Time Savings Using a Standardized Glucose Reporting System and Ambulatory Glucose Profile.

BACKGROUND: Diabetes care is predominately done at home by the patient. When clinics do not have a reliable, easy process for obtaining this patient data, clinical decisions must be made with incomplete verbal recall reports. Unused or inaccessible glucose data represent a large information gap affecting clinical decision making. This study's purpose was to design an optimized glucose device download system with a standardized report and to evaluate its efficiency. METHODS: Observations and evaluations of glucose data retrieval occurred at two clinics; an additional clinic utilized the optimized process doing only post process timings. Patients/families and clinicians were surveyed about their experiences with the system and the standardized report (AGP). The study was approved by all the sites' IRBs. RESULTS: Optimized systems saved staff at least 3 min per patient. Standardized AGP reports and an optimized data system made the work flow of glucose data easier to complete. The AGP report was preferred by patients, families, and clinicians. CONCLUSIONS: An optimized system takes advantage of patient lobby downtime to download glucose devices and ensures that diabetes clinical decisions are made utilizing all available data. Staff and patients liked the software lobby system and found it a valuable time-saving tool.

Understanding the cognitive processes involved in writing to learn.

Writing is often used as a tool for learning. However, empirical support for the benefits of writing-to-learn is mixed, likely because the literature conflates diverse activities (e.g., summaries, term papers) under the single umbrella of writing-to-learn. Following recent trends in the writing-to-learn literature, the authors focus on the underlying cognitive processes. They draw on the largely independent writing-to-learn and cognitive psychology learning literatures to identify important cognitive processes. The current experiment examines learning from 3 writing tasks (and 1 nonwriting control), with an emphasis on whether or not the tasks engaged retrieval. Tasks that engaged retrieval (essay writing and free recall) led to better final test performance than those that did not (note taking and highlighting). Individual differences in structure building (the ability to construct mental representations of narratives; Gernsbacher, Varner, & Faust, 1990) modified this effect; skilled structure builders benefited more from essay writing and free recall than did less skilled structure builders. Further, more essay-like responses led to better performance, implicating the importance of additional cognitive processes such as reorganization and elaboration. The results highlight how both task instructions and individual differences affect the cognitive processes involved when writing-to-learn, with consequences for the effectiveness of the learning strategy. (PsycINFO Database Record

Universal screening for Lynch syndrome among patients with colorectal cancer: patient perspectives on screening and sharing results with at-risk relatives.

Universal screening for Lynch syndrome (LS) among all cases of colorectal cancer (CRC) could increase the diagnosis of LS and reduce morbidity and mortality of LS-associated cancers. Given universal screening includes all patients, irrespective of high risk factors such early age at onset or family history of CRC, it is important to understand perspectives of all patients and not just those at high risk. As part of a study to assess the feasibility and implementation of universal screening, 189 patients newly diagnosed with CRC were surveyed about their interest in screening for LS and communication of results with at-risk family members. Overall, participants responded positively regarding screening for LS, with most wanting to know their genetic risks in general (86%) and risk of hereditary CRC (93%). Prior to receiving screening results, most participants stated they intended to share their screening results with parents (89%), siblings (96%), and children (96%). Of the 28 participants who received a positive LS screening result, 26 (93%) reported sharing their result with at least one first-degree family member. Interest in screening for LS and communication of screening results with family members was not associated with high risk factors. This study indicates that patients are interested in being screened for LS and that sharing information on the risk of LS with at-risk family members is not a significant barrier. These findings provide novel insight into patient perspectives about screening for LS and can guide successful implementation of universal screening programs.

Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.

PURPOSE: Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. METHODS: We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). RESULTS: We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. CONCLUSION: We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

Prospective memory and aging: evidence for preserved spontaneous retrieval with exact but not related cues.

We examined whether normal aging spares or compromises cue-driven spontaneous retrieval processes that support prospective remembering. In Experiment 1, young and older adults performed prospective-memory tasks that required either strategic monitoring processes for retrieval (nonfocal) or for which participants relied on spontaneous retrieval processes (focal). We found age differences for nonfocal, but not focal, prospective-memory performance. Experiments 2 and 3 used an intention-interference paradigm in which participants were asked to perform a prospective-memory task (e.g., press "Q" when the word money appears) in the context of an image-rating task and were then told to suspend their prospective-memory intention until after completing an intervening lexical-decision task. During the lexical-decision task, we presented the exact prospective-memory cue (e.g., money; Experiments 2 and 3) or a semantically related lure (e.g., wallet; Experiment 3), and we inferred spontaneous retrieval from slowed lexical-decision responses to these items relative to matched control items. Young and older adults showed significant slowing when the exact prospective-memory cue was presented. Only young adults, however, showed significant slowing to the semantically related lure items. Collectively, these results partially support the multiprocess theory prediction that aging spares spontaneous retrieval processes. Spontaneous retrieval processes may become less sensitive with aging, such that older adults are less likely to respond to cues that do not exactly match their encoded targets.

Neural signatures of test-potentiated learning in parietal cortex.

