Results of the RVA Breathes randomized controlled trial.

OBJECTIVE: This study tested a randomized controlled trial of RVA Breathes, a community asthma program, in reducing asthma-related healthcare utilization among children living in an area with a high poverty rate. METHODS: Participants included 250 caregivers (78% African American/Black; 73.3% household income<$25,000/year) and their children with asthma (5-11 years). Inclusion criteria included an asthma-related emergency department (ED) visit, hospitalization, unscheduled doctor's visit, or systemic steroids in the past 2 years. Families were randomized to a full active intervention (asthma education with community health workers [CHWs], home remediation with home assessors, and a school nurse component; n = 118), partial active intervention (asthma education and home remediation; n = 69), or a control group (n = 63) for 9 months. Measures on healthcare utilization and asthma-related factors were collected. Follow-up assessments occurred across a 9-month period. RESULTS: Although we did not find any significant effects, there was a trend toward significance for a group by time effect with objective healthcare utilization as the outcome (F4,365 = 2.28, p = .061). The full intervention group experienced a significant decrease from baseline to 9-month follow-up compared with the other groups (p < .001). Only the full intervention group experienced a significant increase in reported asthma action plans across time (no significant group effect). CONCLUSIONS: In the context of the unprecedented COVID-19 pandemic, which led to a substantial global decrease in healthcare utilization, the study's main hypotheses were not supported. Nevertheless, findings support the benefit of community asthma programs that integrate care across multiple settings and connect families with CHWs.

An examination of individual differences in levels of processing.

The present study examined individual differences in levels of processing. Participants completed a cued recall task in which they made either rhyme or semantic judgements on pairs of items. Pupillary responses during encoding were recorded as a measure of the allocation of attentional effort and participants completed multiple measures of working and long-term memory. The results suggested levels of processing effect in both accuracy and pupillary responses with deeper levels of processing demonstrating higher accuracy and larger pupillary responses than shallower levels of processing. Most participants demonstrated levels of processing effect, but there was substantial variability in the size of the effect. Variation in levels of processing was positively related to individual differences in long-term memory and the magnitude of the pupillary levels of processing effect, but not working memory. These results suggest that some of the variation in levels of processing is likely due to individual differences in the allocation of attentional effort (particularly to items processed deeply) during encoding.

The importance of conative factors for individual differences in attention control.

Relations between conative factors (task-specific motivation, attention self-efficacy, and self-set goals) and individual differences in attention control (AC) performance were investigated in two latent variable studies. Participants performed AC tasks along with measures of working memory and processing speed. During the AC tasks, participants self-reported their motivation, self-efficacy, and self-set goals for the tasks. Task-unrelated thoughts were also assessed. Confirmatory factor analyses demonstrated that latent factors for the constructs could be formed and the conative factors were each related to the AC factor. Structural equation modeling further suggested that the conative factors tended to account for unique variance in attention, even after accounting for shared variance with working memory and processing speed. These results provide evidence that conative factors are important for individual differences in AC and further suggest that multiple factors likely contribute to variation in performance on AC tasks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Individual differences in attention control: A meta-analysis and re-analysis of latent variable studies.

A meta-analysis and re-analysis of prior latent variable studies was conducted in order to assess whether there is evidence for individual differences in broad attention control abilities. Data from 90 independent samples and over 23,000 participants suggested that most (84.4%) prior studies find evidence for a coherent attention control factor with average factor loadings of .51. This latent attention control factor was related to other cognitive ability factors including working memory, shifting, fluid intelligence, long-term memory, reading comprehension, and processing speed, as well as to self-reports of task-unrelated thoughts and task specific motivation. Further re-analyses and meta-analyses suggest that the results remained largely unchanged when considering various possible measurement issues. Examining the factor structure of attention control suggested evidence for sub-components of attention control (restraining, constraining and sustaining attention) which could be accounted for a by a higher-order factor. Additional re-analyses suggested that attention control represents a broad ability within models of cognitive abilities. Overall, these results provide evidence for attention control abilities as an important individual differences construct.

Artificial Intelligence: Can It Save Lives, Hospitals, and Lung Screening?

