Patient Satisfaction with Telehealth Services Compared to In-Office Visits: A Systematic Literature Review

Telehealth is changing the current paradigm of healthcare. As an emerging mode of healthcare delivery, telehealth stands to help alleviate the shortage of primary care and specialty care providers especially patients in rural areas. In addition to increasing access of healthcare, this service allows for flexibility, convenience and has the potential to decrease healthcare costs while improving patient outcomes. The objective of this literature review was to examine patient satisfaction with telehealth compared to in-office visits. A systematic search was conducted and a total of 17 articles that met inclusion criteria were examined. Data and factors evolving around patient satisfaction with telehealth were extracted and descriptively synthesized from the inclusion articles. Multiple factors were identified that impacted patient satisfaction with telehealth including travel time/convenience, access to healthcare, cost savings, clinical outcomes, provider relationship, and inhibiting influences of telehealth. The overall findings are in consensus that patients are equally, if not more, satisfied with telehealth when compared to inoffice visits. Despite this, there is a paucity of high-quality research related to this topic. Telehealth is a growing role for advanced practice registered nurses, therefore adding to the importance of prioritizing the understanding of the identified themes within this literature review and how they impact patient satisfaction with telehealth

Effects of aripiprazole once-monthly on domains of personal and social performance: Results from 2 multicenter, randomized, double-blind studies

Objective: To assess the effects of maintenance therapy with aripiprazole once-monthly 400 mg on personal and social functioning. Methods: Data were analyzed from 2 randomized, double-blind trials of patients with schizophrenia requiring chronic antipsychotic treatment. One study was a 52-week trial of aripiprazole once-monthly 400 mg versus placebo; the other was a 38-week trial of aripiprazole once-monthly 400 mg, oral aripiprazole (10-30 mg daily), and aripiprazole once-monthly 50 mg (subtherapeutic dose to test assay sensitivity). Functioning was assessed using the Personal and Social Performance (PSP) scale, comprising 4 domain subscales. Results: In the 52-week study, 403 patients stabilized on aripiprazole once-monthly 400 mg were randomized to receive aripiprazole once-monthly 400 mg (n=269) or placebo (n=134). In the 38-week study, 662 patients stabilized on oral aripiprazole were randomized to receive aripiprazole once-monthly 400 mg (n=265), oral aripiprazole (n=266), or aripiprazole once-monthly 50 mg (subtherapeutic dose; n=131). In the 52-week study, mean changes from baseline were significantly worsened with placebo compared with aripiprazole once-monthly 400 mg for PSP total score (

Classifying Candidate Axioms via Dimensionality Reduction Techniques

We assess the role of similarity measures and learning methods in classifying candidate axioms for automated schema induction through kernel-based learning algorithms. The evaluation is based on (i) three different similarity measures between axioms, and (ii) two alternative dimensionality reduction techniques to check the extent to which the considered similarities allow to separate true axioms from false axioms. The result of the dimensionality reduction process is subsequently fed to several learning algorithms, comparing the accuracy of all combinations of similarity, dimensionality reduction technique, and classification method. As a result, it is observed that it is not necessary to use sophisticated semantics-based similarity measures to obtain accurate predictions, and furthermore that classification performance only marginally depends on the choice of the learning method. Our results open the way to implementing efficient surrogate models for axiom scoring to speed up ontology learning and schema induction methods

Biochemical properties of Paracoccus denitrificans FnrP:Reactions with molecular oxygen and nitric oxide

