Using second life to teach health professions students about Alzheimer's Disease: A comprehensive review.

Increased training is necessary to ensure that the next generation of health care professionals are prepared to effectively and compassionately serve patients with Alzheimer's Disease. Second Life® is a virtual world shown to provide a safe, convenient, and effective environment for teaching health-related content. To date, there has been no comprehensive review of studies using Second Life in education about Alzheimer's Disease. The authors conducted a scoping review of the literature on the use of Second Life in the education of medical, nursing, and health professions students about Alzheimer's Disease. Searches were conducted in PubMed, SCOPUS, and CINAHL. Thirty-two studies containing outcomes of the application of virtual reality and the virtual world Second Life were identified. Studies were classified using the Kirkpatrick Four-Level Training Evaluation Model. Changes in knowledge, attitudes, and confidence (Level 2), were most commonly reported, followed by positive reactions (Level 1). No studies identified system-level results and few examined changes in behavior. While results indicate positive student reactions and enhanced learning from Second Life interventions related to Alzheimer's Disease, they also highlight a need for future research examining outcomes at the higher Kirkpatrick levels.

Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy.

BACKGROUND: Depression leads to poor health outcomes in patients with coronary heart disease (CHD). Despite guidelines recommending screening and treatment of depressed patients with CHD, few patients receive optimal care. We applied behavioral and implementation science methods to (1) identify generalizable, multilevel barriers to depression screening and treatment in patients with CHD and (2) develop a theory-informed, multilevel implementation strategy for promoting guideline adoption. METHODS: We conducted a narrative review of barriers to depression screening and treatment in patients with CHD (ie, medications, exercise, cardiac rehabilitation, or therapy) comprising data from 748 study participants. Informed by the behavior change wheel framework and Expert Recommendations for Implementing Change, we defined multilevel target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multilevel implementation strategy, targeting health care systems/providers and patients. RESULTS: We identified implementation barriers at the system/provider level (eg, Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (eg, Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. Expert Recommendations for Implementing Change strategies included learning collaborative, audit, feedback, and educational materials. The final multicomponent strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (electronic shared decision-making) tool with several functions for patients, for example, patient activation, patient treatment selection support. CONCLUSIONS: We applied implementation and behavioral science methods to identify implementation barriers and to develop a multilevel implementation strategy for increasing uptake of depression screening and treatment in patients with CHD as a use case. The multilevel implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.

Bipolar Disorder, Religion, and Spirituality: A Scoping Review.

Mental health clinicians frequently study the religion and spirituality (R/S) of their patients. There is, however, a paucity of empirical research concerning R/S of patients with bipolar disorder. This lack is exacerbated by the absence of an evaluation of how these studies relate to each other. Reviews to date concern almost exclusively quantitative studies; a review that synthesizes quantitative and qualitative research is needed. The aim of this paper is to provide a synthesis of empirical studies that is useful in clinical practice. Systematic searches for relevant journal articles in SCOPUS, PubMed, and PsycInfo found 14 quantitative and four qualitative studies. The research reveals that intrinsic religiosity and positive religious coping are the dimensions of R/S that have the most positive correlations with improvement of bipolar disorder symptoms as revealed by measures of clinical outcomes. Patients struggle with their religious experiences, and they wish that R/S would be taken into account by mental health professionals. The quantitative studies are not in conflict with the patient/person-centered focus of qualitative studies. This integration of quantitative data with a patient/person-centered focus shows how belief and illness affect each other. The tensions inherent in such an integration provide new insights for research and treatment. Unfortunately, the qualitative literature has not caught up with quantitative approaches in terms of diagnostic rigor.

Refusal of Treatment of Childhood Cancer: A Systematic Review.

CONTEXT: Refusal of treatment for childhood cancer engenders much discussion. No systematic study of this phenomenon exists in countries where access to treatment is readily available. OBJECTIVE: To identify and describe all published cases of treatment refusal for childhood cancer in the contemporary era. DATA SOURCES: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, LexisNexis Academic, personal database, and secondary bibliographies. STUDY SELECTION: Eligible studies included at least 1 child <18 years of age and addressed refusal of medically recommended interventions intended to cure cancer. DATA EXTRACTION: Cases were analyzed with respect to key features, including demographics, rationale for refusal, legal action, and medical outcome; data were combined for multiple publications discussing the same case. RESULTS: Of 4342 unique publications identified, 579 were eligible after screening; 96 scholarly articles and 19 judicial opinions addressed 73 unique cases of treatment refusal. Most cases occurred in the United States. Rationales for refusal were broadly grouped into 4 categories. Fifty-one cases (70%) involved legal action at the time of refusal. Legal action did not reliably predict survival. : Publication bias and missing data, especially for cases without legal action, were limitations. CONCLUSIONS: We identified important gaps in the literature, including the significant variation in approaches and lack of consensus regarding the prognostic threshold necessary for compelling treatment and the absence of voices of children and adolescents who have received treatment over their families' objections. More research reporting effective strategies for working with families who refuse is needed.

Gluten sensitivity: new epidemic or new myth?

Fueled in part by recent bestselling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion-dollar industry it has created-stems from the spreading belief that eating foods containing wheat or other gluten-laden grains may not only result in weight gain and obesity, but can also lead to a laundry list of ailments ranging from depression and anxiety to arthritis and autism. One popular book contends that current recommendations for a high-grain/low-fat diet underlie much of today's chronic health problems and that a low-carbohydrate, high-fat/cholesterol diet is ideal. Every major change in our diet carries with it the possibility of unforeseen risks. Concern about the impact of such popularized dietary recommendations on overall well-being-and on cardiovascular health in particular-warrants discussion in the medical community.

Gluten sensitivity: new epidemic or new myth? Every major change in our diet carries with it the possibility of unforeseen risks.

Fueled in part by recent best-selling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion dollar industry it has created-stems from the spreading belief that eating foods containing wheat or other gluten-laden grains may not only result in weight gain and obesity but can also lead to a laundry list of ailments ranging from depression and anxiety to arthritis and autism. One popular book contends that current recommendations for a high-grain, low-fat diet underlie much of today's chronic health problems and that a low-carbohydrate, high-fat/cholesterol diet is ideal. Every major change in our diet carries with it the possibility of unforeseen risks. Concern about the impact of such popularized dietary recommendations on overall well-being-and on cardiovascular health in particular-warrants discussion in the medical community.