Gianluca De Leo

An update on out-of-hospital airway management practices in the United States

OBJECTIVE We characterized out-of-hospital airway management interventions, outcomes, and complications using the 2012 NEMSIS Public-Release Research Data Set containing almost 20 million Emergency Medical Services activations from 40 states and two territories. We compared the outcomes with a previous study that used 2008 NEMSIS data containing 16 states with 4 million EMS activations. METHODS Patients who received airway management interventions including endotracheal intubation (ETI), alternate airways (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and cricothyroidotomy (needle and surgical) were identified. Using descriptive statistics, airway management success and complications were examined in the full cohort and key subsets including cardiac arrest, non-arrest medical, non-arrest injury, children<10 years, children 10-19 years, rapid sequence intubation (RSI), population setting, U.S. census region, and U.S. census division. RESULTS Among 19,831,189 EMS activations, there were 74,993 ETIs, 21,990 alternate airways, and 1332 cricothyroidotomies. ETI success rates were: overall 63,956/74,993 (85.3%; 95% CI: 85.0-85.5), cardiac arrest 33,558/39,270 (85.5%), non-arrest medical 12,215/13,611 (89.7%), non-arrest injury (90.1%), children <10 years 2069/2468 (83.8%), children 10-19 years 1647/1900 (86.7%), adults >19 years 58,965/69,144 (85.3%), and rapid sequence intubation 5265/5658 (93.1%). Major complications included bleeding 677 (4.4 per 1000 interventions), vomiting 1221 (8 per 1000 interventions), esophageal intubation immediately detected 874 (5.7 per 1000 interventions), and esophageal intubations other 219 (1.4 per 1000 interventions). CONCLUSIONS Low out-of-hospital ETI and alternate airway success rates were observed. These data may guide national efforts to improve out-of-hospital airway management quality leading efforts to better educate providers on ETI.

A Smart-Phone Application and a Companion Website for the Improvement of the Communication Skills of Children with Autism: Clinical Rationale, Technical Development and Preliminary Results

Autism is a complex neurobiological disorder that is part of a group of disorders known as autism spectrum disorders (ASD). Today, one in 150 individuals is diagnosed with autism. Lack of social interaction and problems with communication are the main characteristics displayed by children with ASD. The Picture Exchange Communication System (PECS) is a communication system where children exchange visual symbols as a form of communication. The visual symbols are laminated pictures stored in a binder. We have designed, developed and are currently testing a software application, called PixTalk which works on any Windows Mobile Smart-phone. Teachers and caregivers can access a web site and select from an online library the images to be downloaded on to the Smart-phone. Children can browse and select images to express their intentions, desires, and emotions using PixTalk. Case study results indicate that PixTalk can be used as part of ongoing therapy.

Smartphones to facilitate communication and improve social skills of children with severe autism spectrum disorder: special education teachers as proxies

We present an overview of the approach we used and the challenges we encountered while designing software for smartphones to facilitate communication and improve social skills of children with severe autism spectrum disorder (ASD). We employed participatory design, using special education teachers of children with ASD as proxies for our target population.

Supporting Autobiographical Memory in Patients with Alzheimer's Disease Using Smart Phones

An estimated 5.1 million Americans suffer from Alzheimers disease (AD). A symptom of AD is the gradual loss of autobiographical memory. Support services have been shown to slow such loss, thereby improving the quality of life of patients and their caregivers. In this case study, a subject in Stage 4 of AD on the Functional Assessment Staging (FAST) scale carried a smart phone with a lanyard for 4 weeks. The smart phone was programmed to take pictures at 5-minute intervals for 12 hours during the day. The pictures were collected, combined in a video slide show, saved to a DVD, and mailed to the subject on a weekly basis. The subject and his caregiver had to view the DVD. In order to evaluate the subjects memory before and after viewing the DVD, a test concerning the most important events of the week was developed. The subject and his caregiver had to answer a satisfaction questionnaire as well. The results of this case study confirmed that the DVD helped the subject recall recent events significantly better and that carrying the smart phone was not considered intrusive to daily routines. This manuscript illustrates how smart phone technology can assist in exercising autobiographical memory.

Measuring sense of presence and user characteristics to predict effective training in an online simulated virtual environment.

Introduction Virtual-reality solutions have successfully been used to train distributed teams. This study aimed to investigate the correlation between user characteristics and sense of presence in an online virtual-reality environment where distributed teams are trained. A greater sense of presence has the potential to make training in the virtual environment more effective, leading to the formation of teams that perform better in a real environment. Being able to identify, before starting online training, those user characteristics that are predictors of a greater sense of presence can lead to the selection of trainees who would benefit most from the online simulated training. Methods This is an observational study with a retrospective postsurvey of participants’ user characteristics and degree of sense of presence. Twenty-nine members from 3 Air Force National Guard Medical Service expeditionary medical support teams participated in an online virtual environment training exercise and completed the Independent Television Commission–Sense of Presence Inventory survey, which measures sense of presence and user characteristics. Nonparametric statistics were applied to determine the statistical significance of user characteristics to sense of presence. Results Comparing user characteristics to the 4 scales of the Independent Television Commission–Sense of Presence Inventory using Kendall &tgr; test gave the following results: the user characteristics “how often you play video games” (&tgr;(26) = −0.458, P < 0.01) and “television/film production knowledge” (&tgr;(27) = −0.516, P < 0.01) were significantly related to negative effects. Negative effects refer to adverse physiologic reactions owing to the virtual environment experience such as dizziness, nausea, headache, and eyestrain. The user characteristic “knowledge of virtual reality” was significantly related to engagement (&tgr;(26) = 0.463, P < 0.01) and negative effects (&tgr;(26) = −0.404, P < 0.05). Conclusions Individuals who have knowledge about virtual environments and experience with gaming environments report a higher sense of presence that indicates that they will likely benefit more from online virtual training. Future research studies could include a larger population of expeditionary medical support, and the results obtained could be used to create a model that predicts the level of presence based on the user characteristics. To maximize results and minimize costs, only those individuals who, based on their characteristics, are supposed to have a higher sense of presence and less negative effects could be selected for online simulated virtual environment training.

