Use of the patient portal among older adults with diagnosed dementia and their care partners

INTRODUCTION

Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis.

METHODS

We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients.

RESULTS

Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%).

DISCUSSION

The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access.

The Short and Long-Term Correlates of Change in Loneliness Status: The Role of Epidemic Control Measures During the COVID-19 Pandemic

The COVID-19 pandemic and corresponding measures taken to control it seem to have had negative effects on the well-being of older people. The present study regressed short and long-term loneliness scores on the degree of stringency of epidemic control policies in Europe and in Israel, and on other pandemic-related variables, controlling for a range of possible confounders. The longitudinal sample numbered 18,265 persons, aged 65 and older. The analysis revealed that loneliness rose at both post-outbreak time measurement points. Moreover, stringency was related to change for the worse in loneliness status. Electronic-based communication did not reduce loneliness, while face-to-face contact did. The findings underscore that pandemic-related policy measures have unintended social consequences that need to be addressed.

Prevalence of Workplace Cyberbullying among Dental Hygienists

Purpose Increased use of technology, including social media, has led to a new phenomenon of workplace cyberbullying, specifically within the health care professions. The purpose of this study was to measure the prevalence of workplace cyberbullying among clinical dental hygienists and identify relationships between these behaviors and demographic characteristics.Methods A cross-sectional survey research design was used with a non-probability sample of clinical dental hygienists (n=714) recruited via social media. The validated Workplace Cyberbullying Measure (WCM) survey instrument was used for data collection which included work-related (10 items) and person-related (7 items) subscales. Data analysis included descriptive statistics and correlations.Results The completion rate was 88.8% (n=634). The prevalence of workplace cyberbullying among participants was 19%, with the highest frequency of negative acts occurring now and then. When comparing the two subscales among different workplace settings corporate dental/Dental Service Organizations (DSOs) had a higher work-related subscale score (M=1.84, SD=0.78) than private practice (p=0.03), but not community/public health clinical settings (p=0.69). Community/public health clinics had a higher work-related subscale score (M=1.78, SD=0.68) than private practice (p<0.001). Corporate dental/DSOs had a higher person-related cyberbullying score (M=1.49, SD=0.59) than private practice (p=0.003) but not community/public health clinics (p=0.37). Corporate dental/DSOs had higher work-related and person-related cyberbullying scores than private practice, however community/public health clinic participants reported a greater incidence of WCB.Conclusion Dental hygienists (20%) report experiencing workplace cyberbullying in the past 6 months especially in corporate dental/DSOs and community/public health settings. Corporate dental/DSOs may need to investigate educating personnel on WCB. Employers, particularly corporate/DSOs and public health agencies, need to have policies in place to manage WCB.

Implementation of a Web-Based Communication System for Primary Care Providers and Cancer Specialists

Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs' experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist's initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists.

Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

BACKGROUND

Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists.

OBJECTIVE

This study aimed to examine whether a web- and text-based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or posttreatment survivorship care.

METHODS

In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization.

RESULTS

The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to the 1-month follow-up for GAD-7 (mean difference -2.3; P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and the 6-month follow-up (mean difference -1.7; P=.03) and between baseline and the 12-month follow-up (mean difference -2.4; P=.004).

CONCLUSIONS

PCPs' and cancer specialists' access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs' and cancer specialists' access to the eOncoNote intervention may be a factor in reducing patient anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785.

Use of Electronic Communication with Clinicians Among Cancer Survivors: Health Information National Trend Survey in 2019 and 2020

Purpose: To describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. Methods: Secondary analysis included cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the past 12 months. Bivariate analysis and logistic regression were conducted to examine factors associated with e-communication use. All analyses considered the complex survey design using the jackknife replication method. Results: The prevalence of e-communication use was 64% among cancer survivors. The overall e-communication use slightly increased after the start of the COVID-19 pandemic (63% vs. 64%, p = 0.79). Older adults (≥65 years old) were less likely to use e-communication (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.36-0.86); survivors who were white (OR = 2.30; 95% CI, 1.36-3.86), living in a metro area (OR = 2.47; 95% CI, 1.44-4.27), diagnosed with breast cancer (OR = 2.03; 95% CI, 1.06-3.88), seeking cancer-related information previously (OR = 2.89; 95% CI, 1.83-4.58), or having a regular health care provider (OR = 2.07,; 95% CI, 1.10-3.88) were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use (p = 0.053) when other variables were controlled. Conclusion: This nationally representative survey analysis has identified disparities in e-communication use among cancer survivors and revealed the potential increase in e-communication use under the impact of the COVID-19 pandemic. Additional support is clearly warranted for those older, nonwhite, living in rural areas, or without a regular provider, to promote their e-communication use for the delivery of optimal and high-quality cancer care.

