Sex Ed to Go: A Content Analysis of Comprehensive Sexual Education Apps

Mobile applications ("apps") designed for sexual health education have the potential to reach teens and young adults that are hard to reach through traditional platforms; however, little is known about availability of these apps and their adherence to existing guidelines. Following a search on the two major app stores, data from 2,693 apps were analyzed. Only 697 (25%) addressed sexual health, and only 15 (1%) of apps met inclusion criteria for comprehensive programs and their content was further analyzed. The content of most of these apps narrowly focused on sexually transmitted infections and pregnancy prevention and lacked information on puberty, sexual identity, and personal safety. Theoretically grounded strategies including self-efficacy and modeling behavior to strengthen behavior change efforts were largely absent. Last, we identified significant shortcomings in the literate design of these apps, including limited use of interactive features, such as videos, quizzes, or games. These findings indicate that the potential of apps as sexual health promotion tools has not yet been fully realized. We outline recommendations for developing theory- and evidence-based sexual education apps and provide suggestions for health educators on how to select relevant apps when working for youth.

Towards an enhanced conceptualization of fidelity for instructional design in simulation-based respiratory therapy education

Despite the apparent centrality of fidelity to clinical simulation instructional design and practice in respiratory therapy education, it remains one of most contested constructs in the simulation literature. Fidelity has been described as educationally under-theorized resulting in an emphasis often being placed on technological sophistication rather than theory-informed design, particularly in respiratory therapy. This article critically examines various conceptualizations of fidelity in the field of clinical simulation in an effort to inform its instructional design practices. We adopt the perspective that a shift in the theoretic lens from individualistic to a more socio-cultural orientation may better support our understanding of learning in simulation environments. The instructional design framework (IDF) developed by the Canadian Network for Simulation in Healthcare provides a solid pedagogical foundation on which to base clinical simulations design. The IDF has also been a platform upon which designers can frame the characteristics of simulation environments. We propose an enhanced IDF informed by contemporary education theory describing the joint learning relationship that exists between learners and technology-enhanced learning environments. The enhanced IDF includes each of the interdependent design elements in the original model and incorporates a socio-culturally informed conceptualization of fidelity. The framework will be useful in fostering the relationships that support an effective clinical simulation learning environment. This will be of particular value to practitioners, researchers, and theorists in the clinical simulation-based respiratory therapy education field.

Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis

Background

Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps.

Objective

This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price.

Methods

Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM).

Results

The most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms.

Conclusions

Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities.

The practice of simulation-based assessment in respiratory therapy education

Clinical simulation has gained prominence as an educational approach in many Canadian respiratory therapy programs and is strongly associated with improved learning, clinical and nonclinical skill, future performance, and patient outcomes. Traditionally, the primary assessment approach employed in clinical simulation has been formative debriefing for learning. Contextual factors, such as limited opportunities for learning in clinical practice and technologically oriented perspectives on learning in clinical simulation, are converging to prompt a move from using formative debriefing sessions that support learning in simulation to employing high-stakes testing intended to measure entry-to-practice competencies. We adopt the perspective that these factors are intricately linked to the profession's regulatory environment, which may strongly influence how simulation practices become embedded with respiratory therapy educational programs. Through this discussion we challenge the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments.

Staffing patterns of respiratory therapists in critical care units of Canadian teaching hospitals

BACKGROUND

The optimal level of respiratory therapy staffing in Canadian intensive care units (ICUs) has not been described in the literature. An examination of practice patterns is an essential first step in developing an understanding of the contribution of respiratory therapists (RTs) to both short- and long-term patient outcomes in this context.

OBJECTIVE

To identify the ratio of mechanically ventilated patients to respiratory therapist (Vent:RT ratio) in the ICUs of Canadian teaching hospitals and the factors that influence this ratio.

METHODS

The present observational study investigated all adult ICUs (n=38) of the primary teaching hospital associated with each Canadian medical school. An electronic survey was administered at three intervals over a period of three months to control for seasonal variation. Data collected included the hours worked by all RTs, the number of mechanically ventilated patients receiving care, ICU characteristics and the practice patterns of the RTs. Data were used to calculate the Vent:RT ratio, and repeated measures ANOVA examined for variation between findings of each of the data collection points. Correlation analyses between key variables were performed and identified associations were further explored using the t test. Approval for the study was granted by the University of Manitoba Research Ethics Board (Winnipeg, Manitoba).

