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BACKGROUND Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. OBJECTIVE We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. METHODS A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample’s self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. RESULTS In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7%) resulted in the opening of MEMS caps within 30 minutes of the reminder. CONCLUSIONS Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions.

BACKGROUND Asthma is a major chronic disease affecting 8.6% of children in the United States. OBJECTIVE The purpose of this research was to assess the use of clinical simulation scenarios using augmented reality technology to evaluate learning outcomes for nurse practitioner students studying pediatric asthma management. METHODS A mixed-methods pilot study was conducted with 2 cohorts of graduate pediatric nurse practitioner students (N=21), with each cohort participating for 2 semesters. RESULTS Significant improvements in pediatric asthma test scores (P CONCLUSIONS The study results suggest augmented reality simulation to be valuable in teaching pediatric asthma management content in graduate nursing education.

BACKGROUND Pain is difficult to manage in older adults. Pain management in older adults has been recommended to include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence but is biased because behavior has been verified by self-report. OBJECTIVE The purpose of this study was to describe objective medication adherence and latency of medication use in a subsample of older adults that used a voice assistant reminder to take scheduled pain medications. METHODS This observational feasibility study was conducted in the homes of community-dwelling older adults. Of the 15 older adults using voice assistant reminders for pain medications, we randomly selected a subsample of participants to use a medication event monitoring system to observe medication adherence. We collected demographics, self-reported health history, and pain medication name, dose, and dose frequency. Baseline data were collected on pain severity and interference using the Brief Pain Inventory-SF; concern and necessity beliefs about pain medications using the Beliefs About Medicines Questionnaire; self-confidence in managing pain with the PROMIS Self-Efficacy for Managing Symptoms and medication adherence with a Medication Event Monitoring System. RESULTS Participants used pain medications to alleviate pain severity ranging from moderate to severe. Each participant had varying beliefs about pain medicines and self-efficacy in managing pain symptoms. Overall latency was 55 minutes. The absolute latency (before or after reminder) varied among the participants; the shortest average time was 17 minutes and the longest was 4.5 hours. Our results found that 15% of the pain medications were taken within 5 minutes over 60% were taken within 30 minutes. CONCLUSIONS Voice assistant reminders may help cue patients to take medications, but the timing of use may vary. It may be helpful to monitor the absolute timing of scheduled medication use as a part of medication adherence behaviors in older adults especially when frequent dosing is prescribed. CLINICALTRIAL Adherence, Pain Medications, Older Adults, Reminders, mHealth, Voice Assistants

BACKGROUND Unguided, web-based psychoeducational interventions are gaining interest as a way to reach patients while reducing pressure on clinical resources. However, there has been little research on how patients with cancer use these interventions. OBJECTIVE The objective of this analysis was to evaluate how women newly diagnosed with breast cancer used the unguided web-based, psychoeducational distress self-management program CaringGuidance After Breast Cancer Diagnosis while enrolled in a pilot feasibility study. METHODS Women with stage 0 to II breast cancer diagnosed within the prior three months were recruited from clinics primarily in the Northeastern United States for participation in a 12-week pilot study of CaringGuidance plus usual care versus usual care alone. Usage prompts included sets of emails sent weekly for 12 weeks; standardized congratulatory emails after every two hours of program use, and informative emails for each cognitive-behavioral exercise. Individual user activity on the site was automatically tracked by an analytics system and recorded directly in the CaringGuidance database. RESULTS Complete usage data were available for 54 subjects. Ninety-eight percent of the intervention group logged into CaringGuidance independently at least once. Thirty-eight (70%) logged in during all three months, 15 (28%) were intermittent users, and one (2%) was a non-user. Users (n=53) averaged 15.6 (SD 9.85) logins. Mean logins were greatest in month 1 (7.26, SD 4.02) and declined in months 2 (4.32, SD 3.66) and month 3 (4.02, SD 3.82). Eleven (21%) used CaringGuidance with both the frequency and activity level intended at study outset, 9 (17%) exceeded intended frequency and activity (high-high users), and 10 (19%) were below expected usage on both login frequency and activity (low-low users). Low-low users and high-high users differed significantly (PP=.018, .019). Higher baseline distress was associated with more unique views of program resources (r=.281, P=.043). Change in intrusive/avoidant thoughts from baseline to month 3, and the number of users’ unique exercise views were negatively correlated (r=–.319, P=.035) so that more unique exercise views, equated with greater decline in intrusive/avoidant thoughts from baseline to month 3. CONCLUSIONS These findings favor the hypothesis that the key ingredient is not the amount of program use, but each user’s self-selected activity within the program. More research is needed on the ideal ways to maintain use, and capture and define engagement and enactment of behaviors by people with cancer accessing unguided, self-management web-based programs.