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Aim: Balance training can help reduce the frequency of ankle joint injuries in adults, but data on young girls is relatively scant. Methods: Out of 91 female basketball players (7-16 years), 40 players were assigned to an experimental balance training group, and 51 players were assigned to a control group. Both groups performed their typical basketball training but the experimental group performed additional balance-focused exercises during the warm-up of their basketball training sessions. Results: A total of 47 girls (52 %) reported at least one ankle joint injury in their entire basketball history (52.5 % in the experimental, 50.9% in the control group). There was a positive correlation between the number of ankle joint injuries and age before the experiment (r = 0.34, p < 0.001). During the 12-month study period, girls who participated in balance training suffered significantly fewer ankle joint injuries than the control group (χ2 = 3.8423, df = 1, p-value < 0.05). Increased risk for ankle joint injury in the future was confirmed according to logistic regression for girls with previous ankle joint injury in history (4.33 times) and girls who did not participate in the balance training program (3.97 times). Conclusions: A progressive, barefoot balance training program that is simple and short enough to be performed during normal warmups can reduce the likelihood of suffering an ankle joint injury in young girls basketball players, which may be useful for athletes in other sports as well. [ABSTRACT FROM AUTHOR]

Klára Da&dcaron;ová,1 Miroslav Petr,2 James J Tufano,2 Lenka Sontáková,2 Eva Krauzová,3,4 Marek Št&ecaron;pán,3 Michaela Šiklová,3 Michal Šteffl2 1Department of Adapted Physical Education and Sports Medicine, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic; 2Department of Physiology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic; 3Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; 4Department of Internal Medicine, Královské Vinohrady University Hospital and Third Faculty of Medicine, Prague, Czech RepublicCorrespondence: Michal Šteffl, Department of Physiology, Faculty of Physical Education and Sport, Charles University, J. Martího 31, 162 52 Praha 6, Prague, Czech Republic, Tel +420 778701882, Email steffl@ftvs.cuni.czPurpose: In our study, we examined changes in short-term episodic memory and brain-derived neurotrophic factor (BDNF) in women after an exercise program alone or in combination with omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation.Patients and Methods: Fifty-five healthy elderly women (65– 80 years) were randomly split into two groups: in the first group were women attending an exercise program while taking wax esters-rich oil (Calanus) supplementation (n = 28) and in the other group were women undergoing the same exercise program while taking placebo (n = 27). The 16-week exercise program consisted of functional circuit training (twice a week) and Nordic walking lessons (once a week). Short-term episodic memory was evaluated by the Czech screening Test “Pojmenování OBrázk&uring; A jejich Vybavení” (POBAV) baseline and after the program lasting 16 weeks.Results: Our results show that short-term memory significantly improved following the exercise program, but there was no added value in using n-3 PUFA supplements. BDNF values did not differ between baseline and follow-up in either group. However, there was a statistically significant positive relationship between relative change (%) in the POBAV test and VO2peak in the placebo group (r = 0.49).Conclusion: Despite the added value of n-3 PUFA supplementation not being proven, our results may strengthen the importance of physical activity in averting age-related memory decline and dementia.Keywords: cognitive function, n-3 PUFA, physical activity, aging, circuit training, Nordic walking

Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient–provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient–provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time. [ABSTRACT FROM AUTHOR]

The article presents research on the determination of the significance and the association between bone characteristics and isometric strength in ballet dancers in Australia. Results of the study indicate the use of lower limb strength measurements as an alternative method for bone health evaluation, the characteristics and prevention of bone diseases, and the strength of the lower limb of ballet students.

