A classification model of patient engagement methods and assessment of their feasibility in real-world settings

Objective

Examine existing reviews of patient engagement methods to propose a model where the focus is on engaging patients in clinical workflows, and to assess the feasibility of advocated patient engagement methods.

Methods

A literature search of reviews of patient engagement methods was conducted. Included reviews were peer-reviewed, written in English, and focused on methods that targeted patients or patient–provider dyads. Methods were categorized to propose a conceptual model. The feasibility of methods was assessed using an adapted rating system.

Results

We observed that we could categorize patient engagement methods based on information provision, patient activation, and patient–provider collaboration. Methods could be divided by high and low feasibility, predicated on the extent of extra work required by the patient or clinical system. Methods that have good fit with existing workflows and that require proportional amounts of work by patients are likely to be the most feasible.

Conclusion

Implementation of patient engagement methods is likely to depend on finding a “sweet-spot” where demands required by patients generate improved knowledge and motivate active participation.

Practice implications

Attention should be given to those interventions and methods that advocate feasibility with patients, providers, and organizational workflows.     

The neurophysiological bases of EEG and EEG measurement: A review for the rest of us

A thorough understanding of the EEG signal and its measurement is necessary to produce high quality data and to draw accurate conclusions from those data. However, publications that discuss relevant topics are written for divergent audiences with specific levels of expertise: explanations are either at an abstract level that leaves readers with a fuzzy understanding of the electrophysiology involved, or are at a technical level that requires mastery of the relevant physics to understand. A clear, comprehensive review of the origin and measurement of EEG that bridges these high and low levels of explanation fills a critical gap in the literature and is necessary for promoting better research practices and peer review. The present paper addresses the neurophysiological source of EEG, propagation of the EEG signal, technical aspects of EEG measurement, and implications for interpretation of EEG data.     

Metabolic profiling of four synthetic stimulants,including the novel indanyl-cathinone 5-PPDi,after human hepatocyte incubation

Synthetic cathinones are new psychoactive substances that represent a health risk worldwide.For most of the 130 reported compounds,information about toxicology and/or metabolism is not available,which hampers their detection(and subsequent medical treatment)in intoxication cases.The principles of forensic analytical chemistry and the use of powerful analytical techniques are indispensable for stab-lishing the most appropriate biomarkers for these substances.Human metabolic fate of synthetic cathinones can be assessed by the analysis of urine and blood obtained from authentic consumers;however,this type of samples is limited and difficult to access.In this work,the metabolic behaviour of three synthetic cathinones(4-CEC,4-CPrC and 5-PPDi)and one amphetamine(3-FEA)has been evalu-ated by incubation with pooled human hepatocytes and metabolite identification has been performed by high-resolution mass spectrometry.This in vitro approach has previously shown its feasibility for obtaining excretory human metabolites.4-CEC and 3-FEA were not metabolised,and for 4-CPrC only two minor metabolites were obtained.On the contrary,for the recently reported 5-PPDi,twelve phase I metabolites were elucidated.Up to our knowledge,this is the first metabolic study of an indanyl-cathinone.Data reported in this paper will allow the detection of these synthetic stimulants in intoxi-cation cases,and will facilitate future research on the metabolic behaviour of other indanyl-based cathinones.     

Optimization of the Esperanza window trap for the collection of the African onchocerciasis vector Simulium damnosum sensu lato

A simple inexpensive trap (Esperanza window trap) was shown recently to collect significant numbers of Simulium ochraceum sensu lato, a major vector of Onchocerca volvulus in Mesoamerica. Here, we report studies optimizing this trap for the collection of Simulium damnosum s.l., the major vector of O. volvulus in Africa. A shortened, blue and black striped version of the Esperanza window trap, when baited with a combination of CO₂ and worn trousers, rivalled human landing collections in the number of S. damnosum s.l. females collected. Traps baited with a commercially available human skin lure and CO₂ resulted in collections that were not significantly different than those obtained from traps baited with worn trousers and CO₂. This suggests that the Esperanza window trap may offer a replacement for human landing collections for monitoring onchocerciasis transmission in Africa.     

Correlates of Incident Cognitive Impairment in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Objective: To identify approximately 500 cases of incident cognitive impairment (ICI) in a large, national sample adapting an existing cognitive test-based case definition and to examine relationships of vascular risk factors with ICI. Method: Participants were from the REGARDS study, a national sample of 30,239 African-American and White Americans. Participants included in this analysis had normal cognitive screening and no history of stroke at baseline, and at least one follow-up cognitive assessment with a three-test battery (TTB). Regression-based norms were applied to TTB scores to identify cases of ICI. Logistic regression was used to model associations with baseline vascular risk factors. Results: We identified 495 participants with ICI of 17,630 eligible participants. In multivariable modeling, income (OR 1.83 CI 1.27,2.62), stroke belt residence (OR 1.45 CI 1.18,1.78), history of transient ischemic attack (OR 1.90 CI 1.29,2.81), coronary artery disease(OR 1.32 CI 1.02,1.70), diabetes (OR 1.48 CI 1.17,1.87), obesity (OR 1.40 CI 1.05,1.86), and incident stroke (OR 2.73 CI 1.52,4.90) were associated with ICI. Conclusions: We adapted a previously validated cognitive test-based case definition to identify cases of ICI. Many previously identified risk factors were associated with ICI, supporting the criterion-related validity of our definition.     

Chronic hyperoxia and the development of the carotid body

Preterm infants often experience hyperoxia while receiving supplemental oxygen. Prolonged exposure to hyperoxia during development is associated with pathologies such as bronchopulmonary dysplasia and retinopathy of prematurity. Over the last 25 years, however, experiments with animal models have revealed that moderate exposures to hyperoxia (e.g., 30–60% O₂ for days to weeks) can also have profound effects on the developing respiratory control system that may lead to hypoventilation and diminished responses to acute hypoxia. This plasticity, which is generally inducible only during critical periods of development, has a complex time course that includes both transient and permanent respiratory deficits. Although the molecular mechanisms of hyperoxia-induced plasticity are only beginning to be elucidated, it is clear that many of the respiratory effects are linked to abnormal morphological and functional development of the carotid body, the principal site of arterial O₂ chemoreception for respiratory control. Specifically, developmental hyperoxia reduces carotid body size, decreases the number of chemoafferent neurons, and (at least transiently) diminishes the O₂ sensitivity of individual carotid body glomus cells. Recent evidence suggests that hyperoxia may also directly or indirectly impact development of the central neural control of breathing. Collectively, these findings emphasize the vulnerability of the developing respiratory control system to environmental perturbations.