Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

Background: Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results: PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion: Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care

Enantioselective S‐H Insertion Reactions of α‐Carbonyl Sulfoxonium Ylides

The first example of enantioselective S‐H insertion reactions of sulfoxonium ylides is reported. Under the influence of thiourea catalysis, excellent levels of enantiocontrol (up to 95% ee) and yields (up to 97%) are achieved for 31 examples in S‐H insertion reactions of aryl thiols and α‐carbonyl sulfoxonium ylides

The Positive Impact of Occupational Therapy Involvement in Interprofessional Education

It is essential that members of a successful interprofessional healthcare delivery team understand the crucial roles and responsibilities of each profession. Participation in interprofessional education and practice has been suggested to improve understanding of the roles of each discipline on an allied health team, however, often understanding of the occupational therapy scope of practice is confusing to other allied health professionals. This study presents the outcomes of a community-based interprofessional practice experience with occupational therapy, physical therapy, and physician assistant students on perceived understanding of each profession’s roles and responsibilities. In addition, this study introduces the Primary Care Training and Enhancement (PCTE) Interprofessional Actual and Perceived Knowledge Questionnaire to assess actual understanding of health professions’ roles and responsibilities. The inclusion of occupational therapy students in the interprofessional practice experience resulted in a significant increase in physical therapy and physician assistant students’ perceived understanding of occupational therapy’s scope of practice (an increase of 11.0% and 23.4%, respectively,

Effective supersymmetric theory and muon anomalous magnetic moment with R parity violation

The effective supersymmetric theory (ESUSY) with R parity conservation cannot give a large anomalous magnetic moment of $\mu$. It is pointed out that the flavor conservation and a large $(g-2)_\mu$ within the experimental limits are achievable in the ESUSY with R parity violating couplings involving the third generation superparticles.Comment: LaTeX file of 14 pages, including 4 figure

A survey to investigate the association of pain, foot disability and quality of life with corns

Background Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL). Methods Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ-5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot-related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life. Results The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot-related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns. Conclusions The effect of pain was shown to mediate the relationship between sex and foot-related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter-digital corns

Muon anomalous magnetic moment in string inspired extended family models

We propose a standard model minimal extension with two lepton weak SU(2) doublets and a scalar singlet to explain the deviation of the measured anomalous magnetic moment of the muon from the standard model expectation. This scheme can be naturally motivated in string inspired models such as E_6 and AdS/CFT.Comment: 9 pages, RevTeX, 2 figures, version to be published in Phys. Rev.

Comparison between variable flavor number schemes for charm quark electroproduction

Where appropriate, the abbreviation 'VFNS' is replaced by 'CSN' to indicate the scheme using massive heavy quark coefficient functions proposed in this paper. The text below Eq. (2.13) and between Eqs. (2.33) and (2.36) has been considerably changed.Comment: 64 pages, LaTeX, 16 Postscript figure

Complete Next to Leading Order QCD Corrections to the Photon Structure Functions F2γ(x,Q2)F^\gamma_2(x,Q^2) and FLγ(x,Q2)F_L^\gamma(x,Q^2)

We present the complete NLO QCD analysis of the photon structure functions $F_2^\gamma(x,Q^2)$ and $F_L^\gamma(x,Q^2)$ for a real photon target. In particular we study the heavy flavor content of the structure functions which is due to two different production mechanisms, namely collisions of a virtual photon with a real photon, and with a parton. We observe that the charm contributions are noticeable for $F_2^\gamma(x,Q^2)$ as well as $F_L^\gamma(x,Q^2)$ in the x-region studied.Comment: Latex 34 pages, 24 figures, uuencoded, attached at end, ITP-SB-93-46, FERMILAB-Pub-93/240-T, SMU HEP 93-1