Testing Reminders Research Articles

Optimizing postpartum care for the patient with gestational diabetes mellitus

Gestational diabetes mellitus poses well-established risks to both the mother and infant. As >50% of women with gestational diabetes mellitus will develop type 2 diabetes mellitus in their lifetime, performing postpartum oral glucose tolerance testing is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with gestational diabetes mellitus is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. Previous studies have suggested strategies to promote oral glucose tolerance testing completion to identify type 2 diabetes mellitus. Based on existing evidence, we propose best practices for the postpartum care of women with gestational diabetes mellitus: (1) enhanced patient support for identifying long-term health care providers, (2) patient-centered medical home utilization when possible, (3) patient and provider test reminders, and (4) formalized obstetrician-primary care provider hand offs using the Situation Background Assessment Recommendation (SBAR) mnemonic. These strategies deserve future investigation to solidify a multilevel approach for identifying and preventing the continuum of diabetes.

Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study.

BackgroundAlthough gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV) infection, few test for HIV at regular intervals. Smartphone apps may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently the apps are downloaded, whether they continue to be used over months or years, and the degree to which such apps are tailored to the needs of this population.ObjectiveThe primary objectives of this study were to answer the following questions. (1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones? (2) What features and functions of smartphone apps are most likely to influence MSM’s sustained use of apps over time? (3) What features and functions do MSM prefer in an HIV testing smartphone app?MethodsWe conducted focus groups (n=7, with a total of 34 participants) with a racially and ethnically diverse group of sexually active HIV-negative MSM (mean age 32 years; 11/34 men, 33%, tested for HIV ≥10 months ago) in the United States in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, and deidentified for analysis. We used a constant comparison method (ie, grounded theory coding) to examine and reexamine the themes that emerged from the focus groups.ResultsMen reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. Participants also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors.ConclusionsMobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of an HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.

The Promise and Pitfalls of the Real

Audience members sit at tables and desks in an interactive classroom, an immersive performance space designed to evoke a K–12 classroom. Blackboards are covered with homework assignments and test reminders, posters with test-taking tips and motivational quotes such as “For success, attitude is as important as ability.” Collaboraction's production of Forgotten Future: The Education Project begins as an interracial, intergenerational ensemble of actors enters the space chanting and waving signs reading “Support our Schools: Don't Close Them” and “Save our Schools” in protest of Chicago's dysfunctional public school system. They wear red T-shirts, and several are clad in the real-life protest T-shirts worn during the school closure protests and the teachers' strike during the 2012–13 school year. The audience soon claps and chants along: “There's no power like the power of the people and the power of the people don't stop” (clap, clap). Adult actors playing parents and teachers give speeches in between the chants. The kids in the ensemble try to speak, but the adults run right over them. By the end of the rally, the kids are standing off in a corner of the space, forlorn and ignored, while the adults yell on their behalf without ever asking for their perspective.

Going mobile with diabetes support: a randomized study of a text message-based personalized behavioral intervention for type 2 diabetes self-care.

Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program.Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor.Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05).Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

Recruitment and retention of young women into nutrition research studies: practical considerations.

BackgroundSuccessful recruitment and retention of participants into research studies is critical for optimising internal and external validity. Research into diet and lifestyle of young women is important due to the physiological transitions experienced at this life stage. This paper aims to evaluate data related to recruitment and retention across three research studies with young women, and present practical advice related to recruiting and retaining young women in order to optimise study quality within nutrition research.MethodsRecruitment and retention strategies used in three nutrition studies that targeted young women (18 to 35 years) were critiqued. A randomised controlled trial (RCT), a crossover validation study and a cross-sectional survey were conducted at the University of Newcastle, Australia between 2010 and 2013Successful recruitment was defined as maximum recruitment relative to time. Retention was assessed as maximum participants remaining enrolled at study completion.ResultsRecruitment approaches included notice boards, web and social network sites (Facebook and Twitter), with social media most successful in recruitment. The online survey had the highest recruitment in the shortest time-frame (751 participants in one month). Email, phone and text message were used in study one (RCT) and study two (crossover validation) and assisted in low attrition rates, with 93% and 75.7% completing the RCT and crossover validation study respectively. Of those who did not complete the RCT, reported reasons were: being too busy; and having an unrelated illness.ConclusionRecruiting young women into nutrition research is challenging. Use of social media enhances recruitment, while Email, phone and text message contact improves retention within interventions. Further research comparing strategies to optimise recruitment and retention in young women, including flexible testing times, reminders and incentives is warranted.

