Using Avatars to Model Weight Loss Behaviors: Participant Attitudes and Technology Development

Background:

Virtual reality and other avatar-based technologies are potential methods for demonstrating and modeling weight loss behaviors. This study examined avatar-based technology as a tool for modeling weight loss behaviors.

Methods:

This study consisted of two phases: (1) an online survey to obtain feedback about using avatars for modeling weight loss behaviors and (2) technology development and usability testing to create an avatar-based technology program for modeling weight loss behaviors.

Results:

Results of phase 1 (n = 128) revealed that interest was high, with 88.3% stating that they would participate in a program that used an avatar to help practice weight loss skills in a virtual environment. In phase 2, avatars and modules to model weight loss skills were developed. Eight women were recruited to participate in a 4-week usability test, with 100% reporting they would recommend the program and that it influenced their diet/exercise behavior. Most women (87.5%) indicated that the virtual models were helpful. After 4 weeks, average weight loss was 1.6 kg (standard deviation = 1.7).

Conclusion:

This investigation revealed a high level of interest in an avatar-based program, with formative work indicating promise. Given the high costs associated with in vivo exposure and practice, this study demonstrates the potential use of avatar-based technology as a tool for modeling weight loss behaviors.     

A Failure to Communicate: A Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations

BackgroundCare coordination between adult hospitalists and primary care providers (PCPs) is a critical component of successful transitions of care from hospital to home, yet one that is not well understood.ObjectiveThe purpose of this study was to understand the challenges in coordination of care, as well as potential solutions, from the perspective of hospitalists and PCPs in North Carolina.ApproachInterview guides included questions about care coordination, information exchange, follow-up care, accountability, and medication management. Focus group sessions were recorded, transcribed verbatim, and analyzed in ATLAS.ti. The constant comparative method was used to evaluate differences between hospitalists and PCPs.ConclusionsHospitalists and PCPs encounter similar challenges in care coordination, yet have important experiential differences related to sending and receiving roles for hospital discharges. Efforts to improve coordination of care between hospitalists and PCPs should aim to understand perspectives of clinicians in each setting.KEY WORDS: care transitions, care coordination, accountability     

The Impact of Ulcerative Colitis on Patients’ Lives Compared to Other Chronic Diseases: A Patient Survey

Purpose  

This study was designed to identify the impact chronic ulcerative colitis (UC) has on the lives of patients compared to other chronic conditions. Overall, 451 patients with UC, 309 with rheumatoid arthritis, 305 with asthma, and 305 with migraine headaches were recruited in an Internet survey designed to assess a variety of disease-impact indices.     

Improving Hypertension Control and Patient Engagement Using Digital Tools

Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available that transmitted data directly to the electronic medical record. Digital-medicine patients averaged 4.2 blood pressure readings per week. At 90 days, 71% of digital-medicine vs 31% of usual-care patients had achieved target blood pressure control. Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine, vs 4/2 mm Hg in usual care (P < .001). Excess sodium consumption decreased from 32% to 8% in the digital-medicine group (P = .004). Mean patient activation increased from 41.9 to 44.1 (P = .008), and the percentage of patients with low patient activation decreased from 15% to 6% (P = .03) in the digital-medicine group. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.     

COVID-19 Pandemic Increased Anxiety Among Patients with Inflammatory Bowel Disease: A Patient Survey in a Tertiary Referral Center

Digestive Diseases and Sciences - COVID-19 is the first global pandemic in more than 100&nbsp;years, and at its onset, the effects were largely unknown. Immunocompromised patients, including...     

Information on Cardiovascular Disease in the Digital Era: Results From a Cross-Sectional Patient Survey