RESULTS

A mean (± SD) Vent:RT ratio of 5.1:1±2.818 was determined. Repeated measures ANOVA demonstrated no significant differences between findings of the three data collection points (F [1.7,30.5]=0.695; P=0.492). Several variables were associated with a significant difference in the Vent:RT ratio including ICUs where RTs insert arterial monitoring lines (4.05±2.89 versus 6.97±2.85; t[17.6]=-2.64; P=0.02), neurological ICUs (4.04±2.76 versus 6.40±3.35; t[30]=-2.092; P=0.04) and coronary care units (5.72±2.80 versus 3.10±1.88; t[35]=2.72; P=0.01). Significant differences were also identified in the mean number of RT hours worked in ICUs where RTs intubated (31.40±9.71 versus 60.54±47.20; t(13)=-2.17; P=0.049) and procured arterial blood gases (41.68±30.85 versus 77.33±46.22; t[35]=-2.79; P=0.01).

CONCLUSIONS

The present study is the first to report the Vent:RT ratio and RT practice patterns in Canadian adult ICUs. The results serve as a baseline for comparison of staffing norms and will enlighten future research on the impact of RT staffing and practice patterns on patient outcomes.

Innovation in respiratory therapy and the use of three-dimensional printing for tracheostomy management

Technological advances have influenced practice patterns and innovation in many health disciplines, including respiratory therapy. Collaborative approaches and knowledge-sharing environments are vital in addressing problems and adopting emerging technology. This article illustrates how the emergence of low-cost three-dimensional printing technology to physically reproduce the results of computed tomography imaging data can provide ways to assess airway abnormalities and symptomology not explained by traditional diagnostic methods.

Privacy and security of patient data in the pathology laboratory

Data protection and security are critical components of routine pathology practice because laboratories are legally required to securely store and transmit electronic patient data. With increasing connectivity of information systems, laboratory work-stations, and instruments themselves to the Internet, the demand to continuously protect and secure laboratory information can become a daunting task. This review addresses informatics security issues in the pathology laboratory related to passwords, biometric devices, data encryption, internet security, virtual private networks, firewalls, anti-viral software, and emergency security situations, as well as the potential impact that newer technologies such as mobile devices have on the privacy and security of electronic protected health information (ePHI). In the United States, the Health Insurance Portability and Accountability Act (HIPAA) govern the privacy and protection of medical information and health records. The HIPAA security standards final rule mandate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and security of ePHI. Importantly, security failures often lead to privacy breaches, invoking the HIPAA privacy rule as well. Therefore, this review also highlights key aspects of HIPAA and its impact on the pathology laboratory in the United States.

Public health in Canada: Evolution, meaning and a new paradigm for respiratory therapy

Chronic disease burden in Canada poses an imminent public health threat. The impact of respiratory disease in Canada alone is significant, affecting one in five and leading any other cause of repeat hospitalization in all age groups. Public health action is considered to be an important means of addressing these issues. Historical understanding of health has evolved to support the adoption of paradigms by professions that recognize the limitations of medical intervention in addressing the fundamental basis of disease when compared with the broader public health perspective. Several key historical events have shaped this understanding in the Canadian context including the Lalonde and Epp reports, and public health emergencies such as the severe acute respiratory syndrome outbreak in 2003. The profession of respiratory therapy has historically existed within a medicalized paradigm of practice; however, forces both internal and external to the profession are pressuring it to consider adopting broader social-and population-based approaches. As a rapidly evolving profession, there is a need to explore emerging areas of practice opportunities in the discipline. Investigating alternative knowledge and ideology can ensure that effective strategies for addressing the contemporary respiratory heath needs of Canadians are undertaken. The present article explores the rationale for a public health- and population-based approach to health in general, and its applicability to the respiratory therapist's role in addressing respiratory health-related issues in Canada.

Effectiveness of primary angioplasty for acute myocardial infarction in patients on dialysis

We sought to characterize the outcome in patients who were on long-term dialysis and who underwent primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction. Of 2,831 consecutive patients who underwent primary PTCA for acute myocardial infarction from 1993 to 2001, 15 patients on long-term dialysis were identified. This small cohort had a 40% incidence of cardiogenic shock on admission. Despite the angiographic success rate for primary PTCA of 80%, in-hospital mortality was 53%.

