bluuebunny/crossref_metadata_2025 huggingface dataset:
E. Milkeyev’s poetics in the context of experience of translation of Heine’s “Ein Fichtenbaum steht einsam” by his contemporaries (F. Tyutchev, M. Lermontov)
Authors: Pyatkov Sergey S.
Published: August 2019

The specifics of the national literary process of the 1820s — early 1840s remains a problematic field in the national philological science, which requires the accumulation of experience in specific studies involving regional material. E. Milkeyev (1815-1845), the poet of the generation of P. Yershov from Siberia, translates the text of Heinrich Heine’s “Ein Fichtenbaum steht einsam”, thereby integrating into the tradition of his artistic reception in Russian literature, in which the versions “From another side” of F. Tyutchev and “In the wild North...” of M. Lermontov are most important and polar (figuratively and thematically). The purpose of the presented research is to use the combination of elements of a system-holistic, structural-semiotic and culturological approach to the analysis of literary phenomena to determine the specific features of the poetics of E. Milkeyev in its relationship with the artistic intentions of the leading poets of Russian literature of the 1830s-1840s. It turns out that the mythological consciousness of E. Milkeyev records the biblical-Christian imagery in the translation of Heinrich Heine’s text. The rhetorical and didactic orientation of the poem, its complexly organized literary space accomplish the exit of the symbolic potential of the German original into a supra-individual transcendental sphere. This correlates with the poetic orientation of F. Tyutchev and philosophical romantic school. However, other artistic and aesthetic tasks do not make the translation of E. Milkeyev the symbol-sign, which was characteristic of “allegorical landscapes” by M. Yu. Lermontov. The article presents for the first time a comparative analysis of the poetics of E. Milkeyev, F. Tyutchev, and M. Lermontov as representatives of a single historical and literary field through the sphere of translation.
3D Printed Teeth for the Preclinical Education of Dental Students
Authors: Höhne Christian , Schmitter Marc
Published: August 2019

A need for more realistic tooth models for education has often been expressed by dental students. The aim of this study was to design and create 3D printed teeth with anatomical details for use in preclinical dental education. A tooth with realistic carious lesions and pulp cavity was designed, and this tooth was used in 2018 with 47 dental students for preclinical education in caries excavation, direct capping of the pulp, core build‐up, and crown preparation. The students had the ability to identify the carious lesions by a simulated radiograph and by tactile sense of the consistency. The benefits of the 3D printed tooth were evaluated by a questionnaire. The printed tooth was evaluated by grades (1=excellent, 2=good, 3=satisfactory, 4=adequate, 5=poor). The students gave the tooth an overall mean grade of 1.9, with a grade of 2.0 for the haptic impression, 1.5 for the exercise, 1.9 for the examination, and 1.5 for high practical relevance in contrast to a standard model tooth. The new features of the printed tooth were given a mean grade of 2.0 for the radiograph, 2.3 for consistency of the caries, 2.0 for the tooth filling, and 1.7 for the pulp capping as realistic. The students had the possibility to generate a complete concept for prosthodontic tooth treatment on an artificial 3D printed tooth.
Clinical Integration in a Dental School Clinic Through an Enhanced Patient Intake Process
Authors: Robinson Fonda G. , Fischbach Henry , Salisbury Jessica , Stefanik Dawne , Kearney Rachel , Fields Henry W.
Published: August 2019

Dental care in the U.S. is based on a general practice model of care delivery that can be enhanced by the integration of the dentists and allied dental professionals. There are 25 U.S. dental schools with associated dental hygiene programs, presenting distinctive opportunities for educating the dental health care team. Integrated educational clinical experiences are believed to positively influence teamwork and quality of care that parallels the authentic general practice environment. Lean management, developed by Toyota and used in a variety of types of organizations including health care, provides a distinctive blend of engineering principles and operations management to enhance business and operations processes. A fundamental principle of Lean management is the elimination of waste and preservation of only those value‐added components of a process. The faculty and staff of The Ohio State University College of Dentistry, trained in Lean process improvement, applied techniques to enhance and integrate an inefficient patient intake (admissions) process. The aim of this initiative was to improve patient throughput in the patient intake process and to provide dental and dental hygiene students with enhanced educational experiences from improved clinical integration. These goals were achieved through streamlining patient flow and relocating major phases of the process. Although new patient retention and cancellation/no‐show rates remained mostly unchanged, this enhancement project resulted in improved access to care, improved continuity of care, expanded scope of dental services offered, improved patient satisfaction, and enhanced dental and dental hygiene student collaboration and teamwork. These outcomes suggest that process improvement initiatives can serve as valuable opportunities for integration of the dental health care team.
The Teaching of Personalized Dentistry in North American Dental Schools: Changes from 2014 to 2017
Authors: Zheng Linda Y. , Rifkin Barry R. , Spielman Andrew I. , London Lucille , London Steven D.
Published: August 2019

