Optimizing Patient Comprehension of Information Visualizations for Medication Adherence and Blood Pressure

Introduction: This dissertation focused on designing hypertension self-management visualizations that facilitate patient comprehension of blood pressure and medication adherence information. The objectives of this research were to: 1) assess patient preferences and understanding of visualization features; 2) assess whether condensing the display of blood pressure and medication adherence information into a single visualization improves patient comprehension of the inferred relationship between medication adherence and blood pressure control (compared to separate visualizations); 3) assess whether health literacy moderates the effect of condensed visualizations on comprehension; and 4) assess the validity and reliability of a newly developed hypertension-related visualization comprehension scale. Methods: Patients with hypertension (n=6) participated in user assessments to understand preferences for visualization features. Another sample of patients with hypertension (n=6) participated in cognitive interviews that assessed understanding of visualizations that incorporated patient preferences. A survey experiment with patients with hypertension (n=137) then assessed whether condensed visualizations improved comprehension of blood pressure and medication adherence information. Multiple regression analysis was used to assess the main effect of visualization type (condensed versus separate display) on comprehension, and the moderating effect of health literacy on comprehension. Exploratory and confirmatory factor analysis were used to assess the validity and reliability of the comprehension scale. Results: Patients preferred visualizations with blue/orange color-coded culturally recognizable symbols to show medication adherence, and the use of labeled blood pressure data points, horizontal reference lines, and a shaded “normal” blood pressure zone. Patients best understood a shaded “normal” blood pressure zone with color-coded symbols to show medication adherence. Condensed visualizations did not significantly improve comprehension, and health literacy did not moderate the relationship between visualization type and comprehension. However, greater health literacy (B=0.61, p=.0001) and hypertension knowledge (B=0.10, p<0.0001) were positively associated with comprehension. Exploratory and confirmatory factor analyses supported a unidimensional 4-item solution for the comprehension scale. Conclusion: This study is an important step in developing useful and useable data visualizations for self-managing HTN. Condensed-display visualizations did not improve patient comprehension of BP and medication adherence information. Future research should further investigate how to design visualizations that improve comprehension, specifically for patients with low health literacy.Doctor of Philosoph

A Review of Electronic Devices to Assess Inhaler Technique

Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.)

Adolescent, caregiver, and friend preferences for integrating social support and communication features into an asthma self-management app

This study examines: 1) adolescent preferences for using asthma self-management mobile applications (apps) to interact with their friends, caregivers, medical providers, and other adolescents with asthma and 2) how caregivers and friends would use mobile apps to communicate with the adolescent and serve as sources of support for asthma management

Oncogenetics of Lung Cancer Induced by Environmental Carcinogens

The molecular landscape of non-tobacco-induced primary lung tumors displays specific oncogenetic features. The etiology of these tumors has been largely associated with exposure to well-established environmental lung carcinogens such as radon, arsenic, and asbestos. Environmental carcinogens can induce specific genetic and epigenetic alterations in lung tissue, leading to aberrant function of lung cancer oncogenes and tumor suppressor genes. These molecular events result in the disruption of key cellular mechanisms, such as protection against oxidative stress and DNA damage-repair, which promotes tumor development and progression. This chapter provides a comprehensive discussion of the specific carcinogenic mechanisms associated with exposure to radon, arsenic, and asbestos. It also summarizes the main protein-coding and non-coding genes affected by exposure to these environmental agents, and the underlying molecular mechanisms promoting their deregulation in lung cancer. Finally, the chapter examines the anticipated challenges in personalized intervention strategies in non-tobacco-induced lung cancer

Tumour Suppressor Genes with Oncogenic Roles in Lung Cancer

Lung cancer is one of the most common cancers and the leading cause of cancer-related deaths worldwide. High-throughput sequencing efforts have uncovered the molecular heterogeneity of this disease, unveiling several genetic and epigenetic disruptions driving its development. Unlike oncogenes, tumour suppressor genes negatively regulate cell cycle control and exhibit loss-of-function alterations in cancer. Although tumour suppressor genes are more frequently disrupted, oncogenes are more likely to be drug-targeted. Many genes are described as presenting both tumour suppressive and oncogenic functions in different tumour types or even within the natural history of the disease in a single tumour. In this chapter, we describe current knowledge of tumour suppressor genes in lung tissues, focusing on tumour suppressor/oncogene duality

The Relationship Between Social Support, Social Constraint, and Psychological Adjustment for Patients with Rare Autoimmune Disease.