In Paracoccus denitrificans, three CRP/FNR family regulatory proteins, NarR, NnrR and FnrP, control the switch between aerobic and anaerobic (denitrification) respiration. FnrP is a [4Fe-4S] cluster containing homologue of the archetypal O2 sensor FNR from E. coli and accordingly regulates genes encoding aerobic and anaerobic respiratory enzymes in response to O2, and also NO, availability. Here we show that FnrP undergoes O2-driven [4Fe-4S] to [2Fe-2S] cluster conversion that involves up to 2 O2 per cluster, with significant oxidation of released cluster sulfide to sulfane observed at higher O2 concentrations. The rate of the cluster reaction was found to be ~6-fold lower than that of E. coli FNR, suggesting that FnrP can remain transcriptionally active under microaerobic conditions. This is consistent with a role for FnrP in activating expression of the high O2 affinity cytochrome c oxidase under microaerobic conditions. Cluster conversion resulted in dissociation of the transcriptionally active FnrP dimer into monomers. Therefore, along with E. coli FNR, FnrP belongs to the subset of FNR proteins in which cluster type is correlated with association state. Interestingly, two key charged residues, Arg140 and Asp154, that have been shown to play key roles in the monomer-dimer equilibrium in E. coli FNR are not conserved in FnrP, indicating that different protomer interactions are important for this equilibrium. Finally, the FnrP [4Fe-4S] cluster is shown to undergo reaction with multiple NO molecules, resulting in iron nitrosyl species and dissociation into monomers

Quisquis: A new design for anonymous cryptocurrencies

Despite their usage of pseudonyms rather than persistent identifiers, most existing cryptocurrencies do not provide users with any meaningful levels of privacy. This has prompted the creation of privacy-enhanced cryptocurrencies such as Monero and Zcash, which are specifically designed to counteract the tracking analysis possible in currencies like Bitcoin. These cryptocurrencies, however, also suffer from some drawbacks: in both Monero and Zcash, the set of potential unspent coins is always growing, which means users cannot store a concise representation of the blockchain. Additionally, Zcash requires a common reference string and the fact that addresses are reused multiple times in Monero has led to attacks to its anonymity. In this paper we propose a new design for anonymous cryptocurrencies, Quisquis, that achieves provably secure notions of anonymity. Quisquis stores a relatively small amount of data, does not require trusted setup, and in Quisquis each address appears on the blockchain at most twice: once when it is generated as output of a transaction, and once when it is spent as input to a transaction. Our result is achieved by combining a DDH-based tool (that we call updatable keys) with efficient zero-knowledge arguments

Suicidality and hostility following involuntary hospital treatment

Background Psychiatric patients showing risk to themselves or others can be involuntarily hospitalised. No data is available on whether following hospitalisation there is a reduction in psychopathological indicators of risk such as suicidality and hostility. This study aimed to assess changes in suicidality and hostility levels following involuntary admission and their patient-level predictors. Methods A pooled analysis of studies on involuntary treatment, including 11 countries and 2790 patients was carried out. Suicidality and hostility were measured by the Brief Psychiatric Rating Scale. Results 2790 patients were included; 2129 followed-up after one month and 1864 after three months. 387 (13.9%) patients showed at least moderate suicidality when involuntarily admitted, 107 (5.0%) after one month and 97 (5.2%) after three months. Moderate or higher hostility was found in 1287 (46.1%) patients after admission, 307 (14.5%) after one month, and 172 (9.2%) after three months. Twenty-three (1.2%) patients showed suicidality, and 53 (2.8%) patients hostility at all time-points. Predictors of suicidality three months after admission were: suicidality at baseline, not having a diagnosis of psychotic disorder and being unemployed. Predictors of hostility were: hostility at baseline, not having a psychotic disorder, living alone, and having been hospitalized previously. Conclusions After involuntary hospital admission, the number of patients with significant levels of suicidality and hostility decreases substantially over time, and very few patients show consistently moderate or higher levels of these symptoms. In patients with psychotic disorders these symptoms are more likely to improve. Social factors such as unemployment and isolation could hamper suicidality and hostility reduction and may be targeted in interventions to reduce risk in involuntarily admitted patients

Qualitative perspectives of the North Carolina healthy food small retailer program among customers in participating stores located in food deserts

Background: The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. Methods: Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers’ food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. Results: Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. Conclusions: Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations

Care for patients with severe mental illness: the general practitioner's role perspective

BACKGROUND: Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. METHODS: A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. RESULTS: 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. CONCLUSION: GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients