Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit: Results from a Double-Blinded, Prospective, Randomized Controlled Trial.

BACKGROUND: Patient-reported outcome measures (PROMs) are metrics that assess physical health, mental health, pain, and satisfaction. However, PROM collection in orthopaedic clinics presents numerous logistical and financial challenges. These challenges are reduced when PROMs are completed before clinic encounters, relieving the workflow constraints of in-office PROM collection. The purpose of this study was to determine the efficacy of 3 different methods with respect to pre-visit electronic PROM completion. METHODS: Consecutive adult orthopaedic patients with no previous PROM participation were enrolled. Patients who registered with the electronic medical record (EMR) patient portal (MyChart) and with active e-mail addresses were randomly assigned to 1 of 3 arms: control (no pre-visit messages), MyChart (EMR patient portal pre-visit messages), and e-mail (e-mail pre-visit messages). The primary outcome measure was pre-visit PROM completion rates in orthopaedic patients, and the secondary outcome measures were time to pre-visit PROM form completion and PROM form completion rates according to patient demographic characteristics. By default, the Patient-Reported Outcomes Measurement Information System (PROMIS) forms were available for completion through the portal by 7 days before scheduled visits. Pre-visit messages were sent 7 days prior to the scheduled visit except in the control group, with reminders sent 3 days prior if still not completed. The patients in each arm who completed all assigned forms were labeled as having total PROM completion, and those who completed at least 1 completed form were considered as having partial PROM completion. Multivariable logistic regression models were used to assess differences in PROM completion rates between study arms. Kruskal-Wallis tests were performed to compare the date of the form completion. RESULTS: A total of 291 patients were included. The pre-visit total completion rates for assigned PROMs were higher in the MyChart arm (49% of 97 patients; p = 0.005) and the e-mail arm (52% of 100 patients; p = 0.002) in comparison with the control arm (30% of 94 patients). Male patients were more likely than female patients to have partial pre-visit PROM completion (odds ratio [OR], 1.74; p = 0.03), and Caucasian patients were more likely to have partial pre-visit PROM completion than African American patients (OR, 2.28; p = 0.01). CONCLUSIONS: Orthopaedic patients receiving either e-mail or patient portal messages demonstrated higher pre-visit PROM completion rates. Pre-visit messaging appears to be a useful strategy for increasing PROM completion rates and limiting the clinical workflow strain imposed by in-clinic PROM administration. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Quality and Reliability of YouTube for Patient Information on Neurotoxins.

YouTube is a common source of medical information for patients. This is the first study to assess the reliability and educational value of YouTube videos on neurotoxin procedures. YouTube.com was searched on June 15, 2020 using the keyword "Botox" or "neurotoxin." A total of 100 videos were reviewed. Sixty-one videos met the inclusion criteria and were included in the final analysis. Video characteristics were noted, and a score was assigned to each video using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS) to measure source reliability and educational value, respectively. A total of 61 videos that met the inclusion criteria had an average length of 589 seconds (9 minutes and 49 seconds), 210,673 views, 5,295 likes, 318 dislikes, and 478 comments. A total of 30 videos (49%) were posted with an intention to educate patients while 31 videos (51%) were posted with the intention to detail a personal experience with neurotoxin. Patient education videos were significantly more reliable (P JAMA< 0.001) and had more educational value (P GQS < 0.001) but were less popular than "personal experience videos." Personal-experience videos posted by patients had higher popularity, more likes and comments, yet lower scores on reliability and education. Patients will continue to seek educational material online, and clinicians should utilize this information to help primarily educate patients with standardized and accurate information about their treatment. KEY POINTS: · Question: Are YouTube videos pertaining to neurotoxin reliable and contain useful information to educate patients to make informed decisions about their neurotoxin treatment?. · Findings: Roughly half of videos reviewed were vlogs (video logs), which were of low quality and educational value, but were more popular compared with videos that were intended to educate patients on neurotoxin treatment.. · Meaning: Patients who use YouTube as a source of information about neurotoxin treatment may be misled with inaccurate and unreliable information. Physicians must be aware of these findings to properly educate patients with standardized and accurate information about their treatment..

Raw regulates glial population of the eye imaginal disc.

Glia are critical for proper development, support, and function of the nervous system. The Drosophila eye has proven an excellent model for gaining significant insight into the molecular mechanisms regulating glial development and function. Recent studies have demonstrated that Raw is required in glia of the central and peripheral nervous systems; however, the function of Raw in glia of the developing eye has not been explored. These studies demonstrate that raw knockdown results in a reduction in the number of glia in the third instar eye imaginal disc and reduced glial spreading across the field of differentiating photoreceptor neurons. Expression of a raw enhancer trap reveals that raw is expressed in eye disc glia. Exploration of the mechanism by which raw knockdown results in glial reduction reveals that Raw is required for glial proliferation and migration into the eye disc. In addition, Raw negatively regulates Jun N-terminal kinase (JNK) signaling in glia of the developing eye and increased JNK signaling results in a reduction in the number of glia populating the eye disc, similar to that observed upon raw knockdown. Thus, Raw functions as a critical regulator of glial population of the eye imaginal disc by regulating glial proliferation and migration and inhibiting JNK signaling.