Usefulness and Usability of a Personal Health Record and Survivorship Care Plan for Colorectal Cancer Survivors: Survey Study

Background: As a result of improvements in cancer screening, treatment, and supportive care, nearly two-thirds of individuals diagnosed with colorectal cancer (CRC) live for 5 years after diagnosis. An ever-increasing population of CRC survivors creates a need for effective survivorship care to help manage and mitigate the impact of CRC and its treatment. Personal health records (PHRs) and survivorship care plans provide a means of supporting the long-term care of cancer survivors. Objective: The purpose of this study is to characterize the usefulness of a CRC PHR and survivorship care plan and to describe the usability of these technologies in a population of CRC survivors. To our knowledge, this is the first study to assess a PHR and survivorship care plan specifically targeting CRC survivors. Methods: Twenty-two patients with CRC were recruited from surgery clinics of an academic medical center and Veterans Affairs hospital in Indianapolis and provided access to an online Colorectal Cancer Survivor’s Personal Health Record (CRCS-PHR). Survey data were collected to characterize the usefulness of the CRCS-PHR and describe its usability in a population of CRC survivors. CRC survivors were surveyed 6 months after being provided online access. Means and proportions were used to describe the usefulness and ease of using the CRC website. Open-ended questions were qualitatively coded using the constant comparative method. Results: CRC survivors perceived features related to their health care (ie, summary of cancer treatment history, follow-up care schedule, description of side effects, and list of community resources) to be more useful than communication features (ie, creating online relationships with family members or caregivers, communicating with doctor, and secure messages). CRC survivors typically described utilizing traditional channels (eg, via telephone or in person) to communicate with their health care provider. Participants had overall positive perceptions with respect to ease of use and overall satisfaction. Major challenges experienced by participants included barriers to system log-in, lack of computer literacy or experience, and difficulty entering their patient information. Conclusions: For CRC, survivors may find the greater value in a PHR’s medical content than the communication functions, which they have available elsewhere. These findings regarding the usefulness and usability of a PHR for the management of CRC survivorship provide valuable insights into how best to tailor these technologies to patients’ needs. These findings can inform future design and development of PHRs for purposes of both cancer and chronic disease management

An Examination of the Application of Three Deep Learning Principles (Active Learning; Bloom\u27s Taxonomy; Neuroscience of Learning) in Counselor Education Masters Level Ethics Courses

Despite the vow to do no harm that clinicians make upon licensure, incidences of ethical violations of varying kinds in the counseling profession occur fairly frequently, regardless of the many inputs of ethical training in the development of a clinician’s ethical identity. The purpose of this qualitative phenomenological study was to examine the application of three deep learning principles in the teaching methods used to instill counselor ethical identity in counselor education masters level ethics courses. Three groups of participants were interviewed: Four Counselor Education Faculty, Three Licensed Practicing Mental Health Providers, and One Non-practicing/Practicing Licensed Mental Health Provider but Sanctioned. The key findings revealed the following themes: synthesis through active learning activities, synthesis through Bloom’s Taxonomy’s cognitive and affective domains, the need for deeper learning of the codes, and the need for deeper awareness of the need for self-care, and recognition of need for consultation, supervision, and personal counseling. The findings of this study demonstrated that although experience with Active Learning and Blooms Taxonomy was reported, deep learning might be gained by integrating neuroscience type learning activities in ethics courses. That approach may strengthen student counselors’ ethical formation and prevent them from committing ethical mistakes affecting their personal and professional lives

The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review

Background: In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective: The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods: Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results: This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions: There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability

Clarifying the Identity of Human Services Through a Content Analysis of Programmatic Accreditation

Throughout the United States, accrediting bodies serve as voluntary self-regulating entities designed to ensure accountability and quality assurance at the institutions that seek accreditation. To examine the impact of accreditation on the field of human services, a mixed-method content analysis was utilized. The 50 human services programs accredited by the Council for Standards on Human Services Education (CSHSE) as of July of 2018 were examined. Researchers also employed a triangulated approach to understand these programs through an analysis of Carnegie Classifications, regional accreditation agencies, and institutions programmatic websites. Results offer insight into how the CSHSE influences the professional identity of human services thorough: (1) variations in the length of time programs have been accredited; (2) regional distinctions between accredited programs; (3) and the titles of programs accredited by the CSHSE

Transitional Urban Voids in Austin, Texas

A city’s urban fabric is constantly evolving through development and decay under the fluctuating rates of habitation. Cities are growing rapidly as populations climb higher, with new demands for the incoming waves of people seeking employment and a place to call home. Austin, Texas is the fastest growing American city today, with a population growth rate of three percent per year. With this growth and its demands for open space, open spaces in the form of urban voids and temporary use spaces become an interest to designers as spaces with flexibility. The approach of this thesis is to understand these spaces as they relate to the urban fabric as well as the opportunities for use while these spaces remain latent. An on-site case study method was developed as a means to analyze the urban voids in a holistic and experiential manner, providing a way for comparison of urban voids from different areas of Austin. The study seeks to understand temporary uses of these sites and the implications of contextual change. With more innovative and creative people in the city, temporary use spaces can open up opportunity for creation, expression, and sharing. Temporary use sites provide a different experience in the city while activating a space which is in transition from latency to permanent use. This transition through time is another aspect of urban voids which has not been deeply investigated by previous research. By studying these transitory spaces, this study reaches a better understanding of the relationship between time and space in a changing urban environment

NASA's Current Evidence and Hypothesis for the Visual Impairment and Intracranial Pressure Risk

While 40 years of human spaceflight exploration has reported visual decrement to a certain extent in a subgroup of astronauts, recent data suggests that there is indeed a subset of crewmembers that experience refraction changes (hyperoptic shift), cotton wool spot formation, choroidal fold development, papilledema, optic nerve sheath distention and/or posterior globe flattening with varying degrees of severity and permanence. Pre and postflight ocular measures have identified a potential risk of permanent visual changes as a result of microgravity exposure, which has been defined as the Visual Impairment and Intracranial Pressure risk (VIIP). The combination of symptoms are referred to as the VIIP syndrome. It is thought that the ocular structural and optic nerve changes are caused by events precipitated by the cephalad fluid shift crewmembers experience during long-duration spaceflight. Three important systems, ocular, cardiovascular, and central nervous, seem to be involved in the development of symptoms, but the etiology is still under speculation. It is believed that some crewmembers are more susceptible to these changes due to genetic/anatomical predisposition or lifestyle (fitness) related factors. Future research will focus on determining the etiology of the VIIP syndrome and development of mechanisms to mitigate the spaceflight risk