Michal Steffl,1 Richard W Bohannon,2 Lenka Sontakova,1 James J Tufano,1 Kate Shiells,3 Iva Holmerova3 1Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, Charles University Prague, Prague, Czech Republic; 2Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA; 3Faculty of Humanities, Centre of Gerontology, Charles University Prague, Prague, Czech Republic Abstract: Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia. The positive influence of PA interventions on sarcopenia has been described previously on many occasions. Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published. The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies. We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia. Twenty-five articles were ultimately included in the qualitative and quantitative syntheses. A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development. Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =0.45; 95% confidence interval [CI] 0.37–0.55). The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia. Keywords: aging, sarcopenia, physical activity

PURPOSE: The purpose of this study was to develop prediction equations for speed and agility within different position groupings of High School football players using age, height, body mass, and vertical jump as predictor variables. METHODS: A total of 987 athletes (14-18y) completed testing at a regional high school football combine. Athletes were divided into three groups according to their playing position: Linemen (LM; n = 354; 16.3 ± 0.8y; 179.4 ± 5.6cm; 105.1 ± 18.3kg), Big Skill Players (BSP; n = 189; 16.2 ± 0.9y; 175.5cm ± 5.2cm; 85.7 ± 11.6kg), and Skill Players (SP; n = 444; 16.4 ± 09y; 175.8 ± 5.9cm; 75.5 ± 8.9kg). The LM included offensive tackles, offensive guards, centers, defensive tackles, and defensive ends. BSP included linebackers, running backs, and tight ends. SP included wide receivers, corner backs, safeties, and quarterbacks. In sequential order, height (HT), body mass (BM), 40 yard sprint (40Y), 5-10-5 shuttle (SH), and countermovement vertical jump height (VJ) were determined on each player. HT and BM were measured using a stadiometer and an electronic scale, respectively. 40Y and SH were measured using hand-held stop watches; the highest of two trials was used for analysis. Two vertical jumps were completed on an electronic pressure mat; vertical jump height was calculated using flight time. For each position grouping, correlations (Pearson's r) were calculated between the four predictor variables (Age, HT, BM, and VJ) and 40Y and SH performance. Combined multivariate models were derived using backward elimination; p < 0.05 was set as the criterion for inclusion. Non-significant variables were eliminated from the final model. RESULTS: Final multivariate models are provided in Table 1. Within LM, 40Y was significantly correlated to AGE (r = -0.22), BM (r = 0.60), and VJ (r = -0.84); SH was correlated to AGE (r = -0.22), BM (r = 0.46), and VJ (r = -0.67). Within the BSP group, 40Y was significantly correlated to AGE (r = -0.20), BM (r = 0.30), and VJ (r = -0.77); SH was correlated to AGE (r = -0.27) and VJ (r = -0.47). Within the SP group, 40Y was significantly correlated to AGE (r = -0.31) and VJ (r = -0.61); SH was correlated with AGE (r = -0.26) and VJ (r = -0.37). CONCLUSIONS: These data suggest that VJ and Age are a strong predictor of 40y and SH regardless of position. BM is a strong indicator of speed within the LM, but is less important to other positions. The combined regression models are more accurate for 40Y than SH indicating that physical characteristics not measured in the study could contribute to SH performance. PRACTICAL APPLIACTIONS: Because VJ is a strong predictor of speed regardless of position, football players desiring to increase 40Y should incorporate exercises that improve vertical ground reaction forces. Reduction in body mass is important for improving speed in LM, but this may not be advantageous for success at the position.Table. Multivariate regression models to predict 40Y and SH within positions. [ABSTRACT FROM AUTHOR]