Patient and Healthcare Provider Perspectives on the Implementation of a Web-Based Clinical Communication System for Cancer: A Qualitative Study

Previous research has identified communication and care coordination problems for patients with cancer. Healthcare providers (HCPs) have reported communication issues due to the incompatibility of electronic medical records (EMR) software and not being consistently copied on patient reports. We evaluated an asynchronous web-based communication system ("eOncoNote") for primary care providers and cancer specialists to improve cancer care coordination. The objectives were to examine patients' perceptions of the role of eOncoNote in their healthcare, and HCPs' experiences of implementing eOncoNote. Qualitative interviews were conducted with patients with breast and prostate cancer, primary care providers, and cancer specialists. Eighteen patients and fourteen HCPs participated. Six themes were identified from the patient interviews focusing on HCP and patient roles related to care coordination and patient awareness of communication among their HCPs. Four themes were identified from HCP interviews related to the context of care coordination and experience with eOncoNote. Both patients and HCPs described the important role patients and caregivers play in care coordination. The results show that patients were often unaware of the communication between their HCPs and assumed they were communicating. HCPs encountered challenges incorporating eOncoNote into their workflow.

A Graphene Acid - TiO2 Nanohybrid as Multifunctional Heterogeneous Photocatalyst for the Synthesis of 1,3,4-Oxadiazoles

The immobilization of TiO₂ nanoparticles on graphene acid (GA), a conductive graphene derivative densely functionalized with COOH groups, is presented. The interaction between the carboxyl groups of the surface and the titanium precursor leads to a controlled TiO₂ heterogenization on the nanosheet according to microscopic and spectroscopic characterizations. Electronic communication shared among graphene and semiconductor nanoparticles shifts the hybrid material optical features toward less energetic radiation but maintaining the conductivity. Therefore, GA-TiO₂ is employed as heterogeneous photocatalyst for the synthesis of 2,5-disubstituted 1,3,4-oxadiazoles using ketoacids and hydrazides as substrates. The material presented enhanced photoactivity compared to bare TiO₂, being able to yield a large structural variety of oxadiazoles in reaction times as fast as 1 h with full recyclability and stability. The carbocatalytic character of GA is the responsible for the substrates condensation and the GA-TiO₂ light interaction ability is able to photocatalyze the cyclization to the final 1,3,4-oxadiazoles, demonstrating the optimal performance of this multifunctional photocatalytic material.

Digital solution for follow-up in congenital cardiac surgery

BACKGROUND

In this era of public scrutiny, there is an ongoing need for innovative methods for patient follow-up.

OBJECTIVES

As part of a quality initiative, we developed an automated post-operative follow-up system for patients following discharge after cardiac surgery at Boston Children's Hospital.

METHODS

Discharge Communication (DisCo) is a web-based system developed at Boston Children's Hospital. An automated text and e-mail with a link to a health status survey are sent at 30 days and 1 year post-discharge in English/Spanish. If there is no response, surveys are completed via phone calls to the patient/patient's physician or chart review. Responses are stored in the DisCo database and the patient's medical record. Patients who underwent cardiac surgery and survived to hospital discharge from October, 2016 received the surveys.

RESULTS

Overall, 3345 30-day and 2563 1-year surveys were sent between October, 2016 and June, 2020. Of 3345 30-day surveys, there were 3191 responses (95%). Of 2563 1-year surveys, there were 1807 responses (71%). Most patients/families responded directly to the link at 30 days (65% for paediatrics/75% for adults) and at 1 year (72% for paediatrics/78% for adults). Multi-variable logistic regression revealed that higher complexity of cardiac lesion, presence of major non-cardiac anomalies and presence of major residua were associated with readmission and catheter/surgical reinterventions. Non-cardiac anomalies were associated with increased need for services for learning, development or behaviour.

CONCLUSIONS

DisCo provides a successful web-based health status assessment of patients following congenital cardiac surgery. It helps to identify high-risk patients who need closer follow-up.

