Near real-time patient experience feedback with data relay to providers: a systematic review of its effectiveness.

Near Real-Time Feedback (NRTF) on the patient's experience with care, coupled with data relay to providers, can inform quality-of-care improvements, including at the point of care. The objective is to systematically review contemporary literature on the impact of the use of NRTF and data relay to providers on standardized patient experience measures. Six scientific databases and five specialty journals were searched supplemented by snowballing search strategies, according to the registered study protocol. Eligibility included studies in English (2015-2023) assessing the impact of NRTF and data relay on standardized patient-reported experience measures as a primary outcome. Eligibility and quality appraisals were performed by two independent reviewers. An expert former patient (Patient and Family Advisory Council and communication sciences background) helped interpret the results. Eight papers met review eligibility criteria, including three randomized controlled trials (RCTs) and one non-randomized study. Three of these studies involved in-person NRTF prior to data relay (patient-level data for immediate corrective action or aggregated and peer-compared) and led to significantly better results in all or some of the experience measures. In turn, a kiosk-based NRTF achieved no better experience results. The remaining studies were pre-post designs with mixed or neutral results and greater risks of bias. In-person NRTF on the patient experience followed by rapid data relay to their providers, either patient-level or provider-level as peer-compared, can improve the patient experience of care. Reviewed kiosk-based or self-reported approaches combined with data relay were not effective. Further research should determine which approach (e.g. who conducts the in-person NRTF) will provide better, more efficient improvements and under which circumstances.

Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective.

AIM: To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. METHOD: Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. RESULTS: Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. CONCLUSION: Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.

Dynamics of bacterial community in the foregut and hindgut of earthworms with the nutrition supplied by kitchen waste during vermicomposting.

Earthworm gut microbiota is vital in degrading bio-waste during vermicomposting. However, microbial dynamics in earthworm gut during this process are unclear. Thus, the aim is to firstly report the bacterial dynamics in both foregut and hindgut of earthworms over a 28 days' timeframe of vermicomposting by Eisenia foetida with the nutrition supplied by kitchen waste. Results showed that except the changing of the bacterial diversity, composition and structure, dynamics of the foregut and hindgut bacteria also differed during vermicomposting which related to the changes of nutrient provision. Day 3 was a turning point. The abundant bacteria of the top 20 % genera nearly did not overlap between the foregut and hindgut. In the end of vermicomposting, a remarkable stable bacterial structure appeared in the hindgut compared to somewhat muddled one in the foregut. Understanding the dynamics of earthworm gut microbiota enables the improvements to regulate the efficiency of organic waste vermicomposting.

The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment.

Introduction: Emotional functioning in older adults is influenced by normal aging and cognitive impairment, likely heterogeneous across positive versus negative aspects of emotional functioning. Little is known about positive emotional experiences at the early stages of cognitive impairment. Methods: We assessed different aspects of emotional functioning among 448 participants aged 65+ (Normal Control (NC) = 276, Mild Cognitive Impairment (MCI) = 103, and mild dementia of the Alzheimer type (mild DAT) = 69) and tested moderators. Results: Compared to NC, older adults with MCI and mild DAT have maintained many positive aspects of emotional functioning, despite higher levels of negative affect, sadness, and loneliness. Among the oldest-old, the mild DAT group experienced higher fear and lower self-efficacy. Discussion: Older adults at early stages of cognitive impairment can experience positive aspects of emotional functioning, such as positive affect, purpose, and life satisfaction, all of which are important buildable psychological resources for coping.

Uses of the NIH Toolbox® in Clinical Samples: A Scoping Review.

Background and Objectives: The NIH Toolbox® for the Assessment of Neurologic and Behavioral Function is a compilation of computerized measures designed to assess sensory, motor, emotional, and cognitive functioning of individuals across the life span. The NIH Toolbox was initially developed for use with the general population and was not originally validated in clinical populations. The objective of this scoping review was to assess the extent to which the NIH Toolbox has been used with clinical populations. Methods: Guided by the Joanna Briggs Methods Manual for Scoping Reviews, records were identified through searches of PubMed MEDLINE, PsycINFO, ClinicalTrials.gov, EMBASE, and ProQuest Dissertations and Theses Global (2008-2020). Database searches yielded 5,693 unique titles of original research that used at least one NIH Toolbox assessment in a sample characterized by any clinical diagnosis. Two reviewers screened titles, abstracts, and full texts for inclusion in duplicate. Conflicts at each stage of the review process were resolved by a group discussion. Results: Ultimately, 281 publication records were included in this scoping review (nJournal Articles = 104, nConference Abstracts = 84, nClinical Trial Registrations = 86, and nTheses/Dissertations = 7). The NIH Toolbox Cognition Battery was by far the most used of the 4 batteries in the measurement system (nCognition = 225, nEmotion = 49, nMotor = 29, and nSensation = 16). The most represented clinical category was neurologic disorders (n = 111), followed by psychological disorders (n = 39) and cancer (n = 31). Most (96.8%) of the journal articles and conference abstracts reporting the use of NIH Toolbox measures with clinical samples were published in 2015 or later. As of May 2021, these records had been cited a total of nearly 1,000 times. Discussion: The NIH Toolbox measures have been widely used among individuals with various clinical conditions across the life span. Our results lay the groundwork to support the feasibility and utility of administering the NIH Toolbox measures in research conducted with clinical populations and further suggest that these measures may be of value for implementation in fast-paced clinical settings as part of routine practice.