The aim of this study was to assess the development of personalized dentistry in the curricula of North American dental schools from 2014 to 2017. In 2014, a web‐based survey on personalized medicine/dentistry (PM/PD) was distributed to academic deans of all U.S. (n=65) and Canadian (n=10) dental schools with graduating classes. The results (n=42; 56% response rate) showed that few schools had plans for implementation of PM/PD at the time, even though the majority of respondents reported feeling that PM/PD should be taught in the curriculum and will impact clinical practice in the future. A three‐year followup survey in 2017, sent to the same 75 schools, was designed to reassess the teaching/practice of PM/PD in dental schools in both didactic and clinical curricula. In the results of the 2017 survey (n=30; 40% response rate), the majority of respondents reported feeling that PM/PD should be taught in dental curricula. However, while most respondents indicated their schools did not teach PM/PD as a portion of their didactic curricula, they reported that specific pertinent PM/PD topics were taught as part of other courses in their curricula. The 2017 survey also evaluated the use of seven genetics‐based and eight non‐genetics‐based PM/PD diagnostics in the schools’ clinical curricula. Overall, non‐genetics‐based diagnostics were used more often than genetics‐based diagnostics, and the use of genetics‐based diagnostics was more prevalent in postgraduate than predoctoral clinics. Personalized dentistry will inevitably be part of the dental professional's future and should be reflected in basic science research, clinical settings, and dental school curricula in both predoctoral and postgraduate programs.
U.S. Re‐Licensure Opioid/Pain Management Continuing Education Requirements in Dentistry, Dental Hygiene, and Medicine
Authors: Wiener R. Constance , Waters Christopher , Bhandari Ruchi , Trickett Shockey Alcinda K. , Panagakos Fotinos
Published: August 2019

Drug‐induced deaths have been accelerating over the last two decades. The aim of this study was to determine if states with high opioid‐induced deaths and overall drug‐induced deaths were more likely to have continuing education (CE) requirements related to opioid use/pain management than states with fewer opioid‐induced deaths. Almost 200 state dental and medical law boards' websites were examined for CE requirements, license renewal periods, and CE requirements for opioid use/pain management in December 2018 and January 2019. Drug‐induced death data were obtained from the Centers for Disease Control and Prevention online database. States were categorized into quartiles of opioid‐induced deaths per 100,000 population. A similar categorization was created for all drug‐induced deaths. The results showed that states in the second, third, and fourth quartiles of opioid‐induced deaths were more likely to have dental boards requiring opioid use/pain management CE than states in the first quartile in dentistry. This pattern was not the case with the medical boards' requirements. Dentists and physicians in states with higher all drug‐induced deaths per 100,000 population were as likely to be required to attend opioid use/pain management CE as dentists and physicians in states with lower opioid‐induced deaths. Although many licensing boards require opioid use/pain management CE in relation to their opioid‐induced death rates, there is a need for policies to increase education in substance use disorders to reduce the number of drug‐induced deaths.
Comparison of Efficiency and Image Quality of Photostimulable Phosphor Plate and Charge‐Coupled Device Receptors in Dental Radiography
Authors: Zhang Wenjian , Huynh Carolyn , Jadhav Aniket , Pinales Jose , Arvizu Liliana , Tsai Jenny , Flores Nidia
Published: August 2019

