluster-randomized trials, also called group-randomized trials, including consideration of crossover and stepped wedge designs. We outlined general themes and challenges and proposed solutions from the pilot phase including topics such as study design, unit of randomization, sample size, and statistical analysis. Our findings are applicable to other pragmatic clinical trials conducted within health care systems. Pragmatic clinical trials using the UH2/UH3 funding mechanism provide an opportunity to ensure that all relevant design issues have been fully considered in order to reliably and efficiently evaluate new interventions and treatments. The integrity and generalizability of trial results can only be ensured if rigorous designs and appropriate analysis choices are an essential part of their research protocols.

Knowing me knowing you: Enhancing emotional literacy through visual arts

Abstract This article presents Enhancing Emotional Literacy through Visual Arts (ELVA) an innovative approach, developed by The Dax Centre, incorporating visual arts and mental health for primary school students. ELVA, beginning as a five-year project, and funded though a philanthropic grant, is the result of the collaborative efforts of a multidisciplinary advisory group of teachers, child psychotherapists, psychiatrists and art therapists, is lead by a project manager and overseen by the Director of the Dax Centre. Through an examination of ELVA’s theoretical frame and its unique experientially based teacher professional learning component, this article will highlight the contribution ELVA offers to existing well-being and visual arts approaches in schools. It will also present the findings of an independent evaluation of the initial pilot phase of ELVA.

A Redesigned Undergraduate Biochemistry Lab

The need for a significant improvement in undergraduate STEM education has been broadly recognized. The primary purposes of this project are to (1) improve understanding of the process of training students to be effective scientists, (2) test the hypothesis that “undergraduate students can characterize proteins of unknown function as the central theme of their biochemistry teaching laboratory”, and (3) that actually doing hypothesis‐driven experimental science is a useful tool in training students to become an experimental scientist. We have incorporated authentic inquiry into an undergraduate biochemistry lab course. Students at RIT are combining computational (in silico) and wet lab (in vitro) techniques as they characterize proteins whose three‐dimensional structures are known but to which functional annotations have not been assigned. Following an initial pilot phase at RIT during the Fall 2015 semester, our curriculum will be implemented at five additional campuses (California Polytechnic, Hope, Oral Roberts, St. Mary's, and Ursinus). The feasibility of the proposed characterization protocols has already been successfully tested in an undergraduate research setting at RIT and Dowling College. Our students have used an internally developed program, ProMOL, to compare over 3000 PDB entries with “unknown function” against a library of known enzyme active site motif templates and have found 64 “good hits”. At the beginning of the semester, students selected one of these good hits and characterized it further with ProMOL and other well‐established in silico methods, such as DALI, Pfam, and BLAST. Following initial bioinformatics characterization, well‐established in vitro techniques for protein expression, purification, and validation of activity have been used. As this new curriculum is focused on research and discovery, it is reasonable to expect some of the students to produce novel results that will contribute to the field of structural biology, both as publications and as annotations to structural biology databases such as the Protein Data Bank.Support or Funding InformationThis project is supported by NSF IUSE 1503811.

Abstract TP254: The Use of Prehospital Telemedicine to Aid in the Decision to Airlift Patients to a Comprehensive Stroke Center From a Rural Area