Testing, or retrieval practice, is beneficial for long-term memory both directly, by enhancing performance on tested information, and indirectly, by facilitating learning from subsequent encounters with the information. Although a wealth of behavioral research has examined the "testing effect," neuroimaging has provided little insight regarding the potential mechanisms that underlie the benefits of retrieval practice. Here, fMRI was used to examine the effects of retrieval practice on later study trials. Human subjects studied pairs of associated words, which were then tested, restudied, or neither tested nor restudied. All pairs were then studied once more in expectation of a final test. We asked how this Final Study episode was affected by prior history (whether the pair had been previously tested, restudied, or neither). The data revealed striking similarities between responses in lateral parietal cortex in the present study and those in a host of studies explicitly tapping recognition memory processes. Moreover, activity in lateral parietal cortex during Final Study was correlated with a behavioral index of test-potentiated learning. We conclude that retrieval practice may enhance learning by promoting the recruitment of retrieval mechanisms during subsequent study opportunities.

Free recall enhances subsequent learning.

Testing, or retrieval practice, has become a central topic in memory research. One potentially important effect of retrieval practice has received little attention, however: It may enhance, or potentiate, subsequent learning. We introduce a paradigm that can measure the indirect, potentiating effect of free recall tests on subsequent learning, and then test a hypothesis for why tests may have this potentiating effect. In two experiments, the benefit of a restudy trial was enhanced when prior free recall tests had been taken. The results from a third, correlational study suggested that this effect might be mediated by the effect of testing on organization. Not only do encoding conditions affect later retrievability, but also retrieval attempts affect subsequent encoding effectiveness.

Test-potentiated learning: distinguishing between direct and indirect effects of tests.

The facilitative effect of retrieval practice, or testing, on the probability of later retrieval has been the focus of much recent empirical research. A lesser known benefit of retrieval practice is that it may also enhance the ability of a learner to benefit from a subsequent restudy opportunity. This facilitative effect of retrieval practice on subsequent encoding is known as test-potentiated learning. Thus far, however, the literature has not isolated the indirect effect of retrieval practice on subsequent memory (via enhancing the effectiveness of restudy) from the direct effects of retrieval on subsequent memory. The experiment presented here uses conditional probability to disentangle test-potentiated learning from the direct effects of retrieval practice. The results indicate that unsuccessful retrieval attempts enhance the effectiveness of subsequent restudy, demonstrating that tests do potentiate subsequent learning.

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

BACKGROUND: Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). METHODS/DESIGN: The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven-day, thirty-day, and continuous abstinence at twelve months, intervention dose response at six and twelve months for AR + IVR recipients, incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months, and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC. DISCUSSION: This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists' services with discharge follow-up care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01236079.

The one-trial learning controversy and its aftermath: remembering Rock (1957).

In 1957 Irvin Rock published an article in the American Journal of Psychology igniting a controversy that dominated the field of verbal learning for the next 8 years before mostly burning out. Rock published 2 paired-associate learning experiments in which he compared performance of a control group that learned a constant list of pairs to the criterion of one perfect trial with an experimental group in which forgotten pairs on each trial were dropped and replaced on the next trial with new pairs. That is, on each trial for experimental subjects, pairs that were correctly recalled were maintained in the next trial, whereas pairs that were not recalled were dropped and replaced randomly with new pairs from a large pool. Surprisingly, Rock found that the 2 groups took the same number of trials to reach criterion. He concluded that learning occurred not with a gradual, incremental increase in strength of memory traces but rather in an all-or-none fashion. Rock's conclusions rocked the world of verbal learning, because all theories followed a gradualist assumption. However, Estes (1960) published research that led him to the same conclusion shortly thereafter. We recount these developments and discuss how the verbal learning establishment rose up to smite down these new ideas, with particular ferocity directed at Rock. Echoing G.A. Miller (1963), we conclude with a note of sympathy for Rock's and Estes's positions and muse about why their work was so summarily dismissed. The important question they raised--the nature of how associations are learned--remains unanswered.

Individual differences in time perspective predict autonoetic experience.

Tulving (1985) posited that the capacity to remember is one facet of a more general capacity-autonoetic (self-knowing) consciousness. Autonoetic consciousness was proposed to underlie the ability for "mental time travel" both into the past (remembering) and into the future to envision potential future episodes (episodic future thinking). The current study examines whether individual differences can predict autonoetic experience. Specifically, the Zimbardo Time Perspective Inventory (ZTPI, Zimbardo & Boyd, 1999) was administered to 133 undergraduate students, who also rated phenomenological experiences accompanying autobiographical remembering and episodic future thinking. Scores on two of the five subscales of the ZTPI (Future and Present-Hedonistic) predicted the degree to which people reported feelings of mentally traveling backward (or forward) in time and the degree to which they reported re- or pre-experiencing the event, but not ten other rated properties less related to autonoetic consciousness.

Imagining the near and far future: the role of location familiarity.

Plausible personal events envisioned as occurring in the near future tend to be reported as more vivid than those set in the far future. Why is this? The present set of three experiments identified one's familiarity with the location in which the event is placed as critical in this regard. Specifically, Experiment 1 demonstrated that amongst a wide range of phenomenological characteristics, clarity of location appears to drive the overall difference in vividness between events imagined to take place in the near and the far future. Experiments 2 and 3 were designed to further elucidate this finding. Experiment 2 demonstrated that near future events are more likely than far future events to be imagined in familiar locations. Experiment 3 showed that future events set in familiar locations tend to be imagined with greater clarity than those set in unfamiliar locations. The results of all three experiments converge on the conclusion that the difference in vividness of events imagined as occurring in the near and far future is mediated by one's familiarity with the location in which the event is imagined to occur.