The photostimulable phosphor (PSP) plate and charge‐coupled device (CCD) are receptors commonly used for intraoral radiography in U.S. dental schools. However, it is unclear which receptor is more beneficial for radiology education and patient care in an academic setting. The aim of this study was to compare the time efficiency, image quality, and operator performance for student‐operated PSP plate and CCD receptors. At one U.S. dental school in 2018, 20 dental hygiene and dental students (n=10 each) were recruited as operators. They each exposed anterior and posterior periapical and bitewing radiographs on dental radiograph teaching and training replica using the PSP plate and CCD as receptors. The time taken to expose the radiographs was recorded. Image sharpness/definition, brightness/contrast, and technical errors, including placement, angulation, and cone cut errors, were evaluated on a three‐point scale with 0=non‐diagnostic, 1=diagnostic acceptable with minor errors, and 2=perfect diagnostic quality. The results showed that it was generally faster for the students to expose intraoral radiographs with CCDs than with PSP plates, although the difference was not significant (p>0.05). Image quality and technical accuracy, especially angulation, were significantly superior for PSP relative to CCD (p<0.05). This study found that PSP imaging was of higher quality and accuracy than CCD, whereas CCD was more efficient. Dental and dental hygiene students would benefit from being trained on both receptors to be able to adapt to a diversified workplace.
Empathy Levels of Dental Faculty and Students: A Survey Study at an Academic Dental Institution in Chile
Authors: Carvajal Melissa , López Susana , Sarabia‐Alvarez Pablo , Fontealba Johana , Padilla Mariela , Sumi Joyce , Díaz‐Narváez Víctor P.
Published: August 2019

A successful health care provider may be described as a clinician capable of establishing a comprehensive diagnosis including identifying related risk factors. However, an equally important quality a clinician should possess is the ability to understand the experiences and feelings of others to allow better communication for better outcomes. It is likely that faculty empathy levels influence students' ability to demonstrate this attribute. The aim of this study was to assess the levels of empathy of dental faculty members relative to dental students at the Universidad San Sebastian in Chile. Using a cross‐sectional design of survey‐collected data collected with the Jefferson Scale of Empathy, the authors compared the perceptions of the dental faculty involved in teaching fourth‐ and fifth‐year dental students (n=116) to the perceptions of basic and preclinical students (n=346) and clinical students (n=189). The data were collected in 2016‐17. The results showed that the mean faculty scores were higher than that of the students in compassionate care (90.1%) and perspective adoption (89.7%); however, for putting oneself in the other's shoes, the faculty had a lower score (57.8%) than the clinical students (58.2%). Future investigations are needed to understand the impact of faculty empathy scores on students and whether pedagogical interventions can increase empathy scores.
Humanities in Predoctoral Dental Education: A Scoping Review
Authors: Marti Kyriaki C. , Mylonas Anastassios I. , MacEachern Mark , Gruppen Larry
Published: August 2019

Health humanities usually includes such disciplines as philosophy, ethics, history, literature, performing arts, and cultural anthropology. The aims of this scoping review were, first, to search the published literature for references to the humanities in predoctoral dental education and, second, to determine if any research studies found that introducing humanities in dental education improved the overall profile of dental graduates. Literature searches were run in Ovid MEDLINE, Embase, ERIC, CINAHL, and Dentistry and Oral Sciences Source. A total of 248 articles were included in the review, with inclusion criteria comprising the areas of the curriculum, the scope of humanities, and predoctoral dental education. Of those articles, 101 referred in a targeted way to ethics in predoctoral dental education, while others mainly referred to the humanities in general or pointed out the role and place of humanities topics in predoctoral dental curricula. Topics covered included professional ethics, music, narrative learning, theater, art, communication skills, empathy, emotional intelligence, and cultural competence in the context of general humanistic education. The review found limited evidence of a clear impact, either short‐term or long‐term, of humanities education in predoctoral dental education. Reflections on humanistic education in the practice of clinical dentistry were sparse, as mainly documented by development of the ideal dentist‐patient relationship, enhancement of empathy for patients, and most importantly, construction of professional moral values.
Review and Application of the Mini‐Clinical Evaluation Exercise (Mini‐CEX) in Advanced Orthodontic Education: A Pilot Study
Authors: Al‐Jewair Thikriat , Kumar Sonal
Published: August 2019

