The impact of medical insurance on health care access and quality for people with multiple sclerosis in the United States: A scoping review.

BACKGROUND: In the United States, health insurance coverage and quality mediate access to health care, a key social determinant of health. OBJECTIVE: To perform a scoping review regarding the impact of insurance coverage and benefit design on health care access and both clinical and quality of life outcomes in people with MS (pwMS). METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. A literature search was conducted from January 2010 to February 2022. Included studies were in English, peer-reviewed, US-based, and evaluated elements of insurance and their relationship with access and quality outcomes for adult pwMS. RESULTS: Our search identified 1619 articles, of which 32 met inclusion criteria. Privately insured pwMS were more likely to be on disease-modifying therapy (DMT). Increased out-of-pocket spending was associated with lower DMT adherence and greater discontinuation rates. Access to specialty pharmacy programs was associated with improved DMT adherence. CONCLUSION: Health insurance coverage and design strongly influences health care for pwMS in the United States and may be a modifiable social determinant of health. Increased pharmaceutical cost-sharing is associated with declines in DMT utilization and adherence. Further study is needed to better characterize the impacts of other core elements of health insurance, including prior authorization requirements and step therapy.

mHealth-Supported Interventions With Potential to Address Sedentary Behavior in Older Adults: A Scoping Review.

Sedentary behavior (SB) is an independent risk for negative health outcomes in older adults. Mobile health (mHealth) technology has potential to address SB in this population. This scoping review aimed to describe, synthesize, and identify gaps in literature on mHealth-supported interventions with potential to reduce sedentariness in older people. Following an iterative search of five major databases, 13 studies were included in the final review. Only three papers described SB-related factors as the primary target of intervention. mHealth-Driven components were frequently paired with nonmobile approaches and aided self-regulation of physical activity as opposed to SB. Most SB-related outcomes were not statistically significant or were inconclusive. This scoping review revealed a paucity of research applying mHealth-supported approaches to directly overcome sedentariness in older people. Protocol studies included in the review provide evidence that efforts to address this research gap continue to be made, but the need for additional high-quality research remains.

A Self-Paced Online Library Orientation: Development, Implementation, and Assessment.

Health sciences librarians may find it difficult to meet demands for in-person or online synchronous library orientations for various reasons, including short-staffing of librarians, expansion of online programs, and temporary campus closures caused by emergencies, such as the COVID-19 pandemic. The authors discuss the development, implementation, and assessment of an asynchronous online orientation tutorial created for use across various health sciences degree, certificate, and training programs. The tutorial can either replace or supplement synchronous orientations, and the original tutorial can be copied and customized for specific programs.

Measuring patrons' technology habits: an evidence-based approach to tailoring library services.

Librarians continually integrate new technologies into library services for health sciences students. Recently published data are lacking about student ownership of technological devices, awareness of new technologies, and interest in using devices and technologies to interact with the library. A survey was implemented at seven health sciences libraries to help answer these questions. Results show that librarian assumptions about awareness of technologies are not supported, and student interest in using new technologies to interact with the library varies widely. Collecting this evidence provides useful information for successfully integrating technologies into library services.

PharmGuide: your guide to free online drug information.

PharmGuide < http://goo.gl/f14Me >is an annotated directory of high quality, freely available, online drug information resources intended for use by librarians, pharmacists, and the public. Given the plethora of drug information websites with varying levels of authoritativeness and accuracy, PharmGuide is intended to facilitate the search for resources by providing links to only those sources that have been critically appraised and that meet specific quality criteria. Methods used in developing the site, evidence of its utility based on usage statistics, and examples of its application in practice are presented within the context of the drug information landscape.

Information intervention in the pharmaceutical sciences.

Professional guidelines state that higher-order thinking skills are a desirable outcome of pharmacy education. In this context, courses in pharmaceutics at the University of Southern California are taught in a learner-centered manner that requires use of chemical reference sources and interpretation of physicochemical information for drug molecules. To facilitate these activities, a librarian worked with faculty to design a class on reference sources and primary literature. Students believed the librarian instruction was beneficial. After the intervention, faculty fielded fewer information-related questions and the librarian received more sophisticated questions. The class emphasizes the importance of collaboration between librarians and faculty in achieving these results.

Outcome of Pregnancy in Women With D-Transposition of the Great Arteries: A Systematic Review.

Background Information on maternal and fetal outcomes of pregnancy in women with D-transposition of the great arteries is limited. We conducted a systematic literature review on pregnancies in women with transposition of the great arteries after atrial and arterial switch operations to better define maternal and fetal risk. Methods and Results A systematic review was performed on studies between 2000 and 2021 that identified 676 pregnancies in 444 women with transposition of the great arteries. A total of 556 pregnancies in women with atrial switch operation were tolerated by most cases with low mortality (0.6%). Most common maternal complications, however, were arrhythmias (9%) and heart failure (8%) associated with serious morbidity in some patients. Worsening functional capacity, right ventricular function, and tricuspid regurgitation occurred in ≈20% of the cases. Rate of fetal and neonatal mortality was 1.4% and 0.8%, respectively, and rate of prematurity was 32%. A total of 120 pregnancies in women with arterial switch operation were associated with no maternal mortality, numerically lower rates of arrhythmias and heart failure (6% and 5%, respectively), significantly lower rate of prematurity (11%; P<0.001), and only 1 fetal loss. Conclusions Pregnancy is tolerated by most women with transposition of the great arteries and atrial switch operation with low mortality but important morbidity. Most common maternal complications were arrhythmias, heart failure, worsening of right ventricular function, and tricuspid regurgitation. There was also a high incidence of prematurity and increased rate of fetal loss and neonatal mortality. Outcome of pregnancy in women after arterial switch operations is more favorable, with reduced incidence of maternal complications and fetal outcomes similar to women without underlying cardiac disease.