Expression of power in triple extension movements is a key to success in many sports. Although power can be measured directly with a force plate, several field equations using vertical jump height (VJ) and body mass (BM) have been developed to predict peak power. Generally, these previously published equations were derived from relatively small numbers (N = 17 to 108) of adults with an average age of 22.0 years. Estimating power using these equations (N<108) and may not be ideal for young athletes. PURPOSE: The purpose of this study was to develop a novel equation to estimate peak power in young athletes and to validate compare its accuracy against previously published equations. METHODS: VJ data were collected from two hundred and seventy (N = 270) youth soccer players. The first two hundred and fifty five (n = 255; 14.1 ± 1.8 yrs) were used to model a new equation to predict peak power. A validation sample was collected at a later time on fifteen different soccer players (n = 15; 15.9 ± 1.1 yrs). All athletes completed a general warm-up, eight dynamic stretches, and a series of jumps to prepare for maximal testing. After a thorough explanation of procedures, BM was determined on each athlete and they were permitted to perform two practice jumps on the force plate. Data were collected at 400 Hz while the subjects performed a single maximal counter movement VJ on the force plate with a wooden dowel held securely across their shoulders. Peak power (PP) and VJ height were derived from a commercial software program. A multivariate regression equation was developed using VJ and BM to predict PP using the original 255 athletes. Using the validation sample (n = 15), the actual PP was compared to power estimated using the novel equation and three previously established equations (Sayers et al 1999, Harman et al. 1991,; and Canavan et al. 2004) using Repeated Measures Analysis of Variance (ANOVA). Holms-Sidak post hoc test was as used for pairwise comparisons with an alpha of p <0.05. RESULTS: To account for a slight curvi-linear relationship between BM and PP, the BM term for each athlete was adjusted by squaring the value (BM2). BM2 (r = 0.89) and VJ (r = 0.80) were significantly correlated with PP (p < 0.05). The new model equation, PP (W) = (0.379 × BM2) + (53.332 × VJ) - 391.107 was significantly correlated with actual peak power (r = 0.96; SEEM = 240.8 W). The actual PP generated during the VJ (3617.1 ± 433.3W) did not differ from power estimated using the novel equation (3528.0 ± 454.8W) or Sayers equation (3477.9 ± 443.0W) equation. However, power estimated using the Harman (3133.2 ± 402.5W), and Canavan (2985.4 ± 376.2W) equations were significantly different than the actual PP (p><00.05). CONCLUSIONS: The PP estimate of the proposed model equation accurately predicts peak power in young athletes. Although slightly less accurate than the novel equation, Sayers equation estimates were not significantly different than the actual peak power. This could be due to the larger sample sizes used to model both equations. PRACTICAL APPLICATION: Strength and conditioning coaches can use the newly modeled equation to more accurately predict peak power using BM and VJ in young athletes; however, more research is needed to validate this and other power estimation equations in a variety of populations. [ABSTRACT FROM AUTHOR]

We assessed the feasibility and acceptability of using mobile phones as part of an existing Web-based system for collaboration between patients with diabetes and a primary care team. In design sessions, we tested mobile wireless glucose meter uploads and two approaches to mobile phone-based feedback on glycemic control. Mobile glucose meter uploads combined with graphical and tabular data feedback were the most desirable system features tested. Participants had a mixture of positive and negative reactions to an automated and tailored messaging feedback system for self-management support. Participants saw value in the mobile system as an adjunct to the Web-based program and traditional office-based care. Mobile diabetes management systems may represent one strategy to improve the quality of diabetes care. [ABSTRACT FROM AUTHOR]

We investigated the convergent validity and intrasession reliability of force, velocity, and power (FVP) variables and the dynamic strength index (DSI) obtained from isometric midthigh pull (IMTP) and squat jump (SJ) testing. Fifteen male combat sports athletes (27 ± 5 years, 77 ± 9 kg, 1.76 ± 0.1 m, 14 ± 6% body fat) participated in a 2-days study. The first day involved testing familiarization, while the second was dedicated to IMTP and SJ testing. Maximal isometric force ( F iso ) was obtained from IMTP, while mean force, mean velocity, jump height, and jump impulse ( J ) were gathered from SJ. To analyze the FVP, we calculated the linear relationship between force and velocity, which allowed us to obtain the slope of the relationship ( S FV ), the theoretical velocity at zero force ( V 0 ), and the theoretical maximal power ( P max ). DSI was obtained as a ratio from SJ peak force and F iso . The convergent validity was investigated using Spearman's ρ coefficients to assess the relationships between jump height and J with F iso , V 0 , S FV , P max , and DSI. The intrasession reliability was assessed using intraclass correlation coefficients (ICC) and coefficient of variations (CV). All variables demonstrated acceptable reliability scores. ICC ranged from moderate to excellent, and the mean CV was <10%. We found a "very large" correlation between jump J and P max , while jump height was not correlated with any variable. In conclusion, the IMTP and SJ combination is a practical way to determine FVP producing capacities that can be reliably measured (intrasession). The P max , derived from FVP, was correlated with jump performance, which might evidence the convergent validity of the method., Competing Interests: The authors declare that they have no competing interests., (© 2024 Vieira et al.)