The changes of antioxidant system and intestinal bacteria in earthworms (Metaphire guillelmi) on the enhanced degradation of tetracycline.

Tetracycline (TC) in soil severely imperils food security and ecosystem function. Metaphire guillelmi is a common species in farmland. It could impact the degradation of antibiotics. However, how it affects is rarely unknown. Hence, the present study aimed to investigate the effects of M. guillelmi on the TC degradation in soil and the changes of the antioxidant system and intestinal bacteria in M. guillelmi. The treatments that M. guillelmi was inoculated on soil contaminated with different TC concentrations were contrasted with those without M. guillelmi. After 21 days, the degradation rate of TC significantly increased by 13.70%, 18.14% and 29.01% at 10, 50 and 100 mg kg -1 TC dose, respectively, due to the inoculation of M. guillelmi. The half-life of TC was also shortened nearly by 1/3 to 2/3. Superoxide dismutase (SOD) increased in a dose-dependent manner with the increase of TC concentration on the 7th and 14th day. Catalase (CAT) and glutathione S-transferase (GST) presented an inverted U-shaped dose response on the 7th day, and the peak of enzyme activities occurred at TC concentration of 0.1, 1 mg kg -1 (CAT) and 0.1 mg kg -1 (GST). Malondialdehyde (MDA) contents did not change significantly. At the phylum level, only Verrucomicrobia significantly decreased under 1 mg kg -1 and 100 mg kg -1 TC dose. Genus Paracoccus, Singulisphaera, Acinetobacter and Bacillus significantly increased and became the dominant bacterium during the TC degradation. Overall, the antioxidant system and intestinal bacteria of M. guillelmi were affected by the different concentrations of TC pollution, which provided new ideas for the research of mechanism of TC degradation by earthworms in the future.

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence.

BACKGROUND: Systematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs. METHODS: We searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies. RESULTS: Based on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs. CONCLUSIONS: Despite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.

The Association between Filial Piety and Perceived Stress among Chinese Older Adults in Greater Chicago Area.

BACKGROUND: Perceived stress influences the health and well-being of older adults. This study aims to examine the association between the expectation and the receipt of filial piety and perceived stress among U.S Chinese older adults. METHODS: Data were drawn from the PINE study, a population-based study of Chinese older adults aged 60 and above in the greater Chicago area. Perceived stress was assessed by the PSS-10 and was the dependent variable. Independent variables were the expectation and the receipt of filial piety examined in six domains. Negative Binomial Regression and Multivariable Logistic Regression analyses were conducted. RESULTS: Of the 3,159 Chinese older adults interviewed, the mean age was 72.8 (SD=8.3) and 58.9% were female. Compared with older adults who received a high level of filial piety, older adults who received a medium level of filial piety were 1.57 (1.29-1.93) times more likely to perceive stress as high, and older adults who received a low level of filial piety were 2.74 (2.26-3.33) times more likely to perceive stress as high, after controlling for the potential confounding variables. The expectation of filial piety was not significantly associated with perceived stress. CONCLUSION: A low level of filial piety receipt may be a risk factor for perceived stress. Our findings suggest incorporating cultural contributors into the analyses of perceived stress.

Religiosity among U.S Chinese Older Adults in Greater Chicago Area-Findings from the PINE Study.

BACKGROUND: Religiosity influences health and well-being. We assessed religiosity among U.S. Chinese older adults. METHODS: Data were drawn from the PINE study based on 3,159 community-dwelling U.S. Chinese older adults aged 60+ in the greater Chicago area. Two items retrieved from Duke University Religion Index (DUREL) were used to assess the frequency of participating in religious activities, and a separate item was used to assess the importance of religion. RESULTS: Overall, 35.4% of participants perceived religion to be important. This study correlated the higher frequency of participation in religious observances with older age groups of the sample, being female, having a higher income, being unmarried, longer duration of residency in the U.S., and not having been born in Mainland China. Higher frequency of participating in organized religious services was correlated with better quality of life. CONCLUSIONS: Religion is important among U.S Chinese older adults. Future longitudinal research is needed to explore aging and religiosity.

