Patient-led development of digital endpoints and the use of computer vision analysis in assessment of motor function in rare diseases.

Digital health technologies are transforming the way health outcomes are captured and measured. Digital biomarkers may provide more objective measurements than traditional approaches as they encompass continuous and longitudinal data collection and use of automated analysis for data interpretation. In addition, the use of digital health technology allows for home-based disease assessments, which in addition to reducing patient burden from on-site hospital visits, provides a more holistic picture of how the patient feels and functions in the real world. Tools that can robustly capture drug efficacy based on disease-specific outcomes that are meaningful to patients, are going to be key to the successful development of new treatments. This is particularly important for people living with rare and chronic complex conditions, where therapeutic options are limited and need to be developed using a patient-focused approach to achieve the biggest impact. Working in partnership with patient Organisation Duchenne UK, we co-developed a video-based approach, delivered through a new mobile health platform (DMD Home), to assess motor function in patients with Duchenne muscular dystrophy (DMD), a genetic, rare, muscular disease characterized by the progressive loss of muscle function and strength. Motor function tasks were selected to reflect the "transfer stage" of the disease, when patients are no longer able to walk independently but can stand and weight-bear to transfer. This stage is important for patients and families as it represents a significant milestone in the progression of DMD but it is not routinely captured and/or scored by standard DMD clinical and physiotherapy assessments. A total of 62 videos were submitted by eight out of eleven participants who onboarded the app and were analysed with pose estimation software (OpenPose) that led to the extraction of objective, quantitative measures, including time, pattern of movement trajectory, and smoothness and symmetry of movement. Computer vision analysis of video tasks to identify voluntary or compensatory movements within the transfer stage merits further investigation. Longitudinal studies to validate DMD home as a new methodology to predict progression to the non-ambulant stage will be pursued.

Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement.

INTRODUCTION/BACKGROUND: Point-of-care testing (POCT) platforms support patient-centered approaches to health care delivery and may improve patient care. We evaluated implementation of a POCT platform at a large, acute care hospital in the Midwestern United States. METHODS: We used lactate testing as part of a sepsis bundle protocol to evaluate compliance and mortality outcomes. Respiratory team members were surveyed to assess perception of efficiency, ease of use, timely patient care, and overall engagement with the POCT system. Annualized cost per test of a benchtop analyzer and a POCT platform were compared across 3 years for each platform. RESULTS: Lactate testing volume increased from 61% to 91%, which was associated with improved sepsis bundle protocol compliance. Employees reported high levels of engagement, improvements in efficiency and time savings, and better patient care with POCT. Average cost per test was $10.02 for the benchtop system and $6.21 for the POCT platform. POCT saved our institution $88,476 annually in labor costs. DISCUSSION: Combined with a robust training program emphasizing the use of lactate testing in the context of the overall clinical picture, POCT enabled adherence to the sepsis bundle protocol and may have contributed to lower mortality. Additionally, the COVID-19 pandemic has provided us with unanticipated benefits of using POCT; it has enhanced our ability to deal with stringent infectious disease protocols, saving time and minimizing patient and staff exposure. CONCLUSIONS: Implementation of a POCT platform was associated with improved compliance to our sepsis protocol, reduced sepsis mortality, high employee engagement, and cost savings.

White racial identity, color-blind racial attitudes, and multicultural counseling competence.

Multicultural counseling competence (awareness, knowledge, and skills) is necessary to provide effective psychotherapy to an increasingly diverse client population (Sue, 2001). Previous research on predictors of competency among White clinicians finds that above having multicultural training, exposure to racially diverse clients, and social desirability, that White racial identity stages predict multicultural counseling competence (Ottavi et al., 1994). Research also suggests that higher color-blind racial attitudes (denying or minimizing racism in society) correlates with less advanced White racial identity stages (Gushue & Constantine, 2007). However, no studies have examined these variables together as they relate to and possibly predict multicultural counseling competence. The current study aims to add to this literature by investigating the effects of these variables together as potential predictors of multicultural counseling competence among (N = 487) White doctoral students studying clinical, counseling, and school psychology. Results of 3 hierarchical multiple regressions found above the effects of social desirability, demographic variables, and multicultural training, that colorblind racial attitudes and White racial identity stages added significant incremental variance in predicting multicultural counseling knowledge, awareness, and skills. These results add to the literature by finding different predictors for each domain of multicultural competence. Implications of the findings for future research and the clinical training of White doctoral trainees are discussed.

Challenges for professional practice in the next decade.

This article is presented in a question and answer format and shares the thoughts of the 2006 President of the American Speech-Language-Hearing Association (ASHA), Alex Johnson, and current Executive Director of ASHA, Arlene Pietranton, regarding several regulatory issues that the professions of audiology and/or speech-language pathology are likely to have to address over the next decade. Specific topics mentioned include: trends affecting our professions; anticipated service delivery changes; public (i.e., Medicaid and Medicare) and private (i.e., health plans, consumer-driven plans) reimbursement; competing for funding dollars; pay-for-performance; the Individuals with Disabilities Education Act; No Child Left Behind; and ASHA's work with various national organizations and federal agencies in the regulatory arena. Several ASHA resources for further information are listed.