Dental Hygienists\u27 Cognitive Process in Periodontal Soft Tissue Charting

Introduction: Dental hygienists have not had the opportunity to be involved in the design and development of the periodontal soft tissue charts and the surrounding interface features that are used while examining dental patients in daily practice. In some cases, dentists are able to give their opinions, wants, and needs into the development of the health information systems that they use on a daily basis, but too often, the dental hygienist is forgotten about and no input is ever given to the developers from the dental hygienists. This project considers the impact of well-designed interfaces on effectiveness and workflow particularly in regard to the dental hygienists. It is focused on improving the surrounding interface of the electronic periodontal soft tissue chart in order to provide effective and efficient patient-centered cognitive support to the dental hygienist during a patient\u27s periodontal examination. Current periodontal soft tissue charts used in daily practice lack dental hygienists’ input during development. This study will fill a gap in knowledge by defining dental hygienists’ workflow and needs, and then proposing a layout and prototype for a periodontal soft tissue chart interface that will meet those needs. Methodology: Using a multi-phase methodology (ethnographic observations, focus groups, and cognitive task analysis) the wants and needs of practicing dental hygienists were defined. Based on the results of the ethnographic observations, focus groups, and cognitive task analysis sessions, a prototypical periodontal soft tissue chart interface was developed. The prototype then underwent usability testing by dental hygienists to compare its usability versus the existing commercial software, Dentrix. Results: Ten dental hygienists participated in the ethnographic observations, focus groups, and cognitive task analysis sessions. The wants and needs of dental hygienists were determined, as well as a “common” workflow among them. Using these results, the prototypical periodontal soft tissue chart interface was developed. Usability testing comparing Dentrix and the prototype revealed that the dental hygienists completed tasks on the prototype with greater success and speed than on Dentrix. Furthermore, the dental hygienists provided more positive comments toward the prototype than Dentrix. Conclusions: This study exhibits the need to properly involve the end users – dental hygienists – in the creation of a prototypical periodontal soft tissue chart interface. Health information systems need to involve the end users at all stages in the development process in order to design and develop a system that is efficient and usable for them

Disclosure of Depression in Primary Care: A Qualitative Study of Women’s Perceptions

Background Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women. Methods Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis. Findings Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure. Conclusions Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy

Multisite Evaluation of Prediction Models for Emergency Department Crowding Before and During the COVID-19 Pandemic

OBJECTIVE: To develop a machine learning framework to forecast emergency department (ED) crowding and to evaluate model performance under spatial and temporal data drift. MATERIALS AND METHODS: We obtained 4 datasets, identified by the location: 1-large academic hospital and 2-rural hospital, and time period: pre-coronavirus disease (COVID) (January 1, 2019-February 1, 2020) and COVID-era (May 15, 2020-February 1, 2021). Our primary target was a binary outcome that is equal to 1 if the number of patients with acute respiratory illness that were ED boarding for more than 4 h was above a prescribed historical percentile. We trained a random forest and used the area under the curve (AUC) to evaluate out-of-sample performance for 2 experiments: (1) we evaluated the impact of sudden temporal drift by training models using pre-COVID data and testing them during the COVID-era, (2) we evaluated the impact of spatial drift by testing models trained at location 1 on data from location 2, and vice versa. RESULTS: The baseline AUC values for ED boarding ranged from 0.54 (pre-COVID at location 2) to 0.81 (COVID-era at location 1). Models trained with pre-COVID data performed similarly to COVID-era models (0.82 vs 0.78 at location 1). Models that were transferred from location 2 to location 1 performed worse than models trained at location 1 (0.51 vs 0.78). DISCUSSION AND CONCLUSION: Our results demonstrate that ED boarding is a predictable metric for ED crowding, models were not significantly impacted by temporal data drift, and any attempts at implementation must consider spatial data drift

Determinants of Trust in Health Care in an Older Population

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110894/1/jgs13316.pd

Satisfaction of Older Patients With Emergency Department Care: Psychometric Properties and Construct Validity of the Consumer Emergency Care Satisfaction Scale.

BACKGROUND: Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales. PURPOSE: The purpose of this study was to examine the construct validity of the CECSS and make suggestions on how to improve the tool to measure overall satisfaction with ED care. METHODS: We administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects. RESULTS: Using several criteria, we improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring. CONCLUSION: We addressed several methodological issues with the CECSS and provided recommendations for improvement

Bone cancer pain: The effects of the bisphosphonate alendronate on pain, skeletal remodeling, tumor growth and tumor necrosis

Patients with metastatic breast, lung or prostate cancer frequently have significant bone cancer pain. In the present report we address, in a single in vivo mouse model, the effects the bisphosphonate alendronate has on bone cancer pain, bone remodeling and tumor growth and necrosis. Following injection and confinement of green fluorescent protein-transfected murine osteolytic tumor cells into the marrow space of the femur of male C3H/HeJ mice, alendronate was administered chronically from the time the tumor was established until the bone cancer pain became severe. Alendronate therapy reduced ongoing and movement-evoked bone cancer pain, bone destruction and the destruction of sensory nerve fibers that innervate the bone. Whereas, alendronate treatment did not change viable tumor burden, both tumor growth and tumor necrosis increased. These data emphasize that it is essential to utilize a model where pain, skeletal remodeling and tumor growth can be simultaneously assessed, as each of these can significantly impact patient quality of life and survival.Peer reviewe

Simultaneous reduction in cancer pain, bone destruction, and tumor growth by selective inhibition of cyclooxygenase-2

More than half of all chronic cancer pain arises from metastases to bone, and bone cancer pain is one of the most difficult of all persistent pain states to fully control. Several tumor types including sarcomas and breast, prostate, and lung carcinomas grow in or preferentially metastasize to the skeleton where they proliferate, and induce significant bone remodeling, bone destruction, and cancer pain. Many of these tumors express the isoenzyme cycloxygenase-2 (COX-2), which is involved in the synthesis of prostaglandins. To begin to define the role COX-2 plays in driving bone cancer pain, we used an in vivo model where murine osteolytic 2472 sarcoma cells were injected and confined to the intramedullary space of the femur in male C3HHeJ mice. After tumor implantation, mice develop ongoing and movement-evoked bone cancer pain-related behaviors, extensive tumor-induced bone resorption, infiltration of the marrow space by tumor cells, and stereotypic neurochemical alterations in the spinal cord reflective of a persistent pain state. Thus, after injection of tumor cells, bone destruction is first evident at day 6, and pain-related behaviors are maximal at day 14. A selective COX-2 inhibitor was administered either acutely [NS398; 100 mg/kg, i.p.] on day 14 or chronically in chow {MF. tricyclic; 0.015%, p.o.} from day 6 to day 14 after tumor implantation. Acute administration of a selective COX-2 inhibitor attenuated both ongoing and movement-evoked bone cancer pain, whereas chronic inhibition of COX-2 significantly reduced ongoing and movement-evoked pain behaviors, and reduced tumor burden, osteoclastogenesis, and bone destruction by >50%. The present results suggest that chronic administration of a COX-2 inhibitor blocks prostaglandin synthesis at multiple sites, and may have significant clinical utility in the management of bone cancer and bone cancer pain.Supported by NIH Grants from the National Institute of Neurologic Disorders and Stoke (NS23970), the National Institute for Drug Abuse (DA11986), National Institute of Dental and Craniofacial Research Dentist Scientist Award (DSA) DE00270, Training Grant DE07288, and a Merit Review from the Veterans Administration.Peer reviewe