Patient web portals, disease management, and primary prevention

Background Efforts aimed at health care reform and continued advances in information technologies have prompted interest among providers and researchers in patient web portals. Patient web portals are password-protected online websites that offer the patients 24-hour access to personal health information from anywhere with an Internet connection. Methods This article, which is based upon bibliographic searches in PubMed, reviews important developments in web portals for primary and secondary disease prevention, including patient web portals tethered to electronic medical records, disease-specific portals, health disparities, and health-related community web portals. Results Although findings have not been uniformly positive, several studies of the effectiveness of health care system patient portals in chronic disease management have shown promising results with regard to patient outcomes. Patient web portals have also shown promising results in increasing adherence with screening recommendations. Racial and ethnic minorities, younger persons, and patients who are less educated or have lower health literacy have been found to be less likely to use patient portals. Conclusion Additional studies are needed of the utility and effectiveness of different elements of web portals for different patient populations. This should include additional diseases and health topics such as smoking cessation and weight management.

User-Centered Design and Augmentative and Alternative Communication Apps for Children With Autism Spectrum Disorders:

Communication difficulties are among the most frequent characteristics of children with autism spectrum disorders (ASD). Lack of communication can have a significant impact on the child’s life. Augmentative and alternative communication (AAC) apps are a common form of AAC interventions that involve a combination of affordable technology with software that can be utilized to assist with communication. While AAC apps have been found to have some impact on improving the communication skills of children with ASD, current research exploring this topic is still limited. Focusing on the design process of AAC apps may provide better insight into improving clinical outcomes and user success. The user-centered design process incorporates a continuous cycle of user feedback to help inform and improve the functions and the capabilities of the technology, and it is an essential component in AAC app development. This article outlines how the user-centered design process could be adopted for the development of AAC apps for children with ASD.

Requirements engineering using appreciative inquiry for an online community of caregivers of children with autism

Appreciative Inquiry, commonly used in organizational development, aims to build organizations, processes or systems based on success stories using a hopeful vision for an ideal future. It produces positive results with organizational change management. We adjusted the user requirements process for an online community of caregivers of children with autism and compared it with the traditional approach. Based on case studies with 4 special education teachers, we found that Appreciative Inquiry was effective for obtaining meaningful requirements and extremely useful in encouraging buy-in with novice users. This outcome was in stark contrast to the traditional approach where our participants showed no interest in an online community. In addition to these results, we present lessons learned in adjusting the Appreciative Inquiry process for user requirements analysis.

Consumer Perspectives on Quality Attributes in Evaluating Health Websites

Healthcare consumers are increasingly turning to the Internet for health information. Health website sponsors and developers are challenged to ensure high quality to satisfy the spectrum of site visitors. Yet, research does not seem to provide needed guidance from the perspective of the healthcare consumer. In response, this study provides a taxonomy of website quality attributes and explores differences in ratings of the importance of 15 quality attributes of health websites from healthcare consumers. Both quantitative and qualitative methods were deployed to collect the data.

Respiratory Therapy Faculty Knowledge of and Attitudes Toward Interprofessional Education

BACKGROUND: Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) faculty were surveyed to evaluate their knowledge and attitudes toward IPE. We report current opportunities for IPE from faculty and compare responses from associates, bachelors, and masters degree programs and profit versus nonprofit institutions. METHODS: We developed an online survey based on IPE literature and questions modified for the RT discipline. The survey was distributed by email to 874 faculty from the Commission on Accreditation for Respiratory Care accredited programs. RESULTS: The response rate was 33%. Faculty identified IPE as an important component of RT education (n = 207, 80%) but reported challenges in integrating IPE into current curriculum. Overall, communication was ranked as the most important IPE competency (n = 104, 39%) and ethics least important (n = 131, 49%). When asked how many credit hours are required to teach IPE, 48% of respondents reported that they were unsure of an appropriate time requirement. Significant differences between associates and bachelors/masters degree program faculty were found on the following topics: institutional resources needed for IPE (P < .001), faculty availability (P < .001), curriculum availability for IPE (P = .02), and importance of including IPE at academic health center campuses (P < .001). CONCLUSIONS: IPE is recognized as an important component of RT education by all faculty respondents. However, significant differences in knowledge and attitudes toward IPE exist between faculty in associates versus bachelors/masters degree programs. Revisiting the current accreditation standards program may allow IPE to take a more prominent role in RT curricula.