During vertical jump evaluations in which jump height is estimated from flight time (FT), the jumper must maintain the same body posture between vertical takeoff and landing. As maintaining identical posture is rare during takeoff and landing between different jump attempts and in different individuals, we simulated the effect of changes in ankle position from takeoff to landing in vertical jumping to determine the range of errors that might occur in real-life scenarios. Our simulations account for changes in center of mass position during takeoff and landing, changes in ankle position, different subject statures (1.44-1.98 m), and poor to above-average jump heights. Our results show that using FT to estimate jump height without controlling for ankle position (allowing dorsiflexion) during the landing phase of the vertical jump can overestimate jump height by 18% in individuals of average stature and performing an average 30 cm jump or may overestimate by ≤60% for tall individuals performing a poor 10 cm jump, which is common for individuals jumping with added load. Nevertheless, as assessing jump heights based on FT is common practice, we offer a correction equation that can be used to reduce error, improving jump height measurement validity using the FT method allowing between-subject fair comparisons., Competing Interests: The authors declare there are no competing interests., (©2024 Gonçalves et al.)

Purpose: This study explored the changes in blood pressure and cardiac autonomic modulation after training programs differin in set configuration. Methods: Thirty-nine individuals were randomly assigned to a traditional, rest-redistribution, or control group. Throughout five weeks, the traditional and rest-redistribution groups performed 10 sessions of four exercises with the same load, number of repetitions, and total rest time, but with different inter-set rest duration and frequency (traditional group: 4 sets of 8 repetitions, 10 repetition maximum load, 5 min rest between sets and exercises; rest-redistribution group: 16 sets of 2 repetitions, 1 min rest between sets, 5 min rest between exercises). Heart rate and heart rate recovery were recorded during each training session, and heart rate variability, baroreflex sensitivity and effectiveness, blood pressure, and blood pressure variability were evaluated at rest bedore and after the interventions. Results: During the sessions, traditional sets entailed greater peak heart rate compared to rest-redistribution ( P = .018) but mean heart rate, minimum heart rate, and heart rate recovery were similar between training programs ( P >.05). Baroreflex effectiveness was reduced after the traditional intervention ( P = .013). No changes were detected for the rest of the cardiovascular variables obtained at rest after intervention ( P > .05). Conclusions: Despite some differences in heart rate response during exercise, neither traditional nor rest-redistribution resistance training protocols produced changes in cardiac autonomic modulation, sympathetic vasomotor tone, and cardiac baroreflex sensitivity of young healthy active individuals. However, traditional sets affected the baroreflex effectiveness.