Public health strategies to reduce cardiovascular disease (CVD) rely on the effective dissemination of evidence-based information to at-risk populations. An improved understanding of the information sources patients use can facilitate content development and promote awareness of effective interventions for CVD prevention, monitoring, and management. We therefore sought to determine the contemporary patterns of CVD information source usage via a prospective, cross-sectional survey study of CVD information sources in a primary care centre in Ontario, Canada. Primary source(s) used for CVD information were defined as: traditional media (television or print media), Internet-based sources, or community resources (community agencies and health care providers). Of 4682 consecutively screened patients aged > 18 years 3189 (68%) participated in the survey. The mean age of the survey respondents was 37 ± 14 years and 54.4% were female. Traditional media (71%) were used more frequently than Internet-based sources (45%) or community health services (23%). Only 20% of respondents identified health care providers as the source of information for CVD. Compared with respondents aged ≥ 55 years, the adjusted odds of Internet-based source use were significantly higher among younger age groups, whereas the adjusted odds of print media and health services usage was lowest among ages 25-34 years. Although traditional print and electronic media remain the primary resource for CVD-related information, younger individuals increasingly rely on Internet-based sources. These findings have important implications for public health policy and resource allocation, highlighting the importance of maintaining traditional media presence in addition to the development of high-quality Internet-based sources of CVD information.     

Intangible Costs and Benefits of Ulcerative Colitis Surveillance: A Patient Survey

Purpose Colonoscopic surveillance in ulcerative colitis has costs and benefits beyond cancer prevention, which might influence program efficacy. This study assesses the more intangible aspects of surveillance. Method A questionnaire was sent to all patients on the St. Mark's colitis surveillance program. Data on quality of life (Euroqol-5D and Hospital Anxiety and Depression Scale), complications, and preferences for surveillance and information (Kranz Health Opinion Survey) were collated with demographics and surveillance history. Results Two hundred eighty-one of 329 patients (85.4 percent) responded. Median Euroqol score was 80. There were no perforations. Bleeding rate was 0.11 percent. No transfusions, endoscopic intervention, or surgeries were required. 24.0 percent were frightened before colonoscopies, correlating with anxiety (r = 0.25, P < 0.0001). 60.2 percent patients found colonoscopies comfortable; experienced colonoscopists caused less discomfort (r = 0.20, P = 0.0007). 83.8 percent patients thought they had received appropriate amounts of information. 97.8 percent patients believed surveillance important, 96.4 percent thought surveillance gave them reassurance, and 67.9 percent believed surveillance greatly reduced their cancer risk. Regarding cancer risk management, one-third of patients indicated they might not necessarily opt for surveillance in its current form. Conclusion Colonoscopic surveillance is well tolerated with an extremely low complication rate. Patients have a good quality of life (although lower than the general population) and believe surveillance is important and reassuring. However, many are anxious before their colonoscopy. The majority are happy with information quantity and quality, although none thought they received too much. Not all patients would necessarily opt for surveillance in its current form, and we must be willing to individualize cancer risk management to comply with patient preferences. Research was conducted at: St. Mark's Hospital. Presented at Digestive Diseases Week, Orlando, Florida, May 18 to 21, 2003, and the meeting of the British Society of Gastroenterology, Birmingham, United Kingdom, March 23 to 26, 2003.     

Effective Learner-Centered Strategies for Teaching Adults: Using Visual Media to Engage the Adult Learner

ABSTRACT

This article offers practical guidance for educators as they prepare specialists to enhance the lives and communities of older persons through the strategic use of visual media in age-related courses. Advantages and disadvantages of this learning innovation are provided as well as seven approaches for enriching instruction. Resources are included for locating effective visual media, matching course content with video resources, determining fair use of copyrighted media, and inserting video clips into PowerPoint presentations. Strategies for accessing assistive services for implementing visual media in the classroom are also addressed. This article promotes the use of visual media for the purpose of enriching gerontological and geriatrics instruction for the adult learner.     

Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees

BACKGROUND Disclosing errors to patients is an important part of patient care, but the prevalence of disclosure, and factors affecting it, are poorly understood. OBJECTIVE To survey physicians and trainees about their practices and attitudes regarding error disclosure to patients. DESIGN AND PARTICIPANTS Survey of faculty physicians, resident physicians, and medical students in Midwest, Mid-Atlantic, and Northeast regions of the United States. MEASUREMENTS Actual error disclosure; hypothetical error disclosure; attitudes toward disclosure; demographic factors. RESULTS Responses were received from 538 participants (response rate = 77%). Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major (93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19% acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with malpractice litigation was not associated with less actual or hypothetical error disclosure. Faculty were more likely than residents and students to disclose a hypothetical error and less concerned about possible negative consequences of disclosure. Several attitudes were associated with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant personal cost. CONCLUSIONS There appears to be a gap between physicians’ attitudes and practices regarding error disclosure. Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation. An erratum to this article can be found at     

A Video-Intervention to Improve Clinician Attitudes Toward Patients with Sickle Cell Disease: The Results of a Randomized Experiment

BACKGROUND  

Clinician attitudes toward patients are associated with variability in the quality of health care. Attitudes are typically considered difficult to change, and few interventions have attempted to do so. Negative attitudes toward adults with sickle cell disease have been identified as an important barrier to the receipt of appropriate pain management for this patient population.     

