Quality Improvement Intervention to Reduce Thirty-Day Hospital Readmission Rates Among Patients With Systemic Lupus Erythematosus.

OBJECTIVE: Systemic lupus erythematosus (SLE) has one of the highest 30-day hospital readmission rates among chronic diseases in the US. This quality improvement initiative developed and assessed the feasibility of a multidisciplinary postdischarge intervention to reduce 30-day readmission rates among SLE patients. METHODS: A retrospective study was performed using electronic health records of patients with SLE admitted to a university hospital prior to (nonintervention group) and after initiation of the study intervention (intervention group). The study population included patients with a diagnosis of SLE who were admitted to the hospital for any reason during an 8-month time period. The intervention involved sending a templated message at the time of discharge to the rheumatology clinic nurses, which prompted the nurses to call the patient to coordinate future visits and provide education. The primary outcome was the 30-day hospital readmission rate. Data were analyzed using a multivariate mixed binomial regression model. RESULTS: There were 59 hospitalizations in the nonintervention group and 73 hospitalizations in the intervention group during the 8-month study period. The 30-day readmission rate was 29% in the nonintervention group and 19% in the intervention group. The difference in readmission rates between the 2 groups was not statistically significant based on the multivariate model. CONCLUSION: Our study demonstrates the feasibility of implementing a multidisciplinary postdischarge intervention to reduce readmission rates for patients with SLE in a large academic medical center. Further investigation is warranted to determine if this approach reduces the unacceptably high hospital readmission rates among SLE patients.

An educational video game for nutrition of young people: Theory and design.

BACKGROUND: Playing Escape from DIAB (DIAB) and Nanoswarm (NANO), epic video game adventures, increased fruit and vegetable consumption among a multi-ethnic sample of 10-12 year old children during pilot testing. Key elements of both games were educational mini-games embedded in the overall game that promoted knowledge acquisition regarding diet, physical activity and energy balance. 95-100% of participants demonstrated mastery of these mini-games suggesting knowledge acquisition. AIM: This article describes the process of designing and developing the educational mini-games. A secondary purpose was to explore the experience of children while playing the games. METHOD: The educational games were based on Social Cognitive and Mastery Learning Theories. A multidisciplinary team of behavioral nutrition, PA, and video game experts designed, developed, and tested the mini-games. RESULTS: Alpha testing revealed children generally liked the mini-games and found them to be reasonably challenging. Process evaluation data from pilot testing revealed almost all participants completed nearly all educational mini-games in a reasonable amount of time suggesting feasibility of this approach. CONCLUSIONS: Future research should continue to explore the use of video games in educating children to achieve healthy behavior changes.

Advantage of impulse oscillometry over spirometry to diagnose chronic obstructive pulmonary disease and monitor pulmonary responses to bronchodilators: An observational study.

OBJECTIVES: This retrospective study was a comparative analysis of sensitivity of impulse oscillometry and spirometry techniques for use in a mixed chronic obstructive pulmonary disease group for assessing disease severity and inhalation therapy. METHODS: A total of 30 patients with mild-to-moderate chronic obstructive pulmonary disease were monitored by impulse oscillometry, followed by spirometry. Lung function was measured at baseline after bronchodilation and at follow-up (3-18 months). The impulse oscillometry parameters were resistance in the small and large airways at 5 Hz (R5), resistance in the large airways at 15 Hz (R15), and lung reactance (area under the curve X; AX). RESULTS: After the bronchodilator therapy, forced expiratory volume in 1 second (FEV1) readings evaluated by spirometry were unaffected at baseline and at follow-up, while impulse oscillometry detected an immediate improvement in lung function, in terms of AX (p = 0.043). All impulse oscillometry parameters significantly improved at follow-up, with a decrease in AX by 37% (p = 0.0008), R5 by 20% (p = 0.0011), and R15 by 12% (p = 0.0097). DISCUSSION: Impulse oscillometry parameters demonstrated greater sensitivity compared with spirometry for monitoring reversibility of airway obstruction and the effect of maintenance therapy. Impulse oscillometry may facilitate early treatment dose optimization and personalized medicine for chronic obstructive pulmonary disease patients.

Video game play, child diet, and physical activity behavior change a randomized clinical trial.

BACKGROUND: Video games designed to promote behavior change are a promising venue to enable children to learn healthier behaviors. PURPOSE: Evaluate outcome from playing "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) video games on children's diet, physical activity, and adiposity. DESIGN: Two-group RCT; assessments occurred at baseline, immediately after Diab, immediately after Nano, and 2 months later. Data were collected in 2008-2009, and analyses were conducted in 2009-2010. SETTING/PARTICIPANTS: 133 children aged 10-12 years, initially between 50th percentile and 95th percentile BMI. INTERVENTION: Treatment group played Diab and Nano in sequence. Control Group played diet and physical activity knowledge-based games on popular websites. MAIN OUTCOME MEASURES: Servings of fruit, vegetable, and water; minutes of moderate to vigorous physical activity. At each point of assessment: 3 nonconsecutive days of 24-hour dietary recalls; 5 consecutive days of physical activity using accelerometers; and assessment of height, weight, waist circumference, and triceps skinfold. RESULTS: A repeated measures ANCOVA was conducted (analyzed in 2009-2010). Children playing these video games increased fruit and vegetable consumption by about 0.67 servings per day (p<0.018) but not water and moderate-to-vigorous physical activity, or body composition. CONCLUSIONS: Playing Diab and Nano resulted in an increase in fruit and vegetable intake. Research is needed on the optimal design of video game components to maximize change.

