Defining and Improving Outcomes Measurement for Virtual Care: Report from the VHA State-of-the-Art Conference on Virtual Care

Virtual care, including synchronous and asynchronous telehealth, remote patient monitoring, and the collection and interpretation of patient-generated health data (PGHD), has the potential to transform healthcare delivery and increase access to care. The Veterans Health Administration (VHA) Office of Health Services Research and Development (HSR&D) convened a State-of-the-Art (SOTA) Conference on Virtual Care to identify future virtual care research priorities. Participants were divided into three workgroups focused on virtual care access, engagement, and outcomes. In this article, we report the findings of the Outcomes Workgroup. The group identified virtual care outcome areas with sufficient evidence, areas in need of additional research, and areas that are particularly well-suited to be studied within VHA. Following a rigorous process of literature review and consensus, the group focused on four questions: (1) What outcomes of virtual care should we be measuring and how should we measure them?; (2) how do we choose the "right" care modality for the "right" patient?; (3) what are potential consequences of virtual care on patient safety?; and (4) how can PGHD be used to benefit provider decision-making and patient self-management?. The current article outlines key conclusions that emerged following discussion of these questions, including recommendations for future research.

Toxicity of synthetic musks to early life stages of the freshwater mussel Lampsilis cardium

Polycyclic musk fragrances are common additives to many consumer products. As a result of their widespread use and slow degradation rates, they are widely found in aquatic environments. This study reports on the lethal and sublethal toxicity of the polycyclic musks AHTN (Tonalide) and HHCB (Galaxolide) to glochidial (larval) and juvenile life stages of the freshwater mussel Lampsilis cardium (Rafinesque, 1820). In glochidia, 24-h median lethal concentrations (LC50s) ranged from 454 to 850 microg AHTN/L and from 1000 to >1750 microg HHCB/L (water solubility). Results for 48-h tests were similar to the 24-h tests. In 96-h tests with juveniles, we did not observe a dose-response relation between mortality and either musk. However, the growth rate was reduced by musk exposure. The median effective concentrations (EC50s, based on growth) were highly variable and ranged from 108 to 1034 microg AHTN/L and 153 to 831 microg HHCB/L. While all adverse effects occurred at concentrations that are much greater than those reported in natural waters (low microg/L to ng/L), these results indicate the potential for adverse effects on these long-lived organisms from exposure to synthetic musk fragrances.

Personality of dental students in two dental schools in the United Kingdom and in Ireland

The personality characteristics of students from two dental schools, one in the United Kingdom which admitted students using interviews, and one in Ireland which accepted students solely on examination results, were assessed using the short form of the Eysenck Personality Questionnaire. Results were compared with norms for age and sex. Personality scores of students from the Irish dental school were not significantly different from normal scores. Female and male students from the United Kingdom school scored higher than would be expected on extraversion, and male students from the same school scored lower than would be expected on neuroticism. The differences in personality between the two schools may be explained by the different methods of admission.

Intestinal migrating myoelectric complexes in rats with acute pancreatitis and bile duct ligation

Intestinal migrating myoelectric complexes (MMC) were studied in rats subjected to common bile duct ligation. Four pairs of bipolar electrodes were implanted on the jejunum and the ileum of 21 rats. Animals were allowed to recover 7 days before electrical recordings were made. Bile duct ligation at the entrance to the duodenum (low) or above the pancreas (high) or sham operation was performed. MMCs were recorded before and 48 and 72 hr after the operation in each animal. MMC intervals were unchanged following high ligation or sham operation. However, 48 hr after low bile duct ligation, the MMC interval (20.6 +/- 2.5 min) was significantly prolonged compared with that before ligation (14.0 +/- 1.2 min). Further prolonged intervals (28.4 +/- 4.2 min) were observed 72 hr after the ligation. There were no significant differences among the slow wave frequencies in any group of animals, being in the range of 34.1 +/- 1.1 to 36.3 +/- 1.0 cycles/min. Thus, the MMC pattern in this rat model may be affected by the development of acute pancreatitis. The mechanism(s) responsible for altering the MMC pattern are not known; however, hepatic biliary secretion alone does not appear to play a primary role.

Age differences in the rating of life-stress events: does contextual detail make a difference?

Twenty-four young (20 to 25 years) and 24 elderly (61 to 81 years) subjects rated the short-term (ST) and long-term (LT) threat of 36 life-events drawn from a community study of elderly people. Subjects were presented either with full contextual detail about the respondent and the event or with an edited version in which only a basic outline of the event was presented. Assignment of subjects to conditions was random. Agreement of subjects within and between groups as to what events were threatening was high and the untrained groups were also in close agreement with the consensus ratings of a trained panel. There were no significant main effects of age or contextual condition. It is concluded that the concept of the 'threat' of an event is generalizable over samples. Analysis of a significant age x context interaction showed that only young subjects rating LT threat were affected by contextual condition. Events supplied with context were rated by them as less threatening than those presented in outline. Some evidence was found to support the view that there may be age differences in the perceived impact of an event over time.