Our goals were to describe the balance of social support to negative social interactions (i.e. social constraint) for autoimmune disease patients and determine whether support and constraint from spouses and non-spousal family and friends interact to influence patients' psychological adjustment. Using crosssectional survey data from 109 married vasculitis and lupus patients, we found that patients reported that spouses and family/friends provided more social support than social constraint. In regression models, constraint from spouses (β= -0.45, p&lt;0.01) and family/friends (β= -0.89, p&lt;0.001) were associated with worse patient psychological adjustment. A significant 3-way interaction revealed that patients with low spousal support had worse psychological adjustment as the levels of family and friend support increased. In contrast, patients with high levels of spousal support reported better psychological adjustment as family and friend support increased. Future longitudinal studies may help to elucidate the complex interplay between constraint and support from spouses, family, and friends

Exploring youth and caregiver preferences for asthma education video content

This study examines: 1) whether youth and their caregivers have different preferences for asthma education video topics and 2) if education topic preferences vary by youth and caregiver sociodemographic characteristics

Small Noncoding RNA Expression in Cancer

Despite an inability to encode proteins, small noncoding RNAs (sncRNAs) have critical functions in the regulation of gene expression. They have demonstrated roles in cancer development and progression and are frequently dysregulated. Here we review the biogenesis and mechanism of action, expression patterns, and detection methods of two types of sncRNAs frequently described in cancer: miRNAs and piRNAs. Both miRNAs and piRNAs have been observed to play both oncogenic and tumor-suppressive roles, with miRNAs acting to directly regulate the mRNA of key cancer-associated genes, while piRNAs play crucial roles in maintaining the integrity of the epigenetic landscape. Elucidating these important functions of sncRNAs in normal and cancer biology relies on numerous in silico workflows and tools to profile sncRNA expression. Thus, we also discuss the key detection methods for cancer-relevant sncRNAs, including the discovery of genes that have yet to be described

Local alkylating chemotherapy applied immediately after 5-ALA guided resection of glioblastoma does not provide additional benefit.

Grade IV glioma is the most common and aggressive primary brain tumour. Gross total resection with 5-aminolevulinic acid (5-ALA) guided surgery combined with local chemotherapy (carmustine wafers) is an attractive treatment strategy in these patients. No previous studies have examined the benefit carmustine wafers in a treatment programme of 5-ALA guided resection followed by a temozolomide-based chemoradiotherapy protocol. The objective of this study was to examine the benefit of carmustine wafers on survival in patients undergoing 5-ALA guided resection. A retrospective cohort study of 260 patients who underwent 5-ALA resection of confirmed WHO 2007 Grade IV glioma between July 2009 and December 2014. Survival curves were calculated using the Kaplan-Meier method from surgery. The log-rank test was used to compare survival curves between groups. Cox regression was performed to identify variables predicting survival. A propensity score matched analysis was used to compare survival between patients who did and did not receive carmustine wafers while controlling for baseline characteristics. Propensity matched analysis showed no significant survival benefit of insertion of carmustine wafers over 5-ALA resection alone (HR 0.97 [0.68-1.26], p = 0.836). There was a trend to higher incidence of wound infection in those who received carmustine wafers (15.4 vs. 7.1%, p = 0.064). The Cox regression analysis showed that intraoperative residual fluorescent tumour and residual enhancing tumour on post-operative MRI were significantly predictive of reduced survival. Carmustine wafers have no added benefit following 5-ALA guided resection. Residual fluorescence and residual enhancing disease following resection have a negative impact on survival

The relationship between partner information-seeking, information-sharing, and patient medication adherence

We describe the medication information-seeking behaviors of arthritis patients’ partners and explore whether partner medication information-seeking and information-sharing are associated with patient medication adherence