The prevalence of cardiopulmonary symptoms among Chinese older adults in the Greater Chicago area.

BACKGROUND: Cardiovascular and pulmonary symptoms influence health and well-being among older adults. However, minority aging populations are often underrepresented in most studies on cardiovascular and pulmonary symptoms. This study aims to examine the prevalence of cardiovascular and pulmonary symptoms among U.S. Chinese older adults. METHODS: Data were drawn from the Population Study of Chinese Elderly study, a population-based survey of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. Clinical Review of Systems was used to assess participants' perceptions of their cardiovascular and pulmonary symptoms. RESULTS: Cardiovascular symptoms (31.6%) and pulmonary symptoms (42.2%) were commonly experienced by U.S. Chinese older adults. Symptoms such as cough (27.4%), sputum production (22.7%), chest pain or discomfort (16.3%), shortness of breath at rest (15.1%), and shortness of breath with activity (12.9%) were commonly reported. Older age, lower income, fewer years residing in the community, poorer self-perceived health status and quality of life, and worsened health over the last year were associated with report of any cardiovascular or pulmonary symptom. CONCLUSIONS: Cardiovascular and pulmonary symptoms are common among Chinese older adults in the U.S. Future longitudinal research is needed to examine changes in Chinese older adults' burden of cardiopulmonary symptoms and their health and well-being.

Trust in physicians among U.S. chinese older adults.

BACKGROUND: Trust in physicians influences the health and well-being of older adults and is an important indicator to assess the quality of medical care. However, Asian aging populations are often underrepresented in studies of patient trust in physicians. This study aims to examine the level of trust in physicians among Chinese older adults in a community-dwelling Chinese aging population. METHODS: Data were drawn from the Population Study of Chinese Elderly, a population-based survey of U.S. Chinese older adults in the Greater Chicago area. Guided by a community-based participatory research approach, a total of 3,159 Chinese older adults aged 60 and above were surveyed. An 11-item scale was used to measure participants' trust in physicians. RESULTS: On a scale of 11-55, the level of trust in physician among U.S. Chinese older adults was 42.0 (SD = 6.3). Items related to confidence in physicians' knowledge and skills were most commonly endorsed, including trusting physicians' judgment on medical care (84.8%), trusting physicians' advice (84.2%), and trusting physicians' words that something is so and must be true (81.2%). Younger age, male gender, higher educational level, fewer years of residing in the United States and in the community, poorer self-reported health status, and poorer quality of life were associated with lower level of trust in physicians. CONCLUSIONS: Trust in physician is commonly endorsed among U.S. Chinese older adults. However, future longitudinal studies are needed to improve our understanding of risk factors and outcomes associated with trust in physicians among U.S. Chinese older adults.

The expectation and perceived receipt of filial piety among Chinese older adults in the Greater Chicago area.

OBJECTIVE: Filial piety is a key Chinese cultural value that determines children's caregiving obligation to older adults. This study aims to evaluate the expectations and perceived receipt of filial piety from the perspectives of Chinese older adults. METHOD: Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based study of U.S. Chinese older adults aged 60 and above in the Greater Chicago area. Filial care was examined in six domains, including care, respect, greeting, happiness, obedience, and financial support. Socio-demographics correlate with expectations and receipt of filial piety were also reported. RESULTS: Participants reported high level of overall expectations and receipts of filial piety, and highest expectation and perceived receipt were placed on the domain of respect. DISCUSSION: This study provides insights on the extent to which U.S. Chinese older adults expect and perceive receipt of filial care. Our findings have implications for the provision of culturally appropriate health care services.

The prevalence of loneliness among U.S. Chinese older adults.

OBJECTIVE: Loneliness is an important indicator of well-being. However, we have limited understanding of loneliness in minority aging populations. This study aims to identify the prevalence of loneliness among U.S. Chinese older adults. METHOD: Data were drawn from the PINE study, a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. RESULTS: Our findings indicated that the prevalence of loneliness was 26.2%. Older adults with older age, female gender, and living alone reported higher prevalence of loneliness. Older adults with worsened health status, poorer quality of life, and negative health changes over the past year were also more likely to experience loneliness. DISCUSSION: Loneliness is common among U.S. Chinese older adults in the Greater Chicago area. Future longitudinal studies are needed to improve the understanding of risk factors and outcomes associated with loneliness in Chinese older adults.