The aims of this study were to review the evidence on the Mini‐Clinical Evaluation Exercise (Mini‐CEX) for work‐ based assessment and to assess, in a pilot study, the utility of the Mini‐CEX in an advanced orthodontic education program. Three evaluators and six first‐year orthodontic residents at one U.S. dental school were recruited for the study between July and December 2017. The evaluators used a modified Mini‐CEX instrument with a nine‐point scale (1=unsatisfactory to 9=superior) to observe 24 resident‐patient encounters (four encounters per resident) that involved orthodontic screening and comprehensive consultation procedures. Seven domains were assessed: interviewing skills, clinical examination, professionalism, clinical judgment, counseling, organization, and overall competence. Evaluators gave individualized feedback immediately after each encounter and recorded the duration of encounter and feedback in minutes. Evaluators and residents also reported their satisfaction with the experience. The mean scores for the screening and consultation encounters were 7.21±1.39 and 7.96±0.97, respectively. Overall, the highest score of all the domains was in organization (8.00±1.14) and the lowest was in clinical judgment (7.11±0.96). Clinical performance improved over four encounters (7.80±0.92, 8.72±1.29, 8.98±1.13, and 8.52±1.45, respectively); however, the difference was not statistically significant. The mean duration of encounters was 15.05±2.39 minutes and of feedback was 8.25±4.64 minutes. Encounter duration was significantly longer in difficult cases than in moderate or simple cases (ANOVA, post‐hoc p=0.004). The mean satisfaction rates of residents and evaluators were high (90% and 84%, respectively). Although there is no gold standard to assess clinical competence in dentistry, this study found that the Mini‐CEX may be a potentially effective method of work‐based assessment in advanced orthodontic education.
Retracted: Differences in Dental Students' Intercultural Competence Across a Four‐Year Program
Authors: Hou Tasha Yuntao , Bohlouli Babak , Amin Maryam
Published: August 2019

Cultural competence is a combination of knowledge, awareness, and skills that dentists must acquire during their training in order to work with diverse populations. The aim of this study was to measure the perceived cultural competence of dental students in all four years at the University of Alberta in Canada. In 2018, a validated 17‐item questionnaire—the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers—was used to assess the students' perceived level of cultural competence on a scale from 1=lowest to 4=highest. Students were grouped into four cohorts (C1, C2, C3, C4) based on their level in the program. Newly admitted students (C1) were surveyed before they took any classes; first‐year students were designated C2; second‐year students were designated C3; and third‐ and fourth‐year students were combined into C4. Of 160 students, 72% responded, and 102 eligible students (64%) were included in the analysis. The average age of participants was 24.6 years (SD=3.23), 56% were men, and 75% were born in Canada. White and East Asian were the most (48%) and second most (23%) prevalent race/ethnicity. The analysis showed a significant relationship between cohort groupings and determinant components for student classification. The overall mean scores by cohort were C1 2.50 (SD=0.81), C2 2.60 (SD=0.79), C3 2.81 (SD=0.69), and C4 3.04 (SD=0.80). The mean scores of C4 were significantly higher than the mean scores of the other cohorts (p=0.001). This study found that clinical‐level students at the University of Alberta had significantly higher perceived cultural competence than those in the preclinical years, though the results also pointed to the need for increased training in this area.
Evaluation of a Distance Education Course Using the 4C‐ID Model for Continuing Endodontics Education
Authors: Kolcu Mukadder İnci Basşer , Öztürkçü Özlem Sürel Karabilgin , Kaki Gülter Devrim
Published: August 2019

Continuing professional development (CPD) is needed in endodontics, and distance learning environments and courses may be preferable for CPD. Instructional designs (IDs) have been reported to strongly influence the educational effectiveness of these courses. Four Component Instructional Design (4C‐ID) is an ID found to be effective for distance learning. The aim of this study was to evaluate the effectiveness of a distance learning CPD course on regenerative endodontic procedures (REPs) designed with a 4C‐ID model. The study was conducted between April 2017 and March 2018 with volunteers from the 2015‐16 graduates of Selçuk University’s Faculty of Dentistry in Turkey. Pre‐ and posttests and skill assessment guide were used for assessment. To determine the participants’ satisfaction levels, the Satisfaction Scale for e‐Learning Process and an open‐ended question were used. Of the 86 graduates invited to participate, 79.1% (n=68) responded they would; but the investigators limited the participants to 30, and the first 30 volunteers who had identified a need for REPs CPD were accepted to the course. Four (0.13%) had to drop out during the course, so data from the 26 who completed it were evaluated. The findings showed the difference between pre‐ and posttest results was significant (p<0.001). The mean score for psychomotor skills at the end of the course was 99.62±1.96 out of 100. On the satisfaction scale, the mean score for all participants was 138.5 on a scale from 29=lower satisfaction to 145=greater satisfaction with the e‐learning process. At the end of the REPs course, the participants’ knowledge levels had increased, and they were able to apply REP steps on a model. These results suggest the 4C‐ID was effective in this distance education course in REPs.
Validity and User Experience in an Augmented Reality Virtual Tooth Identification Test
Authors: Kim‐Berman Hera , Karl Elisabeta , Sherbel Jason , Sytek Lauren , Ramaswamy Vidya
Published: August 2019