Introduction: In patients with acute ischemic stroke, significant time can elapse from symptom onset until initiation of thrombolytic therapy. Prehospital diagnosis can reduce time delays, and remote evaluation using telemedicine may help; especially in the context of rural areas where a decision to airlift the patient to a stroke center must be made. The Florida Keys is a stretch of 126 miles with no stroke center. In order to combat delays to therapy, a system was implemented to airlift patients directly from the field to a comprehensive stroke center. Air transport costs can range $10,000-$50,000 per patient, whereas the cost to place the telemedicine unit inside the ambulance was $2,250. Hypothesis: The purpose of the study was to determine the feasibility of using prehospital telemedicine as a triage tool to air transport stroke patients. Methods: Fire Rescue units in three departments were equipped with a smartphone programmed with encrypted software. Noise cancelling headsets were provided, together with a hard mount antenna. Stroke physicians were given a tablet with the same software. Prehospital providers conducted the CPSS initially, then the MEND exam, and if abnormal, contacted the stroke physician for a telemedicine consult. Crews were stationed on a designated landing zone, in an effort to reduce time to air transport after the exam was performed. Upon the patient’s arrival at the receiving facility, the physician performed the NIHSS again and recorded his/her findings. Results: From January 2013 to July 2015, physicians utilized telemedicine to evaluate 45 stroke patients. The initial pilot phase led to software and hardware upgrades to enhance patient examinations. The average NIHSS was 10. Initial analysis revealed a high correlation between the NIHSS done over telemedicine and the arrival NIHSS performed by the same physician. EMS providers and stroke physicians found the system easy to use and extremely valuable in making the triage determination. Conclusion: The use of prehospital telemedicine to conduct a neurological exam by a stroke physician has proven to be a valuable tool. Prehospital telemedicine for stroke air transport determination is feasible and cost-effective.

Unpacking 'Give Back Box:': A Social Enterprise at the Intersection of Leadership, Innovation, and Sustainability

Once the domain of government agencies and non-profit organizations, a social enterprise integrates social benefits such as employment and sustainability into a for-profit firm’s mission. The social enterprise (SE) bottom line includes both economic and social value, reflecting an intersection of the Jesuit leadership tradition with commercial business enterprise. This case study describes the start-up of Give Back Box (GBB), a Chicago-based social enterprise that supports recycling and repurposing. GBB’s business model involves providing a convenient, no-cost opportunity to follow up an online purchase by recycling the shipping box to forward unneeded items to charities. GBB was founded in 2012 by two entrepreneurs with expertise in global business as well as online retailing. Thus, this case also addresses the entrepreneurial dimension of SE by illustrating the close link between social enterprise and social entrepreneurship. Following its initial pilot phase, GBB has grown steadily, receiving impressive media coverage that has included articles in Forbes, Fast Company, and a feature on NBC’s ‘Today’ show. In 2013 another partner joined GBB: a Colombian engineer with an MBA from a U.S. Jesuit business school who has sought to apply business principles and Jesuit values in his work as a GBB partner. This case study describes the start-up’s inception, its mission and business plan, and its achievements to date, together with recommendations for other SE start-ups.

Feasibility and informative value of environmental sample collection in the National Children's Vanguard Study

BackgroundBirth cohort studies provide the opportunity to advance understanding of the impact of environmental factors on childhood health and development through prospective collection of environmental samples. MethodsWe evaluated the feasibility and informative value of the environmental sample collection methodology in the initial pilot phase of the National Children's Study, a planned U.S. environmental birth cohort study. Environmental samples were collected from January 2009–September 2010 at up to three home visits: pre-pregnancy (n=306), pregnancy (n=807), and 6-months postnatal (n=117). Collections included air for particulate matter ≤2.5µm (PM2.5), nitrogen dioxide, ozone, volatile organic compounds (VOCs), and carbonyls; vacuum dust for allergens/endotoxin; water for VOCs, trihalomethanes (THMs), and haloacetic acids (HAAs); and wipe samples for pesticides, semi-volatile organics, and metals. We characterized feasibility using sample collection rates and times and informative value using analyte detection frequencies (DF). ResultsAmong the 1230 home visits, environmental sample collection rates were high across all sample types (mean=89%); all samples except the air PM2.5 samples had collection times <30min. Informative value was low for water VOCs (median DF=0%) and pesticide floor wipes (median DF=5%). Informative value was moderate for air samples (median DF=35%) and high for water THMs and HAAs (median DF=91% and 75%, respectively). ConclusionsThough collection of environmental samples was feasible, some samples (e.g., wipe pesticides and water VOCs) yielded limited information. These results can be used in conjunction with other study design considerations, such as target population size and hypotheses of interest, to inform the method selection of future environmental health birth cohort studies.