Voluntary Assisted Dying by Practitioner Administration Is Not Suicide: A Way Past the Commonwealth Criminal Code?

Five Australian States - Victoria, Western Australia, Tasmania, South Australia and Queensland - have now legalised voluntary assisted dying (VAD). These State legislative schemes intersect with provisions in the Criminal Code Act 1995 (Cth) (Commonwealth Criminal Code) which prohibit using electronic communication to counsel, promote, or provide instruction on "suicide". These provisions may prevent some conversations and assessments relating to self-administration of VAD occurring via telehealth, thereby restricting access for prospective VAD patients in regional and remote areas. However, as practitioner administration of VAD is not "suicide", the Commonwealth Criminal Code does not apply. The Commonwealth law creates the absurd result that the same conversation conducted via telehealth is illegal when contemplating VAD by self-administration, but legal when discussing practitioner-administered VAD. To avoid this, we advocate amending the Code to remove the inconsistency with state VAD laws. We also recommend State legislatures consider permitting greater access to VAD by practitioner-administered VAD.

Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study

BACKGROUND

Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level.

OBJECTIVE

The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3.

METHODS

Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method.

RESULTS

The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02).

CONCLUSIONS

This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.

Ultralong Room-Temperature Phosphorescence from Boric Acid

For a long time, phosphors with long-lived emission are dominated by rare earth/transition metal ion-doped sulfides and oxides. Recently, organic materials capable of emitting long-lived room-temperature phosphorescence (RTP) are reported, carbon skeletons are almost the exclusive structural feature of the conjugated luminophores. Herein, we reported that boric acid, a non-metal and C-free material, could emit RTP with lifetime up to 0.3 s. Detailed investigations indicated the weak conjugation between the n electrons of the O atoms in the B-O confined space was the possible origin of RTP. Similar RTP was also found in electron-rich N/F systems, namely, BN and BF₃ (BF₄ ^- ). Importantly, the vacant p z 0 orbital of B was found to contribute to the relevant unoccupied molecular orbitals involved in excitation, which is different from previous reports on phosphorescence from arylboronic acids. The results confirm the unique role of B as a versatile structure motif for construction of new RTP materials.

Synthesis and Optoelectronic Properties of a Quinoxalino-Phenanthrophenazine (QPP) Extended Tribenzotriquinacene (TBTQ)

A six‐step synthesis towards a tribenzotriquinacene (TBTQ) bearing three quinoxalinophenanthrophenazine (QPP) units is presented. The optoelectronic properties are investigated and the effect of the three‐dimensional arrangement of the individual QPP planes is examined using optical spectroscopy, electrochemical analysis and quantum‐chemical calculations.

Electronic Communication with Public Administration in the Time of COVID-19-Poland's Experience

The situation associated with the growing number of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections forced ongoing monitoring of the epidemic situation, which entailed an introduction of a number of restrictions and solutions intended to isolate the infected persons on the one hand, and to minimize the risk of development of an epidemic in Poland on the other. Activity of the Polish legislator is also essential, which tried to introduce solutions that would correspond with current expectations and needs. Given the multiplicity of the introduced regulations, interpretation of provisions of statutes has not always been easy. In this paper, the author points to the issues of communication with a public authority by specific reflections on the principles of serving documents on beneficiaries of EU programs under which they were awarded funding for their implementation on the basis of EU regulations addressing the use of the European Regional Development Fund, the European Social Fund and the Cohesion Fund for programs implemented as part of the cohesion policy (Regulations of the European Parliament and of the Council (EU) of 17 December 2013: no. 1303/2013, no. 1301/2013, no. 1304/2013, no 1300/2013, and no. 1299/2013). The author focuses on the issues of communication with an authority in a situation where administrative proceedings are initiated against a beneficiary of EU funds, e.g., for returning the granted funding. The author points to the dynamics of the legislator's work in this respect by analyzing the rules for serving documents by a public authority on beneficiaries who are public entities and those who are not. The author's main research aim is to analyze existing provisions establishing the possibility of electronic communication with a public authority, and also to assess them critically due to the extraordinary situation caused by Coronavirus Disease 2019 (COVID-19). This is intended to verify the main research hypothesis focusing on the attempt to answer a question whether existing regulations, and those created at the time of the epidemic threat and the state of epidemic in Poland facilitate citizens' electronic communication with a public authority. The author aims to answer a question about whether the Polish legislator responds appropriately to the numerous emerging challenges associated with the pandemic and whether it created regulations that effectively ensure the possibility of continuity of contact with a public authority for citizens who are the beneficiaries of public funds. This analysis may contribute to the understanding of whether and how it is possible to improve citizens' contact with public authorities, which in the future may eliminate barriers and obstacles arising in this regard. The author bases her reflections on the experience resulting from providing legal services for one of the Polish Managing Authorities of the Regional Operational Programme using at the same time a number of research methods (i.e., the method of interpretation of applicable laws to establish applicable provisions of the law that regulate admissibility of electronic communication with a public authority and to establish efficiency of such communication, the analytical method, applied in reference to the relevant state of the art in the achievements of legal scholarship, and the empirical method, based on observation and analysis of practical issues resulting from the author's cooperation with a Polish managing authority). In her conclusions, the author points to the lack of introduction of comprehensive regulations (also at the EU level-for all EU Member States) in terms of de-formalizing the principles of communication in the course of pending administrative proceedings. The author notices an absence of unambiguous regulations that allow for a scanned document signed by hand and sent my email to be qualified into the category of documents served by electronic means, through use of means of electronic communication. The author assesses this absence negatively due to the fact that such action seems the simplest in a situation caused by COVID-19.

American College of Physicians Ethical Guidance for Electronic Patient-Physician Communication: Aligning Expectations

Communication is critical to strong patient-physician relationships and high-quality health care. In recent years, advances in health information technology have altered how patients and doctors interact and communicate. Increasingly, e-communication outside of in-person clinical encounters occurs in many ways, including through e-mail, patient-portals, texting, and messaging applications. This American College of Physicians (ACP) position paper provides ethics and professionalism guidance for these forms of e-communication to help maintain trust in patient-physician relationships and the profession and alignment between patient and physician expectations.

Electronic Communication in Confined Space Coronas of Shell-by-Shell Structured Al2 O3 Nanoparticle Hybrids Containing Two Layers of Functional Organic Ligands

A first series of examples for confined space interactions of electron-rich and electron-poor molecules organized in an internal corona of shell-by-shell (SbS)-structured Al₂ O₃ nanoparticle (NP) hybrids is reported. The assembly concept of the corresponding hierarchical architectures relies on both covalent grafting of phosphonic acids on the NPs surface (SAMs formation; SAM=self-assembled monolayer) and exohedral interdigitation of orthogonal amphiphiles as the second ligand layer driven by solvophobic interactions. The electronic communication between the chromophores of different electron demand, such as pyrenes, perylenediimides (PDIs; with and without pyridinium bromide headgroups) and fullerenes was promoted at the layer interface. In this work, it is demonstrated that the efficient construction principle of the bilayer hybrids assembled around the electronically "innocent" Al₂ O₃ core is robust enough to achieve control over electronic communication between electron-donors and -acceptors in the interlayer region. The electronic interactions between the electron-accepting and electron-donating moieties approaching each other at the layer interface were monitored by fluorescence measurements.

Investigating Electronic Communications in meso-meso Ethene-Bridged Unsymmetrical Diporphyrins

At the focal point of this work is the photophysical characterization of three meso-meso ethene-bridged diporphyrins featuring a diverse metallation pattern. Detailed investigations by means of cyclic voltammetry, absorption, fluorescence, and femto-/nanosecond transient absorption spectroscopy revealed the impact of open-shell nickel(II) on the electronic communication in ethene-bridged heterobimetallic diporphyrins.

Oxidative Coupling of Anionic Abnormal N-Heterocyclic Carbenes: Efficient Access to Janus-Type 4,4'-Bis(2H-imidazol-2-ylidene)s

The oxidative coupling of anionic imidazol-4-ylidenes protected at the C2 position with [MnCp(CO)₂ ] or BH₃ led to the corresponding 4,4'-bis(2H-imidazol-2-ylidene) complexes or adducts, in which the two carbene moieties are connected through a single C-C bond. Subsequent acidic treatment of the later species led to the corresponding 4,4'-bis(imidazolium) salts in good yields. The overall procedure offers practical access to a novel class of Janus-type bis(NHC)s. Strikingly, the coplanarity of the two NHC rings within the mesityl derivative 4,4'-bis(IMes), favored by steric hindrance along with stabilizing intramolecular C-H⋅⋅⋅π aryl interactions, allows the alignment of the π-systems and, as a direct consequence, significant electron communication through the bis(carbene) scaffold.

Enhanced Electronic Communication and Electrochemical Sensitivity Benefiting from the Cooperation of Quadruple Hydrogen Bonding and π-π Interactions in Graphene/Multi-Walled Carbon Nanotube Hybrids

By designing a molecule labeled as UPPY with both ureidopyrimidinone (UP) and pyrene (PY) units, the supramolecular self-assembly of multiwalled carbon nanotube (MWNT) and reduced graphene oxide (rGO) was driven by the UP quadruple hydrogen-bonding and PY-based π-π interactions to form a novel hybrid of rGO-UPPY-MWNT in which the morphology of rGO-wrapped MWNT was found. Bridged by the two kinds of noncovalent bonding, enhanced electronic communication occurred in rGO-UPPY-MWNT. Also, under the cooperation of UP quadruple hydrogen-bonding and PY-based π-π interactions, higher electrical conductivity and better charge transfer were observed for rGO-UPPY-MWNT, compared with the rGO-MWNT composite without such noncovalent bonds, and that with just single PY-based π-π interaction (rGO-PY-MWNT) or UP quadruple hydrogen bond (rGO-UP-MWNT). Specifically, the electrical conductivity of rGO-PY-MWNT hybrids was increased approximately sevenfold, and the interfacial charge transfer resistance was nearly decreased by 1 order of magnitude compared with rGO-MWNT, rGO-UP-MWNT, and rGO-PY-MWNT. Resulting from its excellent electrical conductivity and charge transfer properties, the rGO-UPPY-MWNT modified electrode exhibited enhanced electrochemical activity toward dopamine with detection limit as low as 20 nM.

Perceived Barriers to and Facilitators of Patient-to-Provider E-Mail in the Management of Diabetes Care

OBJECTIVES

1) to describe current utilization of e-mail in the clinical care of patients with diabetes; and 2) to identify barriers to and facilitators of the adoption of e-mail in diabetes care.

METHODS

Participants included diabetes care providers, including 9 physicians and 7 allied health professionals (AHPs). Participation involved, first, completing a self-administered survey to evaluate the use of e-mail within diabetes-related clinical practice. Second, focus group discussions were conducted with diabetes care providers using semistructured interviews to collect data about their perceptions of using e-mail to exchange information with patients diagnosed with diabetes. Patients' perspectives on the use of e-communication with their care providers was also proposed on the basis of the discussions.

RESULTS

Significant differences were found between physicians and AHPs concerning questions that were related to the use of e-mail and the amount of time spent using e-mail to communicate to patients. There was perceived function and value to the use of e-mail among AHPs, while few physicians used e-mail routinely and were uncertain about its potential in improving care. Five themes, including barriers, benefits, risks, safeguards and compensation, were developed from the focus group interviews.

CONCLUSIONS

Currently, most of the physicians surveyed do not e-mail patients directly; however, AHPs frequently use e-mail in diabetes care and find this tool valuable. Variation in practices regarding clinical e-mail across care disciplines suggest that appropriate policy with guidelines for e-mail and e-communication within the health care system may improve uptake of clinical e-mail and perhaps, by extension, improve efficiency and access in diabetes care.

Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial

BACKGROUND

Type 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals' decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands.

METHODS/DESIGN

The INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18-65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients. Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients' results. Group 3 is receiving a combination of the interventions for patients and professionals. The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used to analyze changes in outcomes. The cost-effectiveness analysis, from the healthcare services perspective, involves direct medical costs per quality-adjusted life year gained and two periods, a 'within-trial' period and a lifetime Markov model. Deterministic and probabilistic sensitivity analyses are planned.

DISCUSSION

This ongoing trial aims to set up the implementation of evidence-based programs in the clinical setting for chronic patients.

TRIAL REGISTRATION

Clinical Trial.gov NCT01657227.