By leveraging emerging technologies in augmented reality (AR) and virtual reality (VR), a Virtual Dental Library and AR virtual tooth identification test were developed at a U. S. dental school. The AR virtual tooth identification test is a vision‐ based AR application that uses three‐dimensional models of extracted human teeth as test items. The aims of this study were to investigate the validity of the AR virtual tooth identification test and evaluate the users' experience with the virtual testing method. The AR virtual tooth identification test scores were compared with real tooth identification tests, scores on three quizzes, final exam, and final grade for the course to assess its validity. In addition, a survey was used to assess students' perceptions of the AR tool. In 2018, all 109 first‐year dental students who had completed the dental anatomy course were invited to participate in the study. Of the 93 participants, 61 (56% of total students) were included in the correlation analysis (32 were excluded due to incomplete test answer sheets or missing criterion measures). All 93 could respond to the survey and provide comments. In the results, the AR virtual tooth identification test had a positive correlation with the real tooth identification test (r=0.410, p<0.01), a combined score of two real tooth identification tests (r=0.545, p<0.01), the final exam (r=0.489, p<0.01), and overall grade for the dental anatomy course (r=0.661, p<0.01). On the tests, the students had some difficulty in viewing and manipulating the images and experienced technical difficulties related to their smartphones, and their survey responses expressed little support for the AR tool. Nevertheless, this study demonstrated criterion validity of the AR virtual assessment tool for tooth identification.
Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study
Authors: Hansen Arne , Herrmann Maximilian , Ehlers Jan P , Mondritzki Thomas , Hensel Kai Oliver , Truebel Hubert , Boehme Philip
Published: August 2019

Background

Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate.

Objective

We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption.

Methods

This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market.

Results

There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses “H8: Digitization in the health care system will free up jobs,” and “H6: Digitization in the health care system will empower the patients,” perceived to be in profound disagreement (P=.036 and P<.001, respectively).

Conclusions

Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree.
New Patient Education Video on Colonoscopy Preparation: Development and Evaluation Study (Preprint)
Authors: Bernstein Matthew T , Garber Jesse , Faucher Patrick , Reynolds Kristin A , Restall Gayle , Walker John R , Singh Harminder
Published: August 2019

BACKGROUND

Although several patient education materials on colonoscopy preparation exist, few studies have evaluated or compared them; hence, there is no professional consensus on recommended content or media to use.

OBJECTIVE

This study aims to address this need by developing and evaluating a new video on colonoscopy preparation.

METHODS

We developed a new video explaining split-dose bowel preparation for colonoscopy. Of similar content videos on the internet (n=20), the most favorably reviewed video among patient and physician advisers was used as the comparator for the study. A total of 232 individuals attending gastroenterology or urology clinics reviewed the new and comparator videos. The order of administration of the new and comparator videos was randomly counterbalanced to assess the impact of presentation order. Respondents rated each video on the following dimensions: information amount, clarity, trustworthiness, understandability, new or familiar information, reassurance, information learned, understanding from the patient’s point of view, appeal, and the likelihood of recommending the video to others.

RESULTS

Overall, 71.6% (166/232) of the participants preferred the new video, 25.0% (58/232) preferred the comparator video, and 3.4% (8/232) were not sure. Furthermore, 64.0% (71/111) of those who viewed the new video first preferred it, whereas 77.7% (94/121) of the participants who viewed the new video second preferred it. Multivariable logistic regression analysis also demonstrated that participants were more likely to prefer the new video if they had viewed it second. Participants who preferred the new video rated it as clearer and more trustworthy than those who preferred the comparator video.

