Use of Secure Messaging By United States Veterans and Significant Others

ABSTRACT USE OF SECURE MESSAGING BY UNITED STATES VETERANS AND SIGNIFICANT OTHERS By Claudia S. Derman The University of Wisconsin-Milwaukee, 2014 Under the Supervision of Professor Karen H. Morin, PhD, RN, ANEF, FAAN The purpose of this study was to describe the topics discussed using secure messaging (SM), the pattern of use of SM, and whether the themes discussed and/or the pattern of use varied based on gender and age of the SM user. Secure messaging is an example of a technology that focuses on patient-centered communication. Secure messaging allows patients to communicate with their clinicians using the Internet and at their convenience, while maintaining the privacy of the information exchanged. Secure messages, if approved by the patient, may also be written by family members or significant others for the patient. By its nature, the use of SM is indicative of an individual\u27s involvement in their healthcare, utilizing self-management skills. Few studies were found that reported on the content of messages written by patients or their families. No studies were found that reviewed the topics patients write about in these secure messages nor were studies found that tracked the number of messages written by patients and relating to the days and time that were most utilized. A review of 1200 secure messages written by veterans and their caregivers was undertaken to determine what information was contained within the secure messages. The 1200 messages contained 1720 themes that were grouped using content analysis to yield a total of ten topics. The day of week and the time of day of messages were additionally reviewed by gender and age of the individual. Messages written by friends of family members were reviewed and compared to those written by patients. The topic most addressed as that of medications, with more than one-third of the 1720 themes within messages relating to medications. Veterans aged 55 to 64 years were the greatest users of the SM system followed closely by those between the ages of 65 to 74. Men wrote most frequently about medications while women wrote more themes related to the topics of complaints and concerns and consultations with specialists. Pattern of use of relative to time of day and day of the week was also reviewed in subset of the sample (n= 600). The most common time frame during which messages were sent was between 9:00 a.m. and 6 p.m., accounting for more than 70% of all messages. Tuesdays and Thursdays were the most often utilized days of week for SM. The implications of this study include revisiting how MyHealtheVet is configured to enhance the veteran\u27s ability to communicate effectively and appropriately with healthcare providers. It is possible that participants employed SM rather than other identified means to contact providers as they were assured of a response within a defined period of time. Findings have implications for users, clinicians, hospital administrators, and technical staff. The purposes of SM can be revisited with users, clinicians may wish to consider alternative strategies, and administrators may wish to revisit the current structure in terms of identifying a method to sort the information contained in SM

The Promise of Using Protoplasts in Grapevine Research

Protoplasting refers to the isolation of protoplasts from plant material. These protoplasts are cellsbound only by their plasma membranes following the removal of their cell walls. In grapevine research,protoplasting efforts and successes have been reported from 1985 onwards, but recent research has showna renewed focus on grapevine-derived protoplasts, particularly due to the possibility of using protoplastsin applications such as gene-editing approaches. Grapevine species are generally considered recalcitrant tomanipulation in culture and have also proven recalcitrant with regards to protoplasting and particularlyin the regeneration of plants from protoplasts. This review will highlight the important milestones ingrapevine protoplasting while outlining the current efforts to establish grapevine protoplasting as a routinetechnique

Healthy Lifestyle Interventions in General Practice. Part 3: Lifestyle and Chronic Respiratory Disease

Chronic respiratory diseases, in particular chronic obstructive pulmonary disease (COPD), can be classified as a part of the chronic diseases of lifestyle. A lifestyle intervention programme is therefore an essential component of the non-pharmacological management of COPD and other chronic respiratory diseases. The main indication for referral to a lifestyle intervention programme is any symptomatic patient with either COPD or any other chronic respiratory disease, and who also has limited functional capacity. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are smoking cessation, exercise training (minimum of three times per week), education, psychosocial support and nutritional support. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2-3 months to assess progress and to re-set goals. Longer-term (56 months) intervention programmes are associated with better long-term outcomes. South African Family Practice Vol. 50 (6) 2008: pp. 6-

Healthy lifestyle interventions in general practice: Part 15: Lifestyle and lower back pain

Lower back pain (LBP) is one of the most common medical problems in the adult population. LBP can be defined as pain, muscle tension or stiffness that is localised below the costal margin (inferior rib cage) and above the inferior gluteal folds and that can present either with or without leg pain (sciatica), and it can be classified as “specific” or “non-specific”. LBP has a high lifetime prevalence and is associated with a substantial direct and indirect cost to the individual and society. In this review, the focus is on the identification of lifestyle risk factors and interventions that are associated with mainly non-specific chronic LBP. In addition to pharmacotherapy, the best treatment approach is exercise therapy (including physical reconditioning), psychosocial and behavioural intervention and therapeutic education. Other lifestyle changes include nutritional intervention and smoking cessation

Healthy lifestyle interventions in general practice: Part16: Lifestyle and fibromyalgia

Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patient's pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia

Healthy lifestyle interventions in general practice. Part 2: Lifestyle and cardiovascular disease

This article forms the second part of the series on the role of lifestyle modification in general practice with specific reference to chronic cardiovascular disease. Whilst the major risk factors which constitute an unhealthy lifestyle were discussed in part 1 of this series, the focus of part 2 will give specific practical guidelines which the general practitioner may incorporate into their practice when counselling patients with chronic cardiovascular disease

Transcendence of musculoskeletal injury in athletes with disability during major competition

Hamstring injuries are common in jumping and sprinting athletes. This case series documents acute grade I - II hamstring injuries in two Paralympic athletes. These athletes were able to transcend their injuries to compete 4 and 6 days after injury to attain personal best achievements

New transit observations for HAT-P-30 b, HAT-P-37 b, TrES-5 b, WASP-28 b, WASP-36 b, and WASP-39 b

We present new transit light curves for planets in six extrasolar planetary systems. They were acquired with 0.4-2.2 m telescopes located in west Asia, Europe, and South America. When combined with literature data, they allowed us to redetermine system parameters in a homogeneous way. Our results for individual systems are in agreement with values reported in previous studies. We refined transit ephemerides and reduced uncertainties of orbital periods by a factor between 2 and 7. No sign of any variations in transit times was detected for the planets studied.Comment: Submitted to Acta Astronomic