Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

Background: Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)—often referred to as open notes—have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective: This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders’ perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods: A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results: Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members’ mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions: PAEHRs in MHC may strengthen user involvement, patients’ autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention

Controlling light-with-light without nonlinearity

According to Huygens' superposition principle, light beams traveling in a linear medium will pass though one another without mutual disturbance. Indeed, it is widely held that controlling light signals with light requires intense laser fields to facilitate beam interactions in nonlinear media, where the superposition principle can be broken. We demonstrate here that two coherent beams of light of arbitrarily low intensity can interact on a metamaterial layer of nanoscale thickness in such a way that one beam modulates the intensity of the other. We show that the interference of beams can eliminate the plasmonic Joule losses of light energy in the metamaterial or, in contrast, can lead to almost total absorbtion of light. Applications of this phenomenon may lie in ultrafast all-optical pulse-recovery devices, coherence filters and THz-bandwidth light-by-light modulators

Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children

<p>Abstract</p> <p>Background</p> <p>The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP). The Manual Ability Classification System (MACS) was developed recently as a corresponding classification of manual ability. The aim of this study was to describe the association between gross motor function and manual ability in a total population of children with cerebral palsy.</p> <p>Methods</p> <p>365 children, born 1992 to 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden were included in the study. GMFCS was evaluated by the child's physiotherapist and MACS by the occupational therapist. CP diagnosis and subtype were determined by the neuropaediatrician at or after the age of four.</p> <p>Results</p> <p>GMFCS levels were available in all 365 children, MACS levels in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. However, different associations between gross motor function and manual ability were found in the different diagnostic subtypes. Children with spastic hemiplegia generally had a lower level of manual ability than gross motor function (p < 0.001). The reverse association was generally found in children with spastic diplegia (p < 0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant discrepancy between GMFCS and MACS levels.</p> <p>Conclusion</p> <p>Gross motor function and manual ability are often discrepant in children with CP, and the patterns seem to vary across the different subgroups based on the predominant neurological findings. To give a complete clinical picture when evaluating these children, both aspects have to be described. The GMFCS and the MACS seem to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.</p

Development of spasticity with age in a total population of children with cerebral palsy

<p>Abstract</p> <p>Background</p> <p>The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy.</p> <p>Methods</p> <p>All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995–2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0–1 were gathered in one category and levels 2–4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion.</p> <p>Results</p> <p>In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2–4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15.</p> <p>Conclusion</p> <p>In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.</p

Evaluating the potential of whole-genome sequencing for tracing transmission routes in experimental infections and natural outbreaks of bovine respiratory syncytial virus

Bovine respiratory syncytial virus (BRSV) is a major cause of respiratory disease in cattle. Genomic sequencing can resolve phylogenetic relationships between virus populations, which can be used to infer transmission routes and potentially inform the design of biosecurity measures. Sequencing of short

Injury risk and patterns in newly transferred football players: A case study of 8 seasons from a professional football club

This case study investigated injury risk and patterns in players newly transferred to a professional football club. Time-loss injuries were recorded prospectively over 8-seasons (2008-2015). Injury incidence overall, in match and training, and patterns (contact, non-contact, sprain, strain, overuse and re-injury) were compared in transferred players (n=25) across their first versus second seasons and with those in players currently at the club at the moment of the transfer (n=55 individual players, 134 in total). Incidence Rate Ratios [IRR] in transferred players in their first versus second competitive season ranged from a 0.9 lower risk in training to a 1.5 higher risk of sustaining a contact injury (respective p values: 0.74, 0.19, inferences: unclear, likely harmful) in the first season. IRR for transferred players in their first and second seasons compared to rates in the same seasons in current players ranged from a 0.5 lower risk of incurring an overuse injury to a 1.1 higher risk of match injury (respective p values: 0.18, 0.89, inferences: unclear, possibly harmful), both occurring in season 1. For the between season and group comparisons, effect sizes regarding mean injury layoff time and matches missed ranged from trivial to small (0.03-0.22). Although limited to one club, these findings are positive as generally there was no meaningful increase in injury risk or burden in newly transferred players. Potential explanations include systematic pre-participation screening and injury prevention protocols and player rotation strategies in place at the club

Living with a long-term condition: understanding well-being for individuals with thrombophilia or asthma

range of literature has explored the experience of living with a long-term condition (LTC), and frequently treats such experiences and conditions as problematic. In contrast, other research has demonstrated that it may be possible to adapt and achieve well-being, even when living with such a condition. This tends to focus on meaning and the qualitative experience of living with an LTC, and offers alternative perspectives, often of the same or similar conditions. As a result of these conflicting views, this study chose to consider two conditions which, though they may lead to life-threatening illness on occasion, do not appear to impact significantly the lives of all those affected on a daily basis. The aim of this research was to explore and explain how people make sense of two long-term, potentially life-threatening health conditions, namely, thrombophilia and asthma. In doing so, it specifically considered the contribution made by information about the condition. A constructivist grounded theory approach was adopted; this enabled the generation of a theory regarding how people make sense of their LTC, whilst acknowledging the social circumstances in which this was situated. Semi-structured interviews were conducted with 16 participants who had given consent to take part in the research. The findings demonstrate that participants undergo a two-stage process * gaining knowledge and living with a long-term condition . The theory based on these findings indicates that those who are knowledgeable about their condition, making informed decisions in relation to it, and accept their condition are able to live with it, whilst those who do not accept their condition do not fully adapt to it or integrate it into their live

Ultrathin Solar Cells Based on Atomic Layer Deposition of Cubic versus Orthorhombic Tin Monosulfide

Tin monosulfide can be grown in cubic (π-SnS) and orthorhombic (α-SnS) polymorphs by low-temperature atomic layer deposition (ALD). The optical properties of these polymorphs make them attractive for the realization of plasmonic solar cells with ultrathin absorber layers down to 10 nm in thickness. SnS is also an earth-abundant and nontoxic compound semiconductor of high interest for regular thin-film photovoltaics. To better understand the behavior of the two SnS polymorphs in ultrathin solar cell configurations, we here fabricate, characterize, and analyze a range of such devices. ALD is used to grow SnS and form heterojunctions with zinc oxysulfide [Zn(O,S)], acting as a buffer layer with a composition-tunable bandgap. Apart from the roles of the SnS polymorph and Zn(O,S) composition, the effects of the back contact material and thicknesses of buffer and absorber layers are investigated. Devices using π-SnS and pure ZnO buffers yield the highest photocurrents (3.1 mA/cm2) and higher open circuit voltage (159 mV) than similar α-SnS-based devices. Analysis of the equivalent-circuit parameters suggests that interface recombination limits the voltage for these devices. While Zn(O,S) with a higher sulfur content provides chemical passivation of the SnS interface and excessive open circuit voltages above 600 mV, it also exhibits a too high conduction band offset, which hampers current collection. A growth delay during the ALD of Zn(O,S) on SnS initially amplifies the known sulfur–oxygen exchange reaction, such that a sulfur-rich Zn(O,S) region forms next to the SnS interface. This causes a thin ZnS-like barrier to form already for low cycle fractions of the H2S precursor in the ALD super-cycle. Voltage and fill factor trends suggest an optimal SnS absorber layer thickness in the range of 15–35 nm, presenting an opportunity for plasmonic absorption enhancement. Devices with π-SnS show most promise, but interface recombination versus current-blocking is a dilemma for the SnS/Zn(O,S) heterojunction