Challenges, successes and patterns of enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.

ObjectivesThe aim of this report is to describe the challenges, successes and patterns of enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study.Methods START is a collaboration of many partners with central coordination provided by the protocol team, the statistical and data management centre (SDMC), the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) network leadership, international coordinating centres and site coordinating centres. The SDMC prepared reports on study accrual, baseline characteristics and site performance that allowed monitoring of enrolment and data quality and helped to ensure the successful enrolment of this large international trial. We describe the pattern of enrolment and challenges faced during the enrolment period of the trial.ResultsAn initial pilot phase began in April 2009 and established feasibility of accrual at 101 sites. In August 2010, funding approval for an expanded definitive phase led to the successful accrual of 4688 participants from 215 sites in 35 countries by December 2013. Challenges to accrual included regulatory delays (e.g. national/local ethics approval and drug importation approval) and logistical obstacles (e.g. execution of contracts with pharmaceutical companies, setting up of a central drug repository and translation of participant materials). The personal engagement of investigators, strong central study coordination, and frequent and transparent communication with site investigators, community members and participants were key contributing factors to this success.ConclusionsAccrual into START was completed in a timely fashion despite multiple challenges. This success was attributable to the efforts of site investigators committed to maintaining study equipoise, transparent and responsive study coordination, and community involvement in problem‐solving.

Mortality reporting in interventional radiology: Experience of a pilot audit with the Scottish Audit of Surgical Mortality

To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period. Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out. Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient's admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools. Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions.

PTH-174 Development of a Network Multidisciplinary Team and National Referral Centre for Treatment of Complex benign Colorectal Polyps

IntroductionLarge flat or sessile lesions are not uncommon on a screening colonoscopy list and endoscopic removal is often technically challenging. The assessment process for screening colonoscopists in Wales does not...

Rt-PA and Stroke: Does IST-3 Make It All Clear or Muddy the Waters?Answers to the November 2012 Journal Club Questions

Editor’s Note: You are reading the 30th installment of Annals of Emergency Medicine Journal Club. This Journal Club refers to the Third International Stroke Trial (IST-3) that was published in Lancet. Information about the journal club can be found at http://www.annemergmed.com/content/ journalclub. Readers should recognize that these are suggested answers. We hope they are accurate; we know that they are not comprehensive. There are many other points that could be made about these questions or about the article in general. Questions are rated novice “ ,” intermediate “ ,” and advanced “ “ so that individuals planning a journal club can assign the right question to the right student. The “novice” rating does not imply that a novice should be able to spontaneously answer the question. “Novice” means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Improving Rates of Appropriate Venous Thromboembolism Prophylaxis in a Community Hospital.

