Assessing health professionals' perception of health literacy in Rhode Island community health centers: a qualitative study.

BACKGROUND: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. METHODS: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. RESULTS: Eight unique themes centered on health literacy, sources of health information, organizational culture's impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients' health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. CONCLUSIONS: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.

Using PowerPoint 2016 to Create Individualized Matching to Sample Sessions.

Discrete-trial-training procedures, particularly matching to sample (MTS), are often used to teach children with autism and/or intellectual disabilities. An example is touching a picture that corresponds to a spoken word. When conducted in a "tabletop" manner, the teacher must arrange several pictures on a table, provide the spoken word, and present response consequences, all while maintaining procedural integrity and collecting data. Using computer programs can greatly reduce the burden on practitioners, but many do not have the access, funding, or time to use complex and expensive software. This report serves as a guide to making MTS tasks that have many of the benefits of computerization using Microsoft® PowerPoint™ 2016, a program that many practitioners have basic knowledge of, and access to. Past papers have described the use of PowerPoint™ for whole classroom instruction. This report expands the use of PowerPoint™ to present individualized instruction that detects child responses and presents consequences based on those responses.

Effects of methylphenidate on sensitivity to reinforcement delay and to reinforcement amount in pigeons: Implications for impulsive choice.

Methylphenidate has been shown to decrease impulsive choice (increase choices of a larger more delayed reinforcer). The purpose of this study was to investigate 2 potential behavioral mechanisms of this effect: a drug-induced change in control by reinforcement delay (Experiment 1) and/or by reinforcement amount (Experiment 2). In Experiment 1, pigeons responded under a rapid-acquisition, concurrent-chains choice procedure involving delay to reinforcement; the option with the shorter delay varied unpredictably across sessions. The pigeons accurately tracked the shorter delay across sessions (i.e., a preference for the option with the shorter delay developed within each session). Methylphenidate selectively decreased sensitivity to reinforcement delay-it attenuated the acquisition of preference at doses that did not systematically affect bias or response rates. In Experiment 2, pigeons responded under a rapid-acquisition, concurrent-chains choice procedure involving reinforcement amount. The pigeons accurately tracked the option with the larger reinforcement amount across sessions. Methylphenidate selectively decreased sensitivity to reinforcement amount-it attenuated the acquisition of preference at doses that did not systematically affect bias or response rates. These data suggest that methylphenidate attenuates the degree to which the various reinforcement dimensions control choice, and that drug effects on impulsive choice depend upon the relative contributions of drug-induced changes in control of behavior by each relevant dimension. (PsycINFO Database Record

Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy: A Randomized Study.

BACKGROUND: Early in the 20th century, thyroid surgery was performed using local anesthetic techniques. When general anesthesia became safer, surgeons started performing thyroidectomy exclusively under general anesthesia. However, recent descriptions of thyroidectomy under local anesthesia claim similar results to thyroidectomy under general anesthesia. Surgery conducted under local anesthesia can result in early discharge, ie, a hospital stay of less than 8 hours. HYPOTHESIS: Thyroidectomy can be performed under local anesthesia with monitored anesthesia care (MAC) with results similar to general anesthesia in an outpatient or inpatient surgery setting. DESIGN: A prospective randomized study comparing local anesthesia with MAC vs general anesthesia in adult patients undergoing thyroidectomy in a potential outpatient setting, defined as same-day discharge. Patients were excluded if they were not able to receive local or general anesthesia. In addition, we performed an outcome evaluation of the use of local anesthesia with MAC for thyroidectomy and the use of outpatient surgery for thyroidectomy. We compared 58 consecutive thyroidectomies performed prior to the study with 58 consecutive thyroidectomies performed after the study. SETTING: A 486-bed university-affiliated hospital. RESULTS: Fifty-eight patients undergoing thyroidectomy received random assignment: 29 to local anesthesia with MAC and 29 to general anesthesia under study protocol. Fifty-one surgical procedures (88%) were completed as outpatient surgery. No significant differences were found between the 2 study groups in demographics, postoperative adverse symptoms, complications, hospital admission, or patient satisfaction. Patients in the general anesthesia group spent, on average, more time postoperatively than patients in the group that received local anesthesia with MAC in the outpatient surgery center until same-day discharge (P = .02). When compared before the study, we found a significant increase after the randomized study in the use of local anesthesia with MAC (P<.001) and outpatient thyroidectomies (P<.001). CONCLUSIONS: Thyroidectomy can be performed in the studied patient population under either general anesthesia or local anesthesia with MAC, expecting similar operative results, clinical results, and patient satisfaction. In addition, local anesthesia with MAC can reduce the postoperative time spent in an outpatient surgery setting with potential health care cost savings.