BACKGROUND: Early detection is essential in lung cancer survival. Lung screening or incidental detection on unrelated imaging holds the most promise for early detection. With the large volume of imaging performed today, management of incidental pulmonary nodules can be difficult. We hypothesized an artificial intelligence (AI) tool could reliably read all imaging reports, detect, and effectively triage indeterminate pulmonary nodules without adding additional personnel, helping save lives. METHODS: An incidental lung nodule clinic (ILNC) was created using AI and an existing nurse practitioner. Over 26 months, the software read all radiology reports, visualizing any lung tissue. Patients with nodules >3 mm and considered indeterminate by the nurse practitioner were referred to the ILNC. High-risk patients with benign nodules were offered entry into the lung screening program. RESULTS: Of 502,632 imaging reports analyzed, 22,136 (4.4%) had positive findings. Follow-up data were lacking in 11,797 (2.3%), 911 (7.7%) were verified lost, and 518 (4.4%) were referred to the ILNC. There were 393 patients with benign nodules and accepted enrollment in the lung screening program. Mean age of enrolled patients was 61 years, and 53% were men. Workup included 499 diagnostic computed tomographic scans, 39 positron emission tomographic scans, and 27 biopsy samples that identified 15 malignancies (2.9%), with 14 lung cancers (8 stage I, 4 stage III, and 2 stage IV). Treatment included 5 lobectomies, and 4 underwent stereotactic body radiation therapy. Financials were favorable. CONCLUSIONS: AI software can supplement practitioners, help diagnose lung cancer earlier, save lives, and generate value-based revenue for the hospital.

Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States?

OBJECTIVE: Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. METHODS: We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. RESULTS: We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. CONCLUSION: Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3698-3705, 2024.

Medicare Advantage Prior Authorization Requirements for Otolaryngologic Procedures in 2021.

Little is known about the extent of prior authorization requirements in otolaryngology. We performed a secondary analysis of data comparing prior authorization (PA) policies across 5 major Medicare Advantage insurers to estimate the counterfactual proportion of 2021 Medicare Part B fee-for-service spending and utilization for commonly performed otolaryngologic procedures that would have required PA. The counterfactual proportion of spending (range: 20.4%-27.6%) and utilization (range: 1.8%-4.5%) requiring PA was relatively consistent across insurers and largely attributable to rhinologic procedures. However, PA requirements for specific services varied widely among insurers. Among the 70 (of 196; 35.7%) services subject to PA by any insurer, nearly half were subject to PA by a single insurer (n = 34; 48.6%). Only 10 (14.3%) services were subject to PA by 4 (n = 6; 8.6%) or 5 (n = 4; 5.7%) insurers. These discrepancies illustrate the challenges of navigating discordant insurer policies for otolaryngologists and raise concerns about the validity of certain PA requirements.

Transforming Communication on Serious Illness and Frailty: A Comprehensive Approach to Empowering Informed Decision-Making.

Health care professionals can enhance conversations about serious illness and medical decision-making by adopting a transparent, standardized approach. This article critiques established communication strategies, which often emphasize patient values and goals without providing the necessary medical information to align these goals with a shared understanding of prognosis. We propose an alternate strategy that (1) provides detailed explanations of medical conditions at the beginning of the conversation, (2) includes support persons in discussions, (3) considers capacity, and (4) offers tailored advice by clinicians. The proposed framework aims to provide patients (or their delegates) with the information they need to integrate their values in pursuit of well-informed medical decisions. This strategy builds trust by providing honest information about medical conditions and their trajectories. It empowers decision makers to consider realistic outcomes, allowing them to accept or reject treatments in accordance with their preferences. This article presents a thorough step-by-step guide on how to conduct a serious illness conversation and facilitate medical decision-making, including a supplement that provides example phrases for use in clinical practice.

The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study.

PURPOSE: Echocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines. METHODS: We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK's Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making. RESULTS: 1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance. CONCLUSION: Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.

Transforming healthcare delivery: a descriptive study of a novel provider-to-provider virtual care platform.

Introduction: Addressing challenges in access to specialty care, particularly long wait times and geographic disparities, is a pressing issue in the Canadian healthcare system. This study aimed to evaluate the impact and feasibility of provider-to-provider phone consultations between primary care providers (PCPs) and specialists using a novel virtual care platform in Nova Scotia (Virtual Hallway). Methods: We conducted a cross-sectional survey over 5 months, involving 211 PCPs and 34 specialists across Nova Scotia. The survey assessed the need for formal in-person referrals as well as clinician satisfaction. Statistical methods included descriptive statistics and the one-sample t-test. Results: We found that 84% of provider-to-provider phone consultations negated the need for an in-person specialist referral. It was also reported that 90% of patients that did require in-person consultation had enhanced care while they awaited an in-person appointment with a specialist. Very high levels of satisfaction were reported among both PCPs and specialists, and there was a noticeable increase in billing volumes related to these consultations as measured by provincial billing codes. Conclusion: The findings indicate that provider-to-provider phone consultations are feasible, well-accepted and also effective in reducing the need for in-person specialist visits. This approach offers a promising avenue for alleviating waitlist burdens, enhancing the quality of care, and improving the overall efficiency of healthcare delivery.