CONCLUSIONS

This study developed and assessed the strengths of a newly developed colonoscopy educational video.
Feasibility of the Web-Based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) Training and Follow-Up Support Intervention: Randomized Controlled Pilot Study (Preprint)
Authors: Smith Madison B , Albanese-O'Neill Anastasia , Yao Yingwei , Wilkie Diana J , Haller Michael J , Keenan Gail M
Published: August 2019

BACKGROUND

Proper training and follow-up for patients new to continuous glucose monitor (CGM) use are required to maintain adherence and achieve diabetes-related outcomes. However, CGM training is hampered by the lack of evidence-based standards and poor reimbursement. We hypothesized that web-based CGM training and education would be effective and could be provided with minimal burden to the health care team.

OBJECTIVE

The aim of this study was to perform a pilot feasibility study testing a theory-driven, web-based intervention designed to provide extended training and follow-up support to adolescents and young adults newly implementing CGM and to describe CGM adherence, glycemic control, and CGM-specific psychosocial measures before and after the intervention.

METHODS

The “Intervention Designed to Educate and improve Adherence through Learning to use CGM (IDEAL CGM)” web-based training intervention was based on supporting literature and theoretical concepts adapted from the health belief model and social cognitive theory. Patients new to CGM, who were aged 15-24 years with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinic. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. Hemoglobin A1c levels and psychosocial measures were assessed at baseline and 3 months after start of the intervention.

RESULTS

Ten eligible subjects were approached for recruitment and 8 were randomized. Within the IDEAL CGM group, 4 of the 6 participants received exposure to the web-based training. Half of the participants completed at least 5 of the 7 modules; however, dosage of the intervention and level of engagement varied widely among the participants. This study provided proof of concept for use of a web-based intervention to deliver follow-up CGM training and support. However, revisions to the intervention are needed in order to improve engagement and determine feasibility.

CONCLUSIONS

This pilot study underscores the importance of continued research efforts to optimize the use of web-based intervention tools for their potential to improve adherence and glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the health care team. Enhancements should be made to the intervention to increase engagement, maximize responsiveness, and ensure attainment of the skills necessary to achieve consistent use and improvements in glycemic control prior to the design of a larger well-powered clinical trial to establish feasibility.

CLINICALTRIAL

ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.
Patterns in Weight and Physical Activity Tracking Data Preceding a Stop in Weight Monitoring: Observational Analysis (Preprint)
Authors: Frie Kerstin , Hartmann-Boyce Jamie , Jebb Susan , Oke Jason , Aveyard Paul
Published: August 2019

BACKGROUND

Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time.

OBJECTIVE

This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring.

METHODS

We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking.

RESULTS

People lost weight during continuous tracking (mean −0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=−220 daily steps per time period; 95% CI −320 to −120) and physical activity tracking frequency (beta=−3.4 days per time period; 95% CI −3.8 to −3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=−6.6 days per time period; 95% CI −7.12 to −6.16), whereas daily step count on the day’s activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170).

CONCLUSIONS

In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days.
Improving Clinical Translation of Machine Learning Approaches Through Clinician-Tailored Visual Displays of Black Box Algorithms: Development and Validation (Preprint)
Authors: Wongvibulsin Shannon , Wu Katherine C , Zeger Scott L
Published: August 2019

BACKGROUND

Despite the promise of machine learning (ML) to inform individualized medical care, the clinical utility of ML in medicine has been limited by the minimal interpretability and black box nature of these algorithms.

OBJECTIVE

The study aimed to demonstrate a general and simple framework for generating clinically relevant and interpretable visualizations of black box predictions to aid in the clinical translation of ML.

METHODS

To obtain improved transparency of ML, simplified models and visual displays can be generated using common methods from clinical practice such as decision trees and effect plots. We illustrated the approach based on postprocessing of ML predictions, in this case random forest predictions, and applied the method to data from the Left Ventricular (LV) Structural Predictors of Sudden Cardiac Death (SCD) Registry for individualized risk prediction of SCD, a leading cause of death.