Background: We investigated the concurrent validity and test-retest reliability of the Jumpo 2 and MyJump 2 apps for estimating jump height, and the mean values of force, velocity, and power produced during countermovement (CMJ) and squat jumps (SJ)., Methods: Physically active university aged men ( n  = 10, 20 ± 3 years, 176 ± 6 cm, 68 ± 9 kg) jumped on a force plate ( i.e. , criterion) while being recorded by a smartphone slow-motion camera. The videos were analyzed using Jumpo 2 and MyJump 2 using a Samsung Galaxy S7 powered by the Android system. Validity and reliability were determined by regression analysis, typical error of estimates and measurements, and intraclass correlation coefficients., Results: Both apps provided a reliable estimate of jump height and the mean values of force, velocity, and power. Furthermore, estimates of jump height for CMJ and SJ and the mean force of the CMJ were valid. However, the apps presented impractical or poor validity correlations for velocity and power. Compared with criterion, the apps underestimated the velocity of the CMJ., Conclusions: Therefore, Jumpo 2 and MyJump 2 both provide a valid measure of jump height, but the remaining variables provided by these apps must be viewed with caution since the validity of force depends on jump type, while velocity (and as consequence power) could not be well estimated from the apps., Competing Interests: Amilton Vieira and Victor Macedo are designers of the Jumpo app. Data were obtained by an independent observer not related to the app development., (©2023 Vieira et al.)

Advancements in sport technology have made quantifying match-play external load (e.g., total distance, sprint distance, number of sprints) a popular option for athletics personnel. These variables of volume and intensity are useful for both objectively monitoring training in field-based sports and for designing training programs. As physical abilities differ across playing levels, match-play demands likely also differ. This narrative review compiles and compares the match-play external load data for women's soccer at the professional and collegiate levels. Databases were searched through July 2022, yielding 13 primary articles that assessed the match-play demands of women's soccer (3 professional, 8 Division I, 1 Division II, and 1 Division III). The results indicate that the average total distance covered were similar between the professional, Division I and Division III levels, but the variability was greater among Division III compared to professional and Division I players. Data for Division II are scarce, but the total distance covered appears to be less than for professional, Division I and Division III. There was also large variability for sprint distance and number of sprints across data at all playing levels. Considering the lack of studies of Division II and Division III players, more research is necessary to determine how playing level may affect external load profiles, as isolated studies likely only reflect data from isolated teams.

The purpose of this systematic review was to analyze the effects of concurrent training on one repetition maximum (1RM), maximum oxygen consumption (VO 2 max), and peak oxygen consumption (VO 2 peak) in healthy adults. The review followed PRISMA recommendations using randomized controlled trials in nine databases. Twenty-one studies met the inclusion criteria, totaling a sample of 796 subjects to perform the meta-analysis. As result, concurrent training provides similar increases in 1RM as strength training for upper limbs (standardized mean difference [SMD]: 0.12; 95% IC: [-0.18; 0.41]; p =0.43) and for the lower limbs (SMD: -0.32; 95% IC: [-0.79; 0.15]; p =0.19). Similarly, no difference was found in the aerobic capacity between the concurrent training vs. aerobic training groups ([SMD - VO 2 max]: -0.19; 95% IC: [-0.71; 0.33]; p =0.48 and [SMD - VO 2 peak]: -0.24; 95% IC: [-0.57; 0.08]; p =0.14). Based on the results found, we can affirm that a) similar to strength training, concurrent training provides maximum strength development for upper and lower limbs; and b) cardiorespiratory capacity is not impaired by concurrent training in relation to aerobic training, demonstrating the compatibility of the two training sessions., Competing Interests: The authors declare no conflict of interest. In addition, as a literature review (not directly involving human beings), the study does not require approval by the ethics committee, and the manuscript complies with the ethical standards of the International Journal of Sports Medicine 71., (Thieme. All rights reserved.)

This study investigated changes of gait pattern induced by a 4-week robot-assisted gait training (RAGT) in twelve ambulatory spastic diparesis children with cerebral palsy (CP) aged 10.4+/-3.2 years old by using computerized gait analysis (CGA). Pre-post intervention CGA data of children with CP was contrasted to the normative data of typically developing children by using cross-correlation and statistically evaluated by a Wilcoxon test. Significant pre-post intervention changes (p<0.01) include: decreased muscle activity of biceps femoris, rectus femoris, and tibialis anterior; a decrease in range of internal hip joint rotation, higher cadence, step length, and increased stride time. This study suggests that RAGT can be used in muscle reeducation and improved hip joint motion range in ambulatory children with CP.