How can we improve online HIV and STD prevention for men who have sex with men? Perspectives of hook-up website owners, website users, and HIV/STD directors.

Internet-based interventions have potential to reduce HIV and STD transmission among men who meet male sexual partners online. From November 2009 to May 2010 we surveyed dating and hook-up website users (n = 3,050), website owners (n = 18), and health department HIV/STD directors (n = 81) to identify structural and behavioral prevention interventions that could be implemented online and which a majority of website users were willing to use, owners were willing to implement, and HIV/STD directors perceived to be effective. A majority of each of the three stakeholder groups agreed on the following: (1) automated HIV/STD testing reminders, (2) local STD test site directories, (3) links to sex-positive safe sex videos, (4) access to sexual health experts, (5) profile options to include safer sex preference, (6) chat rooms for specific sexual interests, (7) filtering partners by their profile information, and (8) anonymous e-card partner notification for STD exposure. Findings help build consensus about how to prioritize resources for implementing online HIV and STD prevention interventions and highlight differences between stakeholders to guide future discussion about how to advance prevention efforts.

Scope and effectiveness of mobile phone messaging for HIV/AIDS care: A systematic review

The objective of this mixed method systematic review was to assess the scope, effectiveness, acceptability and feasibility of the use of mobile phone messaging for HIV infection prevention, treatment and care. We comprehensively searched the peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed study quality of included studies (any research design) focusing on mobile phone messaging interventions for HIV care. We present a narrative overview of the results. Twenty-one studies met the inclusion criteria: three randomized controlled trials, 11 interventional studies using other study designs and seven qualitative or cross-sectional studies. We also found six on-going trials and 21 projects. Five of the on-going trials and all the above mentioned projects took place in low or middle-income countries. Mobile phone messaging was researched for HIV prevention, appointment reminders, HIV testing reminders, medication adherence and for communication between health workers. Of the three randomized controlled trials assessing the use of short message service (SMS) to improve medication adherence, two showed positive results. Other interventional studies did not provide significant results. In conclusion, despite an extensive search we found limited evidence on the effectiveness of mobile phone messaging for HIV care. There is a need to adequately document outcomes and constraints of programs using mobile phone messaging to support HIV care to assess the impact and to focus on best practice.

Decreasing Missed Opportunities for HIV Testing in Primary Care through Enhanced Utilization of the Electronic Medical Record.

We sought to decrease "missed opportunities" for HIV testing by implementing an electronic medical record based intervention designed to increase HIV testing among previously untested men and women ages 18-64 seeking primary medical care in an urban publicly-funded health care system. In July 2010, we implemented an electronic medical record based reminder to alert providers to the absence of an HIV test among all patients' ages 13-64 years old. We compared the rate of missed opportunities for HIV testing among primary care patients seen during the two and a half years before the intervention with that of patients seen during the two years after the intervention was begun. A "missed opportunity" was defined as the failure of a previously untested patient to obtain HIV testing despite having made one or more primary care office visits during a specified time period. After the implementation of HIV testing reminders, first-time HIV testing increased significantly for both men and women 18-64 years old, resulting in a significant reduction in "missed opportunities." The intervention was equally effective across different racial and ethnic groups. An increase in new HIV diagnoses after the intervention was observed, consistent with an increase in the number of individuals in the population who received testing. An electronic medical record-based reminder can significantly increase HIV testing among men and women ages 18-64 who are seeking primary care services.