Sucrose acetate isobutyrate (SAIB): three-generation reproduction study in the rat and teratology studies in the rat and rabbit

A three-generation reproduction study of sucrose acetate isobutyrate (SAIB) in Fischer 344 rats and teratology studies in Fischer 344 rats and New Zealand white rabbits were performed. Dietary SAIB concentrations to provide dose levels of 0, 0.5, 1.0 and 2.0 g/kg body weight were used for the rat studies, and 0, 0.5, 0.85 and 1.2 g/kg body weight doses of SAIB in corn oil were administered by gavage in the rabbit studies. F0 generation male rats were fed SAIB for 10 wk, and female rats were fed SAIB for 2 wk prior to mating. F1 generation rats were raised on the test diets to maturity, mated to produce F2a litters, and remated to produce the F2b litters that were examined for teratology. F2a rats were mated to study fertility indices for the F3 pregnancy. A decrease in female fertility compared with controls was noted at the highest dose of SAIB during breeding of the F1 generation to produce the F2a litters. No difference in fertility rate between controls and treated animals was noted in the results of the other three matings that were performed, and it was concluded that the reduction in female fertility was not related to SAIB treatment. No morphological abnormalities of soft tissue or skeleton were observed in the rat or rabbit teratology studies. The highest dose levels administered, 2.0 g SAIB/kg body weight in the rat and 1.2 g SAIB/kg body weight in the rabbit, were considered to be no-observed-adverse effect levels (NOAEL).

Small-diameter invasive melanomas: clinical and pathologic characteristics

BACKGROUND

Most melanomas when first diagnosed clinically are larger than common benign melanocytic nevi ( > 6 mm). Smaller melanomas, however, may occasionally occur. Yet, very little is known about them.

OBJECTIVE

To determine the incidence and delineate the clinical and histologic characteristics of small-diameter invasive melanomas.

METHODS

Slides of all melanomas diagnosed between 1984-1993 were reviewed and measured. All invasive lesions less than 6 mm were further scrutinized clinically and morphologically.

RESULTS

Among 357 invasive melanomas, 16 (4.4%) were less than 6 mm. Most lesions lacked some of the histologic features usually seen in large melanomas. One half of them were over 0.75 mm deep. Patients with small melanomas were on average 15 years younger than those with large lesions. In females, sites on the upper extremities predominate. In females, small melanomas had clinical signs of melanoma, while in males they resembled nevi.

CONCLUSION

Melanomas smaller than 6 mm are not rare. Clinicians and pathologists must learn their features in order to diagnose them properly.

Multiplication of Legionella spp. in tap water containing Hartmannella vermiformis

A model was developed to study the multiplication of various Legionella spp. in tap water containing Hartmannella vermiformis. Tap water cultures prepared with the following components were suitable for the multiplication studies: Legionella spp., 10(3) CFU/ml; H. vermiformis, 10(4.4) cysts per ml; and killed Pseudomonas paucimobilis, 10(9) cells per ml. Cocultures were incubated at 37 degrees C for at least 1 week. The following legionellae multiplied in tap water cocultures in each replicate experiment: L. bozemanii (WIGA strain), L. dumoffii (NY-23 and TX-KL strains), L. micdadei (two environmental strains), and L. pneumophila (six environmental strains and one clinical isolate). Growth yield values for these strains were 0.6 to 3.5 log CFU/ml. Legionellae which did not multiply in replicate cocultures included L. anisa (one strain), L. bozemanii (MI-15 strain), L. micdadei (a clinical isolate), L. longbeachae, (one strain), and L. pneumophila (Philadelphia 1 strain). L. gormanii and an environmental isolate of L. pneumophila multiplied in only one of three experiments. None of the legionellae multiplied in tap water containing only killed P. paucimobilis. The mean growth yield (+/- standard deviation) of H. vermiformis in the cocultures was 1.2 +/- 0.1 log units/ml. H. vermiformis supports multiplication of only particular strains of legionellae, some of which are from diverse origins.

A comparative histopathologic study of photodistributed and nonphotodistributed lichenoid drug eruptions

This study compares the histopathologic characteristics of photodistributed and nonphotodistributed lichenoid drug eruptions in 13 patients. Both types have been said to be, in an unknown proportion, different from idiopathic lichen planus in that they can involve the deep as well as the superficial plexus, can contain eosinophils, and have parakeratotic scale. We found that these features were most often present in nonphotodistributed lichenoid drug eruptions and were seldom present in photodistributed eruptions. Thus a biopsy specimen that shows the classic features of lichen planus should not be used as evidence against a drug eruption, especially if the lesions are photodistributed.