A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations

Background Patient-provider electronic communication has proliferated in recent years, yet there is a dearth of published research either leading to, or including, recommendations that improve clinical care and prevent unintended negative consequences. We critically appraise published guidelines and suggest an agenda for future work in this area. Objective To understand how existing guidelines align with current practice, evidence, and technology. Methods We performed a narrative review of provider-targeted guidelines for electronic communication between patients and providers, searching Ovid MEDLINE, Embase, and PubMed databases using relevant terms. We limited the search to articles published in English, and manually searched the citations of relevant articles. For each article, we identified and evaluated the suggested practices. Results Across 11 identified guidelines, the primary focus was on technical and administrative concerns, rather than on relational communication. Some of the security practices recommended by the guidelines are no longer needed because of shifts in technology. It is unclear the extent to which the recommendations that are still relevant are being followed. Moreover, there is no guideline-cited evidence of the effectiveness of the practices that have been proposed. Conclusion Our analysis revealed major weaknesses in current guidelines for electronic communication between patients and providers: the guidelines appear to be based on minimal evidence and offer little guidance on how best to use electronic tools to communicate effectively. Further work is needed to systematically evaluate and identify effective practices, create a framework to evaluate quality of communication, and assess the relationship between electronic communication and quality of care

Fast assembly of bio-inspired nanocomposite films

This paper presents a spin-coating layer-by-layer assembly process to prepare multilayered polyelectrolyte-clay nanocomposites. This method allows for the fast production of films with controlled layered structure. The preparation of a 100-bilayer film with a thickness of about 330 nm needs less than 1 h, which is 20 times faster than conventional dip-coating processes maintaining the same hardness and modulus values. For validation of this technique, nanocomposite films with thicknesses up to 0.5 μm have been created with the common dip self-assembly and with the spin coating layer-by-layer assembly technique from a poly(diallyldimethylammonium)chloride (PDDA) solution and a suspension of a smectite clay mineral (Laponite). Geometrical characteristics (thickness, roughness, and texture) as well as mechanical characteristics (hardness and modulus) of the clay-polyelectrolyte films have been studied. The spin-coated nanocomposite films exhibit clearly improved mechanical properties (hardness 0.4 GPa, elastic modulus 7 GPa) compared to the "pure” polymer film, namely a sixfold increase in hardness and a 17-fold increase in Young's modulu

Inflammatory monocytes require type I interferon receptor signaling to activate NK cells via IL-18 during a mucosal viral infection

The requirement of type I interferon (IFN) for natural killer (NK) cell activation in response to viral infection is known, but the underlying mechanism remains unclear. Here, we demonstrate that type I IFN signaling in inflammatory monocytes, but not in dendritic cells (DCs) or NK cells, is essential for NK cell function in response to a mucosal herpes simplex virus type 2 (HSV-2) infection. Mice deficient in type I IFN signaling, Ifnar(-/-) and Irf9(-/-) mice, had significantly lower levels of inflammatory monocytes, were deficient in IL-18 production, and lacked NK cell-derived IFN-gamma. Depletion of inflammatory monocytes, but not DCs or other myeloid cells, resulted in lower levels of IL-18 and a complete abrogation of NK cell function in HSV-2 infection. Moreover, this resulted in higher susceptibility to HSV-2 infection. Although Il18(-/-) mice had normal levels of inflammatory monocytes, their NK cells were unresponsive to HSV-2 challenge. This study highlights the importance of type I IFN signaling in inflammatory monocytes and the induction of the early innate antiviral response

Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders

Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.OA publication support through Carolina Consortium agreement with Sag

Identification of genes expressed by immune cells of the colon that are regulated by colorectal cancer-associated variants.

A locus on human chromosome 11q23 tagged by marker rs3802842 was associated with colorectal cancer (CRC) in a genome-wide association study; this finding has been replicated in case-control studies worldwide. In order to identify biologic factors at this locus that are related to the etiopathology of CRC, we used microarray-based target selection methods, coupled to next-generation sequencing, to study 103 kb at the 11q23 locus. We genotyped 369 putative variants from 1,030 patients with CRC (cases) and 1,061 individuals without CRC (controls) from the Ontario Familial Colorectal Cancer Registry. Two previously uncharacterized genes, COLCA1 and COLCA2, were found to be co-regulated genes that are transcribed from opposite strands. Expression levels of COLCA1 and COLCA2 transcripts correlate with rs3802842 genotypes. In colon tissues, COLCA1 co-localizes with crystalloid granules of eosinophils and granular organelles of mast cells, neutrophils, macrophages, dendritic cells and differentiated myeloid-derived cell lines. COLCA2 is present in the cytoplasm of normal epithelial, immune and other cell lineages, as well as tumor cells. Tissue microarray analysis demonstrates the association of rs3802842 with lymphocyte density in the lamina propria (p = 0.014) and levels of COLCA1 in the lamina propria (p = 0.00016) and COLCA2 (tumor cells, p = 0.0041 and lamina propria, p = 6 × 10(-5)). In conclusion, genetic, expression and immunohistochemical data implicate COLCA1 and COLCA2 in the pathogenesis of colon cancer. Histologic analyses indicate the involvement of immune pathways

Exploring patterns of recurrent melanoma in Northeast Scotland to inform the introduction a digital self-examination intervention

Peer reviewedPublisher PD

Insecure messaging: how clinicians approach potentially problematic messages from patients

Objective: Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients. Methods: In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes. Results: Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content. Conclusion: Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice. Practical implications: We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients

Periodic vacuum and particles in two dimensions

Different dynamical symmetry breaking patterns are explored for the two dimensional phi4 model with higher order derivative terms. The one-loop saddle point expansion predicts a rather involved phase structure and a new Gaussian critical line. This vacuum structure is corroborated by the Monte Carlo method, as well. Analogies with the structure of solids, the density wave phases and the effects of the quenched impurities are mentioned. The unitarity of the time evolution operator in real time is established by means of the reflection positivity.Comment: Final version, additional references and the proof of reflection positivity added, 41 pages, 16 figure

Invariant measures of the 2D Euler and Vlasov equations

We discuss invariant measures of partial differential equations such as the 2D Euler or Vlasov equations. For the 2D Euler equations, starting from the Liouville theorem, valid for N-dimensional approximations of the dynamics, we define the microcanonical measure as a limit measure where N goes to infinity. When only the energy and enstrophy invariants are taken into account, we give an explicit computation to prove the following result: the microcanonical measure is actually a Young measure corresponding to the maximization of a mean-field entropy. We explain why this result remains true for more general microcanonical measures, when all the dynamical invariants are taken into account. We give an explicit proof that these microcanonical measures are invariant measures for the dynamics of the 2D Euler equations. We describe a more general set of invariant measures, and discuss briefly their stability and their consequence for the ergodicity of the 2D Euler equations. The extension of these results to the Vlasov equations is also discussed, together with a proof of the uniqueness of statistical equilibria, for Vlasov equations with repulsive convex potentials. Even if we consider, in this paper, invariant measures only for Hamiltonian equations, with no fluxes of conserved quantities, we think this work is an important step towards the description of non-equilibrium invariant measures with fluxes.Comment: 40 page