Linking deltahedral Zintl clusters with conjugated organic building blocks: synthesis and characterization of the Zintl triad [R-Ge9-CH=CH-CH=CH-Ge9-R]4-

The accessibility of triads with deltahedral Zintl clusters in analogy to fullerene-linker-fullerene triads is another example for the close relationship between fullerenes and Zintl clusters. The compound {[K(2.2.2-crypt)]4[RGe9-CH=CH-CH=CH-Ge9R]}(toluene)2 (R=(2Z,4E)-7-amino-5-aza-hepta-2,4-dien-2-yl), containing two deltahedral [Ge9] clusters linked by a conjugated (1Z,3Z)-buta-1,3-dien-1,4-diyl bridge, was synthesized through the reaction of 1,4-bis(trimethylsilyl)butadiyne with K4Ge9 in ethylenediamine and crystallized after the addition of 2.2.2-cryptand and toluene. The compound was characterized by single-crystal structure analysis as well asNMR and IR spectroscopy.

Patient-provider communication over social media: perspectives of adolescents with psychiatric illness

BACKGROUND

Social media is an increasingly dominant platform for communication, especially among adolescents. Statements from professional bodies and a growing body of empirical evidence support a role for social media in improving provider-patient interactions. In psychiatry, particular concerns exist about the suitability of this style of communication. Very limited data are available exploring how patients would like to incorporate social media into their communication with their psychiatric providers.

METHODS

We conducted a qualitative study with 20 adolescents attending the Yale Psychiatric Hospital Intensive Outpatient Programme. Interviews were analysed using inductive thematic analysis.

RESULTS

Participants highlighted how social media could allow for constant access to a mental health provider, provide a less anxiety-provoking mode of communication, and allow for them to be monitored in a more on-going fashion. However, participants also identified many potential risks associated with these applications, including the potential for anxiety if a provider was not able to respond immediately, and a sense that online interactions would be less rich overall.

DISCUSSION

Our findings suggest that adolescents are open to the idea of communicating with mental health providers over social media and are able to describe a number of instances where this could be of value. The risks participants described, as well as concerns raised by existing literature, indicate the need for further work and protocol development in order for social media to be a feasible tool for communication between providers and adolescents with psychiatric illness.

E-mail communication in pain practice: The importance of being earnest

BACKGROUND

Information technology can play a vital role in meeting patient needs and reinforcing the relationship among patients and their pain physicians. However, strong resistance remains on the medical side to this type of non-frontal care.

OBJECTIVES

The primary objective of this study was to assess the effectiveness of an E-mail intervention on customers' satisfaction. The secondary goals were to analyze the messages from patients to their clinician (not only the volume but also the content) and the impact on client, professional and health services outcomes.

STUDY DESIGN

A prospective, non-randomized evaluation of patients undergoing treatment for chronic pain from September 2011 to May 2012.

SETTING

A private, specialty referral center in Spain.

MATERIALS AND METHODS

Participants were users visiting the Pain Management Unit evaluated by one physician. The E-mail address of the facility was written in every medical report provided. Patient satisfaction at the end of the 8-month trial period was assessed and outcomes recorded.

RESULTS

Patients reported better communication with their therapist and greater satisfaction with overall care. 780 E-mails were read. Specialists received an average of 5 messages per day (standard deviation 0,3). None of them was unsuitable.

LIMITATIONS

This is a prospective, single center evaluation performed by one doctor. There was no control group due to ethical considerations.

CONCLUSIONS

Electronic communication is a cheap, easy and feasible way to address a wide range of concerns, thus enhancing patients' satisfaction. More efforts are needed to implement routinely usage of this tool. If used appropriately, E-mail can facilitate physician-dependent interactions, promote access to care, save time and reduce costs. Concerns about billing, improper utilization, privacy and confidentiality might complicate its introduction and acceptance. Internet access remains a significant barrier to online patient-provider transference.

Communication breakdowns and diagnostic errors: a radiology perspective

Timely and accurate communication is essential to safe and effective health care. Despite increased awareness over the past decade of the frequency of medical errors and greater efforts directed towards improving patient safety, patient harm due to communication breakdowns remains a significant problem. Communication problems related to diagnostic testing may account for nearly half of all errors made by typical primary care physicians in their medical practices. This article provides an overview of communication breakdowns in the context of radiology related diagnostic errors. In radiology, communication breakdowns between radiologists, referring clinicians, and patients can lead to failure of critical information to be relayed, resulting in delayed or missed diagnosis. New technologies, such electronic health records (EHRs), contribute to the increasing complexity of communication in health care, but if used correctly, they can provide several benefits to safe and effective communication. To address the complexity of communication breakdowns, a multifaceted sociotechnical approach is needed to address both technical and non-technical aspects of health care delivery. The article also provides some future directions in reducing communication breakdowns related to diagnostic testing, including proactive risk assessment of communication practices using recently released SAFER self-assessment guides.

