Identifying barriers to utilization of a medication access program among referred patients surveyed after discharge from an acute care hospital.

BACKGROUND: For uninsured residents of select counties in North Carolina, the Cumberland County Medication Access Program (CCMAP) provides prescriptions at no cost. Uninsured patients hospitalized at Cape Fear Valley Medical Center are referred to CCMAP at discharge by Cape Fear Valley Health System employees, primarily coordination of care personnel and outpatient pharmacy personnel. The purpose of this study was to describe the most frequently reported utilization barriers among surveyed patients referred to CCMAP after discharge from Cape Fear Valley Medical Center. METHODS: This was a single-center, survey-based, descriptive research study. Referring Cape Fear Valley Health System employees collected the medical record number of patients referred to CCMAP at discharge between October 22, 2020 and December 31, 2020. These patients were contacted via a research team member by telephone at least 30 days after discharge to voluntarily participate in a survey regarding their ability to receive prescriptions from CCMAP after discharge. Patient-reported utilization barriers and demographics were recorded. A similar survey was voluntarily completed by referring health system employees. Employee-reported utilization barriers were collected to identify discrepancies in perceived utilization barriers among discharged patients and referring health system employees. RESULTS: There were 69 patients referred to CCMAP at discharge by outpatient pharmacy personnel. A total of 17 patients met inclusion criteria and completed the survey. Of these, 35.29% of the patients reported their greatest utilization barrier to be uncertainty about how to apply for CCMAP. In addition, 25 surveys were completed by referring outpatient pharmacy personnel. Of these, 56% of the participants reported they believe the greatest utilization barrier to be patient uncertainty about how to apply for CCMAP. CONCLUSIONS: Uninsured patients discharged from Cape Fear Valley Medical Center could benefit from increased assistance with completing CCMAP applications and enrollment with the program before discharge to improve continuity of care.

Impact of health system protocol on patient qualification for influenza point-of-care testing.

BACKGROUND: Point-of-care testing (POCT) is a service that community pharmacies are implementing to increase patient access to care. Many pharmacies develop protocols with physicians to maximize patient qualification for POCT, while maintaining patient safety. OBJECTIVE: To determine the number of patients seen for influenza in the emergency department (ED) during the 2018-2019 season who would qualify for protocol-driven influenza testing. METHODS: This was a retrospective review of medical records. Patients seen in this 92 bed ED, level III trauma center between October 1, 2018 and May 1, 2019 were included if their age was older than 11 years or younger than 71 years with an influenza-related diagnosis. Patients were excluded if they were pregnant or breastfeeding, were allergic to oseltamivir, were recently diagnosed with pneumonia, or recently received a live influenza vaccine. Patient information collected included: sex, age, height, weight, pulse, blood pressure, respiratory rate, temperature, oxygen saturation, mental status, symptoms, time since onset of symptoms, immune system status, and history of respiratory illness or respiratory disease. These data points were used to determine eligibility for POCT based on a prespecified protocol that included criteria such as vital signs, symptom presentation, and other health conditions. The primary end point was the number of patients eligible for institutional protocol-driven POCT. RESULTS: There were 1955 ED visits with a primary diagnosis of influenza; 451 were eligible for study inclusion, and 49 (11%) qualified for POCT. The most common reason that patients did not qualify was temperature. If required temperature had been removed from the protocol, 155 patients (34%) would have qualified for POCT. CONCLUSION: On the basis of the institutional protocol, a small proportion of patients qualified for POCT. Without the protocol temperature requirement, the number of patients who qualified for POCT would have greatly increased. This study identified opportunities for improvement in the institutional protocol. Future research is needed to reassess the number of patients who qualify once revisions are made.

An Analysis of Skin of Color Dermatology Related Content on Instagram.

Importance: Social media is making information about skin of color more readily available to those unfamiliar with ethnic skin and hair. Objectives: To answer: 1) what skin of color-related dermatology content is being posted on Instagram? And 2) who is producing this content? Design: Cross-sectional epidemiologic study analyzing the content of posts associated with 31 Instagram skin of color dermatology-related topics (hashtags). Setting: Population-based Participants: The Instagram accounts linked with the top 9 posts as generated by the Instagram algorithm associated with each search term. Exposures: Instagram account holders. Main Outcomes and Measures: [1] The number of posts associated with each skin of color dermatology hashtag search term. [2] Classification of posts as either educational or promotional. [3] Classification of posts as a photo or video. [4] Classification of Instagram accounts that produced the posts (American board-certified dermatologists, dermatology residents, foreign dermatologists, patients, medical interest groups, or other). [5] Quantification of the number of post likes and comments. [6] Comparison of number of educational and promotional posts between board-certified dermatologists and other Instagram users. Results: The 31 sampled hashtags were associated with a total of 9,087,589 posts as of January 16, 2020. 219 of the 288 top posts generated from these queries met inclusion criteria. Board-certified dermatologists (26 posts) only generated 12% of top posts, whereas individuals not certified in dermatology produced 88% of top content. Of this group, social media influencers were the largest subcategory (37 posts). A majority of the top posts were promotional (135 posts, 61.6%) and formatted as photos (181 posts, 82.6%). While there was a significant difference in the number of likes for content posted by board-certified dermatologists vs non-dermatologists (P=0.027), these differences became non-significant after stratifying by the intention of the post (promotional P=0.13, educational P=0.17). Conclusions and Relevance: Board-certified dermatologists are underrepresented among people generating top skin of color dermatology-related content on Instagram. Board-certified dermatologists should establish a more prominent presence on social media platforms so that patients have greater access to accurate, evidenced-based educational resources regarding dermatologic conditions, treatment options, and treatment risks from reliable sources. J Drugs Dermatol. 2020;19(7): doi:10.36849/JDD.2020.5142.

Alkyl pyridinium iodocyanocuprate(i) chains (RPy)2[Cu2I3(CN)]: insight into structural, electronic and spectroscopic properties.

Equimolar mixtures of copper(i) iodide (CuI) and copper(i) cyanide (CuCN) react with N-alkyl pyridinium iodides (RPy+I-, R = Me, Et, n-propyl = Pr, and n-butyl = Bu) to produce pyridinium iodocyanocuprate(i) salts, (RPy)2[Cu2I3CN]. Crystal structures reveal isostructural anionic chains consisting of trigonal pyramidal Cu2(µ2-I)3 clusters bridged by C/N-disordered cyano units. The 1-D chains are nearly linear but vary with respect to whether adjacent clusters are staggered or eclipsed. A detailed investigation via Hirshfeld surface analysis reveals that hydrogen bonding between the triiodide group and pyridinium cation are the driver for assembly in these systems. Interestingly, spectroscopic investigations of absorption edge and emission energies show a general red shift with increasing hydrogen bonding. DFT and TD-DFT calculations were used to determine the electronic structure and band assignment of these materials to elucidate the nature behind this structure/function relationship.

Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review.

OBJECTIVES: To review the research literature on cultural safety education within post-secondary health science programs. METHODS: We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings. RESULTS: A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program.  Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities. CONCLUSIONS: This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people.  Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.

Visuo-haptic integration in object identification using novel objects.

Although some studies have shown that haptic and visual identification seem to rely on similar processes, few studies have directly compared the two. We investigated haptic and visual object identification by asking participants to learn to recognize (Experiments 1, and 3), or to match (Experiment 2) novel objects that varied only in shape. Participants explored objects haptically, visually, or bimodally, and were then asked to identify objects haptically and/or visually. We demonstrated that patterns of identification errors were similar across identification modality, independently of learning and testing condition, suggesting that the haptic and visual representations in memory were similar. We also demonstrated that identification performance depended on both learning and testing conditions: visual identification surpassed haptic identification only when participants explored the objects visually or bimodally. When participants explored the objects haptically, haptic and visual identification were equivalent. Interestingly, when participants were simultaneously presented with two objects (one was presented haptically, and one was presented visually), object similarity only influenced performance when participants were asked to indicate whether the two objects were the same, or when participants had learned about the objects visually-without any haptic input. The results suggest that haptic and visual object representations rely on similar processes, that they may be shared, and that visual processing may not always lead to the best performance.