RESULTS

With the LV Structural Predictors of SCD Registry data, SCD risk predictions are obtained from a random forest algorithm that identifies the most important predictors, nonlinearities, and interactions among a large number of variables while naturally accounting for missing data. The black box predictions are postprocessed using classification and regression trees into a clinically relevant and interpretable visualization. The method also quantifies the relative importance of an individual or a combination of predictors. Several risk factors (heart failure hospitalization, cardiac magnetic resonance imaging indices, and serum concentration of systemic inflammation) can be clearly visualized as branch points of a decision tree to discriminate between low-, intermediate-, and high-risk patients.

CONCLUSIONS

Through a clinically important example, we illustrate a general and simple approach to increase the clinical translation of ML through clinician-tailored visual displays of results from black box algorithms. We illustrate this general model-agnostic framework by applying it to SCD risk prediction. Although we illustrate the methods using SCD prediction with random forest, the methods presented are applicable more broadly to improving the clinical translation of ML, regardless of the specific ML algorithm or clinical application. As any trained predictive model can be summarized in this manner to a prespecified level of precision, we encourage the use of simplified visual displays as an adjunct to the complex predictive model. Overall, this framework can allow clinicians to peek inside the black box and develop a deeper understanding of the most important features from a model to gain trust in the predictions and confidence in applying them to clinical care.
A Culturally Targeted eLearning Module on Organ Donation (Promotoras de Donación): Design and Development (Preprint)
Authors: Alolod Gerard P , Gardiner Heather , Agu Chidera , Turner Jennie L , Kelly Patrick J , Siminoff Laura A , Gordon Elisa J , Norden Robert , Daly Theresa A , Benitez Amanda , Hernandez Ilda , Guinansaca Nancy , Winther Lori Ramos , Bergeron Caroline D , Montalvo Antonette , Gonzalez Tony
Published: August 2019

BACKGROUND

As an overrepresented population on the transplant waitlist, stagnated rates of organ donation registration among Latinxs must be redressed. Promotoras (community health workers), who are effective at advocating and spearheading health promotion efforts in the Latinx community, show promise in their ability to educate about organ donation and donor registration.

OBJECTIVE

This study aimed (1) to develop an interactive, evidence-based program to educate promotoras about organ donation, the need for organ donors in the Latinx American community, and ways to register as deceased organ donors and (2) to train promotoras to lead discussions about organ donation and to promote the act of donor registration.

METHODS

In partnership with 4 promotoras organizations, the culturally targeted Promotoras de Donación eLearning module was developed based on input from 12 focus groups conducted with Latina women (n=61) and promotoras (n=37). Formative work, existing literature, the Vested Interest Theory, and the Organ Donation Model guided curriculum development. In partnership with the Gift of Life Institute and regional promotoras, the curriculum was designed, filmed, and developed in a visually appealing module interface. The module was beta-tested with promotoras before launch.

RESULTS

Promotoras de Donación, available in Spanish with English subtitling, lasts just over an hour. The module comprised 6 sections including various activities and videos, with the curriculum divided into a skills-based communication component and a didactic educational component. Pre- and posttests assessed the module’s direct effects on promotoras’ organ donation knowledge and attitudes as well as confidence promoting the act of donor registration.

CONCLUSIONS

This novel, theoretically and empirically based intervention leveraged the existing network of promotoras to promote the act of donor registration. Future research should assess whether the module helps increase rates of donor registration within Latinx communities and reduce disparities in access to transplantation.

CLINICALTRIAL

ClinicalTrials.gov NCT04007419; https://www.clinicaltrials.gov/ct2/show/NCT04007419
Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study (Preprint)
Authors: Pincus Theodore , Castrejon Isabel , Riad Mariam , Obreja Elena , Lewis Candice , Krogh Niels Steen
Published: August 2019

BACKGROUND

A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances.

OBJECTIVE

This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ.

METHODS

Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire.

RESULTS

The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level.

CONCLUSIONS

The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ.
Selecting Evidence-Based Content for Inclusion in Self-Management Apps for Pressure Injuries in Individuals With Spinal Cord Injury: Participatory Design Study (Preprint)
Authors: Fiordelli Maddalena , Zanini Claudia , Amann Julia , Scheel-Sailer Anke , Brach Mirjam , Stucki Gerold , Rubinelli Sara
Published: August 2019

BACKGROUND

Technological solutions, particularly mobile health (mHealth), have been shown to be potentially viable approaches for sustaining individuals’ self-management of chronic health conditions. Theory-based interventions are more successful, as evidence-based information is an essential prerequisite for appropriate self-management. However, several reviews have shown that many existing mobile apps fail to be either theoretically grounded or based on evidence. Although some authors have attempted to address these two issues by focusing on the design and development processes of apps, concrete efforts to systematically select evidence-based content are scant.