Involvement of practice nurses and allied health professionals in the development and management of care planning processes for patients with chronic disease - A pilot study

INTRODUCTION

Medicare items were introduced in 2005 to encourage general practitioners (GPs) to involve other healthcare providers in the management of patients with chronic disease. However, there appears to be barriers to converting financial incentives and the use of information technology as a communication tool to better patient outcomes. The aim of this study was to explore these barriers from the perspectives of practice nurses and allied health practitioners.

METHODS

Three focus groups were held, comprising a convenience sample of 10 practice nurses and 17 allied health professionals from south-east Melbourne.

FINDINGS

FINDINGS were reported under five themes: (1) attitudes and beliefs, (2) communication using care planning documents, (3) electronic communication, (4) care planning and collaboration between healthcare professionals and (5) ongoing challenges.

CONCLUSION

While allied professionals use care planning tools, there is confusion about the extent to which these tools are for the GPs to provide structured care to assist with communication or funding mechanisms for allied health services. Further research is needed on the contributions of these groups to the care planning process and how communication and collaboration between healthcare professionals can be strengthened.

Effects of care management and telehealth: a longitudinal analysis using medicare data

OBJECTIVES

To evaluate mortality and healthcare utilization effects of an intervention that combined care management and telehealth, targeting individuals with congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus.

DESIGN

Retrospective matched cohort study.

SETTING

Northwest United States.

PARTICIPANTS

High-cost Medicare fee-for-service beneficiaries (N = 1,767) enrolled in two Centers for Medicare and Medicaid Services demonstration participating clinics and a propensity-score matched control group.

INTERVENTION

The Health Buddy Program, which integrates a content-driven telehealth system with care management.

MEASUREMENTS

Mortality, inpatient admissions, hospital days, and emergency department (ED) visits during the 2-year study period were measured. Cox-proportional hazard models and negative binomial regression models were used to assess the relationship between the intervention and survival and utilization, controlling for demographic and health characteristics that were statistically different between groups after matching.

RESULTS

At 2 years, participants offered the Health Buddy Program had 15% lower risk-adjusted all-cause mortality (hazard ratio (HR) = 0.85, 95% confidence interval (CI) = 0.74-0.98; P = .03) and had reductions in the number of quarterly inpatient admissions from baseline to the study period that were 18% greater than those of matched controls during this same time period (-0.035 vs -0.003; difference-in-differences = -0.032, 95% CI = -0.054 to -0.010, P = .005). No relationship was found between the Health Buddy Program and ED use or number of hospital days for participants who were hospitalized. The Health Buddy Program was most strongly associated with fewer admissions for individuals with chronic obstructive pulmonary disease and mortality for those with congestive heart failure.

CONCLUSION

Care management coupled with content-driven telehealth technology has potential to improve health outcomes in high-cost Medicare beneficiaries.

Diagnostic errors in ambulatory care: dimensions and preventive strategies

Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may arise: (1) the provider-patient encounter, (2) performance and interpretation of diagnostic tests, (3) follow-up of patients and diagnostic test results, (4) subspecialty consultation, and (5) patients seeking care and adhering to their instruction/appointments, i.e. patient behaviors. We presented these risk domains to conference participants to elicit their views about sources of and solutions to diagnostic errors in ambulatory care. In this paper, we present a summary of discussion in each of these risk domains. Many novel themes and hypotheses for future research and interventions emerged.

Physicians' use of email with patients: factors influencing electronic communication and adherence to best practices

BACKGROUND

With the public's increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, e-mail use by physicians for clinical care has been slow.

OBJECTIVE

To examine the factors associated with physician-patient e-mail, and report on the physicians' adherence to recognized guidelines for e-mail communication.

METHODS

Cross-sectional survey (March-May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics.

RESULTS

The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used e-mail to communicate with patients. Only 120 (2.9%) used e-mail with patients frequently. In univariate analysis, e-mail use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to e-mail use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for e-mail communication.

CONCLUSIONS

This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of e-mail communication, and little adherence to recognized guidelines for e-mail correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of e-mail communication, and to remove fiscal and legal barriers to its adoption.