HIV Prevalence,Knowledge, Attitudes,and Practices Among Polydrug Users in Brazil: A Biological Survey Using Respondent Driven Sampling

Brazil has a concentrated HIV epidemic among key populations. In 2009, the Ministry of Health conducted a survey in 10 Brazilian cities aiming to estimate HIV prevalence, knowledge, and associated risk behaviors of polysubstance users (PSU). Using Respondent Driven Sampling (RDS), 3449 PSU were recruited, answered an Audio-Computer Self Assisted Interview (ACASI) and were tested for HIV and syphilis. Analyses were weighted by individual’s social network size generated on RDSAT. Pooled HIV prevalence was 5.8% but varied across cities. Most PSU were male, non-white, without income, unemployed, with low levels of education. Overall, 12.0% used injectable drugs, 48.7% had sex with occasional partners and 46.4% engaged in commercial sex. A majority received free condoms (71.4%) but 76.7% exhibited inconsistent condom use. Findings can support policies aiming to improve health care and preventive interventions tailored to this population that remains at high risk of acquiring and transmitting HIV/STI in multiple scenarios.     

Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study

BackgroundRacism negatively impacts health and well-being. Members of the medical community must intervene to address racism.ObjectiveTo assess whether attitudes about the impact of racism on health or society are associated with intervening around racism.DesignCross-sectional survey of a large department of medicine in an urban academic setting.ParticipantsInterns, residents, fellows, and faculty.Main MeasuresThe primary outcome was the likelihood of intervening around an observed racist encounter or a racist policy. Predictor variables included age, gender identity, race/ethnicity, and attitudes about racism.Key ResultsAlthough the majority of the 948 respondents endorsed the impact of racism on health and other societal effects, levels of endorsement were lower among older individuals, or those reporting male gender identity or selecting other race. Higher endorsement of the impact of racism on health was associated with increased odds of speaking up about a racist encounter or racist policy, with odds ratios from 1.18 to 1.30 across scenarios. Likelihood of speaking up about racism did not differ by racial or ethnic group, but older individuals were generally more likely to speak up and individuals between 20 and 29 years of age were more likely to speak with someone other than leadership or the source of a racist encounter.ConclusionsAwareness of the effects of racism on health is associated with increased likelihood of intervening when a racist encounter is observed or a racist policy is noted. Including information on the impact of racism on health and creating safe spaces to discuss racism may increase the likelihood of bystander intervention in anti-racism strategies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07385-1.KEY WORDS: racism, bias, black, bystander, trainee, faculty, attitude     

Patient Characteristics Relevant to Effective Self-Management: Scales for Assessing Attitudes of Adults Toward Asthma

The Asthma Opinion Survey, a 33-item Likert-type instrument, was designed to measure attitudes relevant to self-management in adult outpatients. Items fall into eleven clusters; General Vulnerability, Specific Vulnerability, Attitudes Toward Patient Knowledge, Recognition of Airway Obstruction, Accessibility of Health Care, Panic-Fear, Belief in Treatment Efficacy, Staff-Patient Relationships, Sense of Control, Personal Impact, and Social Impact. Factor analysis of the clusters yielded three factors Vulnerability, Perceived Quality of Care and Recognition and Control. The items, clusters, and factors all had adequate to good score spreads and internal consistencies. Asthma opinions covaried significantly with demographic characteristics, asthma severity, and intensity of health care utilization, and correlated with the Asthma Symptoms Checklist, an instrument developed at the National Jewish Hospital-National Asthma Center, in ways supporting construct validity. These results suggest the Asthma Opinion Survey is achieving its intended purpose.