OBJECTIVE

The objective of this study was to present a procedure for the participatory identification of evidence-based content to ground the development of a self-management app.

METHODS

To illustrate the procedure, we focused on the prevention and management of pressure injuries (PIs) in individuals with spinal cord injury (SCI). The procedure involves the following three steps: (1) identification of existing evidence through review and synthesis of existing recommendations on the prevention and self-management of PIs in SCI; (2) a consensus meeting with experts from the field of SCI and individuals with SCI to select the recommendations that are relevant and applicable to community-dwelling individuals in their daily lives; and (3) consolidation of the results of the study.

RESULTS

In this case study, at the end of the three-step procedure, the content for an mHealth intervention was selected in the form of 98 recommendations.

CONCLUSIONS

This study describes a procedure for the participatory identification and selection of disease-specific evidence and professional best practices to inform self-management interventions. This procedure might be especially useful in cases of complex chronic health conditions, as every recommendation in these cases needs to be evaluated and considered in light of all other self-management requirements. Hence, the agreement of experts and affected individuals is essential to ensure the selection of evidence-based content that is considered to be relevant and applicable.
Responses of Conversational Agents to Health and Lifestyle Prompts: Investigation of Appropriateness and Presentation Structures (Preprint)
Authors: Kocaballi Ahmet Baki , Quiroz Juan C , Rezazadegan Dana , Berkovsky Shlomo , Magrabi Farah , Coiera Enrico , Laranjo Liliana
Published: August 2019

BACKGROUND

Conversational agents (CAs) are systems that mimic human conversations using text or spoken language. Their widely used examples include voice-activated systems such as Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. The use of CAs in health care has been on the rise, but concerns about their potential safety risks often remain understudied.

OBJECTIVE

This study aimed to analyze how commonly available, general-purpose CAs on smartphones and smart speakers respond to health and lifestyle prompts (questions and open-ended statements) by examining their responses in terms of content and structure alike.

METHODS

We followed a piloted script to present health- and lifestyle-related prompts to 8 CAs. The CAs’ responses were assessed for their appropriateness on the basis of the prompt type: responses to safety-critical prompts were deemed appropriate if they included a referral to a health professional or service, whereas responses to lifestyle prompts were deemed appropriate if they provided relevant information to address the problem prompted. The response structure was also examined according to information sources (Web search–based or precoded), response content style (informative and/or directive), confirmation of prompt recognition, and empathy.

RESULTS

The 8 studied CAs provided in total 240 responses to 30 prompts. They collectively responded appropriately to 41% (46/112) of the safety-critical and 39% (37/96) of the lifestyle prompts. The ratio of appropriate responses deteriorated when safety-critical prompts were rephrased or when the agent used a voice-only interface. The appropriate responses included mostly directive content and empathy statements for the safety-critical prompts and a mix of informative and directive content for the lifestyle prompts.

CONCLUSIONS

Our results suggest that the commonly available, general-purpose CAs on smartphones and smart speakers with unconstrained natural language interfaces are limited in their ability to advise on both the safety-critical health prompts and lifestyle prompts. Our study also identified some response structures the CAs employed to present their appropriate responses. Further investigation is needed to establish guidelines for designing suitable response structures for different prompt types.
A Web-Based Self-Titration Program to Control Blood Pressure in Patients With Primary Hypertension: Randomized Controlled Trial (Preprint)
Authors: Kao Chi-Wen , Chen Ting-Yu , Cheng Shu-Meng , Lin Wei-Shiang , Chang Yue-Cune
Published: August 2019

BACKGROUND

Hypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life.

OBJECTIVE

Our primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life.

METHODS

This was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention.

RESULTS

We included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (–21.4 mm Hg and –5.4 mm Hg, respectively; P<.001) and 6 months (–27.8 mm Hg and –9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (–0.202, P=.003) and 6 (–0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001).

CONCLUSIONS

A Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension.

CLINICALTRIAL

ClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974