Abstract 3159Venous Thromboembolism (VTE) is responsible for significant hospital related morbidity and mortality, with 5–10% of hospital related mortality directly attributable to VTE. Despite the evidence supporting VTE prophylaxis, rates of prophylaxis vary between institutions and initiatives to improve prophylaxis are required. A baseline one-day audit was held at our institution to determine the rate of compliance with internal VTE prophylaxis clinical practice guidelines. The audit revealed an 85% compliance rate in eligible patients.The emergency department stood our as having a 76% rate of appropriate VTE prophylaxis during the audit. Targeting prophylaxis rates in the emergency department had the potential to increase the overall rates for the hospital if appropriate VTE prophylaxis could be initiated prior to transfer to in-patient care units, it would likely be continued.A comprehensive plan was put in place to improve VTE prophylaxis rates, which included targeted education, feedback to prescribers and the novel use of pharmacy student resources to increase the rates of VTE prophylaxis at a community hospital. Patients who were not receiving any anticoagulant medication were identified using the hospital information system. Pharmacy students were trained to assess patients for indications for VTE prophylaxis and they assessed all patients not receiving an anticoagulant admitted to the emergency department from Monday to Friday.When students identified a patient who was not receiving prophylaxis who met the criteria for prophylaxis, they reviewed their findings with the emergency department clinical pharmacist to ensure their assessment was accurate given their status as students. If the pharmacist agreed, the students were authorized to make a recommendation to the physician to start VTE prophylaxis. Recommendations included both pharmacological and mechanical prophylaxis options, depending on patient bleeding risk.During the first 60 days of the program, 247 patients were assessed by the students for prophylaxis, taking approximately 20 minutes each or 2.5 hours of student time per day. The pharmacy students made 64 recommendations for prophylaxis and 66% of the recommendations were accepted by the emergency room physicians with another 5% resulting in patients receiving a different mode of prophylaxis than recommended by the student (usually receiving pharmacological prophylaxis due to a change in bleeding risk).There were 794 patients admitted in the emergency department during the initial assessment of the program. Of the 794, 247 patients were assessed by the pharmacy students, who identified patients where prophylaxis was indicated for a rate of a “miss” for VTE prophylaxis in a patient where it was indicated of 8.06% prior to assessment by the student and 2.77% after assessment and recommendations, a 5.3% absolute increase in the rate of appropriate prophylaxis. While the number of patients admitted in the emergency department during the evaluation phase did not decrease, there was a decrease of the number of patients assessed per day by the students from 11 during the first ten days to 7 during the last ten days of the evaluation period. This 36% decrease in the number of patients identified as not receiving prophylaxis was likely multifactorial, and potentially attributed to targeted education, a physician champion who encouraged increased use of the admission pre-printed orders and an increased awareness of VTE prophylaxis due to pharmacy student recommendations.A post-implementation one-day audit was held to determine rates of appropriate VTE prophylaxis in the institution after the pharmacy student program and targeted education were implemented. The rate of appropriate VTE prophylaxis had risen in just 5 months to 97% of hospitalized patients who were eligible to receive prophylaxis were receiving prophylaxis, an 11% increase in the absolute rate of appropriate VTE prophylaxis according to the hospital clinical practice guideline criteria.The program continues beyond the initial pilot phase due to the excellent results. The use of pharmacy students, available year-round from a co-op program is an innovative, sustainable and cost-effective means to improve hospital rates of VTE prophylaxis to achieve goals of improved patient care. Disclosures:No relevant conflicts of interest to declare.

Patient Understanding of Emergency Department Discharge Instructions: Where Are Knowledge Deficits Greatest?

Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post-ED care instructions (including medications, home care, and follow-up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. This was a prospective cohort, phone interview-based study of 159 adult English-speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow-up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis-specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow-up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two-thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow-up (18%), diagnosis (3%), and medications (3%). Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.

College performance prediction test

The purpose of this study was to construct and evaluate the psychometric properties of an instrument that is designed to measure attitudinal, affective, and emotional factors relevant in predicting academic performance in engineering students. The developed instrument makes it possible to obtain a student's profile in terms of his/her attitudes toward science, motivation and anxiety levels that have been revealed to be important factors in previous studies. The research has been developed in various universities in Peru and in different phases: an initial pilot phase with 81 university students; a second phase where the test was applied to 866 engineering students from different socioeconomic and cultural development stratum. The results, after making corrections to the original instrument and verifying the instrument's stability over time (test-retest analysis), makes it possible to affirm that the proposed objective has been achieved, and that an instrument with acceptable reliability and validity of construction is available. Additionally, it will be informed about the predictive ability of the instrument in different considered degrees, and in relation to socioeconomic and cultural aspects of the students.

A policy framework for public health uses of electronic health data

Successful implementation of a program of active safety surveillance of drugs and medical products depends on public trust. This article summarizes how the initial pilot phase of the FDA's Sentinel Initiative, Mini-Sentinel, is being conducted in compliance with applicable federal and state laws. The article also sets forth the attributes of Mini-Sentinel that enhance privacy and public trust, including the use of a distributed data system (where identifiable information remains at the data partners) and the adoption by participants of additional mandatory policies and procedures implementing fair information practices. The authors conclude by discussing the implications of this model for other types of secondary health data uses.