Promotion and uptake of a new online partner notification and retesting reminder service for gay men

In 2006, two new innovative features were added to a website called WhyTest which provided HIV/sexually transmissable infection (STI) information for gay men. The features were the 'Tell them' service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the 'Remind me' service allowing visitors to register for a 3-, 6- or 12-monthly SMS reminder for a sexual health check. We describe the uptake of the new website functionality, and recognition of a health promotion campaign conducted in January-June 2007 to promote these new features. We used Poisson regression to assess trends in monthly partner notification messages and STI testing reminders sent in August 2007-June 2010. We also analysed 2007 Sydney Gay Community Periodic Survey data to measure recall of the campaign. A total of 7923 partner notification messages were sent in the period August 2007-June 2010, with a significant increasing trend in monthly messages sent (P<0001). Of the total messages sent, 7581 (96%) were by SMS and 342 (4%) by e-postcards. A total of 1023 STI testing reminders were sent in the same period, with a significant increasing trend in monthly reminders sent (P<0.001); 516 reminders were by SMS (50.4%) and 507 by email (49.6%). The 2007 Sydney Gay Community Periodic Survey showed that 55% of the 2342 participants recognised the WhyTest image in the campaign. There was high awareness of WhyTest campaign images and the SMS partner notification service was more popular than the e-postcard feature.

The Rise of the Social Pathologist: The Importance of Social Media to Pathology

Most people reading this editorial are older than 55 years and have the paper version of Archives of Pathology & Laboratory Medicine in hand. You surf the Web for news, perhaps buy a few items at Amazon.com, and exchange e-mail with friends and family. Social media or social networking probably seem best left to high school students. But you have seen its power by watching the demonstrations associated with the Iran election and the stream of user-generated images after the earthquakes in China, Haiti, and Chile. Real-time communication platforms like Twitter and Facebook had spread the word about what was happening within these nations, long before the mainstream media reported the story. The Chinese government, for example, first learned about the earthquake in the Sichuan province from its own citizens using social media. These news stories may have led you to explore Facebook and Twitter, but the idea of opening your personal life—let alone your professional one—to Internet commentary seems perverse and an invitation to disaster. But there is no denying that social media—an umbrella term for the various activities that integrate technology, social interaction, and the construction of words, pictures, and audio—is becoming a force. At one point, Twitter was in the running to become Time Magazine’s ‘‘Person of the Year.’’ Social media is part of Web 2.0, the buzzword that refers to the evolution of the Internet from a passive viewing model (Web-as-information source) to a more personal and interactive experience (the participatory Web). A news story that is delivered online becomes social media if there is a place for readers to comment; the interactive component is the key. Internet applications now facilitate information sharing, interoperability, user-content generation, and collaboration, thereby democratizing knowledge and enriching the user experience. Companies are beginning to use social media as a marketing and customer support tool. As of the end of March 2010, 600 hospitals were actively using social media, including 280 YouTube channels, 382 Facebook pages, 470 Twitter accounts, and 82 blogs. But is there any value for physicians in general and pathologists in particular? Let’s take a look at some of the more popular forms of social media and consider the possibilities for our profession. Pathology 2.0 is a term coined by Keith Kaplan, MD, of the Mayo Clinic (Rochester, Minnesota) to describe the ability to share and interact with pathology images and content. It points to the increased use of blogs, wikis, YouTube videos, and other social-networking technologies. Pathologists have been slow to embrace the tools of Pathology 2.0. Even second-year medical students, when offered the ability to actively participate in a lung pathology course using a blog and Twitter account, were very tentative. But such teaching experiments presage a time when most lectures will be Webcasts and the commentary will be driven by social media interchanges. Forums and Listservs have been around a long time and the oldest and most active one, PATHO-L, recently surpassed 800 subscribers. There is a mix of useful information along with politics and nonpathology commentary. It relies on e-mail interchanges and lacks the dynamics and rich media experience of Web 2.0. There is healthy give-and-take, with no risk of anything ‘‘going viral.’’ Excellent pathology blogs are available, such as Bruce Friedman’s Lab Soft News (http://labsoftnews.typepad. com/; accessed April 21, 2010), Keith Kaplan’s Digital Pathology Blog (http://www.tissuepathology.typepad. com/weblog/; accessed April 21, 2010), and Mark Pool’s The Daily Sign-Out (http://pathlabmed.typepad.com/; accessed April 21, 2010). All are well established and provide useful pathology news and opinion, with the option to post comments and to be alerted to new posts via Twitter. Pathologists typically have the largest collection of books in the hospital, aside from the library, but there is nothing that inherently connects those texts. That is the idea of a pathology wiki or online encyclopedia. Created Accepted for publication May 13, 2010. From Affiliated Pathologists Medical Group, Torrance, California. The author has no relevant financial interest in the products or companies described in this article. Reprints: Eric F. Glassy, MD, Affiliated Pathologists Medical Group, 19951 Mariner Ave, Suite 155, Torrance, CA 90503 (e-mail: efglassymd@ affiliatedpath.com). Editorial

Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007)

BackgroundComputerised clinical decision support systems (CDSSs) are used widely to improve quality of care and patient outcomes. This systematic review evaluated the impact of CDSSs in targeting specific aspects of prescribing, namely initiating, monitoring and stopping therapy. We also examined the influence of clinical setting (institutional vs ambulatory care), system- or user-initiation of CDSS, multi-faceted vs stand alone CDSS interventions and clinical target on practice changes in line with the intent of the CDSS.MethodsWe searched Medline, Embase and PsychINFO for publications from 1990-2007 detailing CDSS prescribing interventions. Pairs of independent reviewers extracted the key features and prescribing outcomes of methodologically adequate studies (experiments and strong quasi-experiments).Results56 studies met our inclusion criteria, 38 addressing initiating, 23 monitoring and three stopping therapy. At the time of initiating therapy, CDSSs appear to be somewhat more effective after, rather than before, drug selection has occurred (7/12 versus 12/26 studies reporting statistically significant improvements in favour of CDSSs on = 50% of prescribing outcomes reported). CDSSs also appeared to be effective for monitoring therapy, particularly using laboratory test reminders (4/7 studies reporting significant improvements in favour of CDSSs on the majority of prescribing outcomes). None of the studies addressing stopping therapy demonstrated impacts in favour of CDSSs over comparators. The most consistently effective approaches used system-initiated advice to fine-tune existing therapy by making recommendations to improve patient safety, adjust the dose, duration or form of prescribed drugs or increase the laboratory testing rates for patients on long-term therapy. CDSSs appeared to perform better in institutional compared to ambulatory settings and when decision support was initiated automatically by the system as opposed to user initiation. CDSSs implemented with other strategies such as education were no more successful in improving prescribing than stand alone interventions. Cardiovascular disease was the most studied clinical target but few studies demonstrated significant improvements on the majority of prescribing outcomes.ConclusionOur understanding of CDSS impacts on specific aspects of the prescribing process remains relatively limited. Future implementation should build on effective approaches including the use of system-initiated advice to address safety issues and improve the monitoring of therapy.

Pressing the key pad: trial of a novel approach to health promotion advice

Background. A relatively simple procedure, the Pap test, is effective in detecting early changes in the cervix; however, many at-risk women, even in developed countries, do not have regular Pap tests. Methods. A randomized controlled trial of an interactive voice response (IVR) cervical screening brief advice involving 17,008 households is described. The IVR system automatically made calls to households and explained the nature of the call; selected one eligible woman aged 18–69 years; determined her screening status; delivered a message appropriate to her screening status; offered additional messages to counter common barriers; offered additional information on cervical screening and cancer; offered additional contact numbers; and offered to arrange for someone to call back. Cervical screening rate data were obtained from the Australian Health Insurance Commission (HIC) for 6 months before and following the intervention. Results. The cervical screening rate was found to have increased by 0.43% in intervention compared to the control postcodes, and the increase was greater for older women at 1.34%. Conclusions. The overall conclusion was that IVR technology was a feasible means to contact women to deliver brief interventions aimed at increasing cervical screening rates and could economically target at-risk groups. The potential for linking IVR to centralized Pap test Registers to issue Pap test reminders should be explored.