Background: The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized., Objective: To describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project., Design: Individual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania., Participants: A total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation., Key Results: Three central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice-patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care., Conclusions: Key factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.

Purpose: To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooperative, an integrated health care system in Washington State., Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic compared with seniors enrolled at the remaining 19 primary care clinics owned and operated by Group Health. Analyses of secondary data on quality and cost were conducted for 1,947 seniors in the PCMH clinic and 39,396 seniors in the 19 control clinics. Patient experience with care was based on survey data collected from 487 seniors in the PCMH clinic and of 668 in 2 specific control clinics that were selected for their similarities in organization and patient composition to the pilot clinic., Results: After adjusting for baseline, seniors in the PCMH clinic reported higher ratings than controls on 3 of 7 patient experience scales. Seniors in the PCMH clinic had significantly greater quality outcomes over time, but this difference was not significant relative to control. PCMH patients used more e-mail, phone, and specialist visits but fewer emergency services and inpatient admissions for ambulatory care sensitive conditions. At 1 and 2 years, the PCMH and control clinics did not differ significantly in overall costs., Implications: A PCMH redesign can be associated with improvements in patient experience and quality without increasing overall cost.

Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal ideation, substance abuse, and poor medication adherence. To address this, we developed a web-based, self-administered patient-reported assessment tool and integrated it into routine primary care for HIV-infected adults. Printed results were delivered to providers and social workers immediately prior to patient appointments. The assessment included brief, validated instruments measuring clinically relevant domains including depression, substance use, medication adherence, and HIV transmission risk behaviors. Utilizing the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) approach to quality improvement, we addressed issues with clinic flow, technology, scheduling, and delivery of assessment results with the support of all levels of clinic staff. We found web-based patient-reported assessments to be a feasible tool that can be integrated into a busy multi-provider HIV primary care clinic. These assessments may improve provider recognition of key patient behaviors and outcomes. Critical factors for successful integration of such assessments into clinical care include: strong top-level /ort from clinic management, provider understanding of patient-reported assessments as a valuable clinical tool, tailoring the assessment to meet provider needs, communication among clinic staff to address flow issues, timeliness of delivery, and sound technological resources.

Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.

Background: Drawing on previous web-based diabetes management programs based on the Chronic Care Model, we expanded an intervention to include care management through mobile phones and a game console web browser., Methods: The pilot intervention enrolled eight diabetes patients from the University of Washington in Seattle into a collaborative care program: connecting them to a care provider specializing in diabetes, providing access to their full electronic medical record, allowing wireless glucose uploads and e-mail with providers, and connecting them to the program's web services through a game system. To evaluate the study, we conducted qualitative thematic analysis of semistructured interviews., Results: Participants expressed frustrations with using the cell phones and the game system in their everyday lives, but liked the wireless system for collaborating with a provider on uploaded glucoses and receiving automatic feedback on their blood sugar trends. A majority of participants also expressed that their participation in the trial increased their health awareness., Discussion: Mobile communication technologies showed promise within a web-based collaborative care program for type 2 diabetes. Future intervention design should focus on integrating easy-to-use applications within mobile technologies already familiar to patients and ensure the system allows for sufficient collaboration with a care provider.

Background and Objective: We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting., Methods: We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness., Results: Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04)., Conclusion: Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.

Objective: To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups., Study Design: Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers., Study Population: Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed., Results: Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems., Conclusions: Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior.

Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physician compensation method that supports the group's overall financial and organizational strategies, including managed care contracting strategies; is consistent with the philosophies, beliefs, and attitudes of the group's membership as they pertain to individual productivity; and can be supported by the organization's information technology, decision support, and management infrastructures. This article explains how research in physician profiling, benchmarking, general compensation theory, and physician productivity provides evidence that can serve as the foundation for a pragmatic approach to evaluating physician compensation method alternatives. It also presents a unique production-based compensation model for illustrative purposes.