Serious Video Games for Health How Behavioral Science Guided the Development of a Serious Video Game.

Serious video games for health are designed to entertain players while attempting to modify some aspect of their health behavior. Behavior is a complex process influenced by multiple factors, often making it difficult to change. Behavioral science provides insight into factors that influence specific actions that can be used to guide key game design decisions. This article reports how behavioral science guided the design of a serious video game to prevent Type 2 diabetes and obesity among youth, two health problems increasing in prevalence. It demonstrates how video game designers and behavioral scientists can combine their unique talents to create a highly focused serious video game that entertains while promoting behavior change.

Herd immunity in adults against influenza-related illnesses with use of the trivalent-live attenuated influenza vaccine (CAIV-T) in children.

Highest attack rates for influenza occur in children. Immunization of schoolchildren with inactivated influenza vaccine in Michigan and Japan was associated with decreased morbidity and mortality, respectively, in older community contacts. An open-labeled, non-randomized, community-based trial in children with the cold adapted influenza vaccine, trivalent (CAIV-T) was initiated to determine the coverage necessary to reduce spread of influenza in the community. Age-specific baseline rates of medically attended acute respiratory illness (MAARI) for Scott and White Health Plan (SWHP) members at intervention (Temple and Belton) and comparison communities (Waco, Bryan, and College Station) were obtained in 1997-1998. During three subsequent vaccination years, 4298, 5251 and 5150 children received one dose per season of CAIV-T. Vaccinees represented 20-25% of the age-eligible children. Age-specific MAARI rates were compared for SWHP members in the intervention and comparison sites during the influenza outbreaks. Baseline age-specific MAARI rates per 100 persons for the influenza season were comparable between the intervention and comparison communities. In the subsequent three influenza seasons, the age groups 35-44, 45-54, 55-65 and >64 years experienced reductions in MAARI rates in the intervention communities. In adults > or =35 years of age, significant reductions in MAARI of 0.08 (95% CI: 0.04, 0.13), 0.18 (95% CI: 0.14, 0.22) and 0.15 (95% CI: 0.12, 0.19), were observed in the influenza seasons for vaccination years 1, 2 and 3, respectively. No consistent reduction in MAARI rates was detected in the younger age groups. Vaccination of approximately 20-25% of children, 1.5-18 years of age in the intervention communities resulted in an indirect protection of 8-18% against MAARI in adults > or =35 years of age.

Direct and total effectiveness of the intranasal, live-attenuated, trivalent cold-adapted influenza virus vaccine against the 2000-2001 influenza A(H1N1) and B epidemic in healthy children.

BACKGROUND: The efficacy of the intranasal, live-attenuated, trivalent cold-adapted influenza virus vaccine (CAIV-T) against influenza A(H3N2) and B infections in healthy persons is established, but its effectiveness against natural influenza A(H1N1) infection is unknown. OBJECTIVE: To assess the effectiveness of CAIV-T in healthy children during the 2000-2001 influenza A(H1N1) and B epidemic. DESIGN: Community-based, nonrandomized, open-label trial from August 1998 through April 2001. SETTING: Intervention and comparison communities in central Texas. PARTICIPANTS: Healthy children, aged 1.5 to 18 years, from the intervention communities received a single dose of CAIV-T at least 1 time or more in 1998, 1999, and/or 2000. MAIN OUTCOME MEASURES: The incidence of medically attended acute respiratory illnesses during the 2000-2001 influenza epidemic was compared in 3794 health plan CAIV-T recipients with age-eligible, health plan nonrecipients in the intervention communities for direct effectiveness (n = 9325), and with those in the 2 comparison communities for total effectiveness (n = 16,264). RESULTS: The 2281 CAIV-T recipients in 2000 had significant direct protection against medically attended acute respiratory illness of 18% to 20% during the biphasic influenza A(H1N1) and B epidemic, and 17% to 26% during influenza A(H1N1) predominance. The 931 recipients of CAIV-T in 1999 containing influenza A/Beijing/262/95(H1N1) and B/Beijing/184/93-like viruses had persistent heterovariant protection against the 2000-2001 influenza A/New Caledonia/20/99(H1N1) and B/Sichuan/379/99 variants. The 616 recipients of a single CAIV-T dose in 1999 only, including those younger than 5 years with no prior natural exposure to influenza A(H1N1) viruses, showed persistent protection. CONCLUSION: Healthy children who received CAIV-T in 2000 or 1999 were protected against new variants of influenza A(H1N1) and B in the 2000-2001 influenza epidemic.