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Background Patients and families are important contributors to the diagnostic team, but their perspectives are not reflected in current diagnostic measures. Patients/families can identify some breakdowns in the diagnostic process beyond the clinician's view. We aimed to develop a framework with patients/families to help organisations identify and categorise patient-reported diagnostic process-related breakdowns (PRDBs) to inform organisational learning. Method A multi-stakeholder advisory group including patients, families, clinicians, and experts in diagnostic error, patient engagement and safety, and user-centred design, co-developed a framework for PRDBs in ambulatory care. We tested the framework using standard qualitative analysis methods with two physicians and one patient coder, analysing 2165 patient-reported ambulatory errors in two large surveys representing 25 425 US respondents. We tested intercoder reliability of breakdown categorisation using the Gwet's AC1 and Cohen's kappa statistic. We considered agreement coefficients 0.61-0.8=good agreement and 0.81-1.00=excellent agreement. Results The framework describes 7 patient-reported breakdown categories (with 40 subcategories), 19 patient-identified contributing factors and 11 potential patient-reported impacts. Patients identified breakdowns in each step of the diagnostic process, including missing or inaccurate main concerns and symptoms; missing/outdated test results; and communication breakdowns such as not feeling heard or misalignment between patient and provider about symptoms, events, or their significance. The frequency of PRDBs was 6.4% in one dataset and 6.9% in the other. Intercoder reliability showed good-to-excellent reliability in each dataset: AC1 0.89 (95% CI 0.89 to 0.90) to 0.96 (95% CI 0.95 to 0.97); kappa 0.64 (95% CI 0.62, to 0.66) to 0.85 (95% CI 0.83 to 0.88). Conclusions The PRDB framework, developed in partnership with patients/families, can help organisations identify and reliably categorise PRDBs, including some that are invisible to clinicians; guide interventions to engage patients and families as diagnostic partners; and inform whole organisational learning. [ABSTRACT FROM AUTHOR]

A study was conducted to determine a new model's effectiveness, which uses patient Web services, home blood pressure (BP) monitoring and pharmacist-assisted care in improving BP control. Findings conclude with the note that pharmacist care management delivered through secure patient Web communications improved BP control in patients with hypertension.

Multipath interference data were obtained at a frequency of 95 GHz over pathlengths of 100-250 m by measuring height-gain interference patterns over various types of terrain. Data were collected over grass, lake, ice, snow, concrete, asphalt, and gravel surfaces. The transmit antenna was kept fixed, while the receive antenna translated vertically resulting in grazing angles between approximately 0.5-2.0 [degrees]. Full illumination of the Fresnel zones was accomplished by broad-beamwidth horn antennas at both ends. Measured interference patterns indicate the presence of both specular and diffuse multipath components. A technique was developed to separate these components by filtering in the spatial Fourier-transform domain by appropriate choice of the notch frequency for the specular component and the bandpass-filter bandwidth for the diffuse components. The notch frequency is chosen according to system geometry considerations. Using this unique separation technique, specular and diffuse reflection coefficients were deduced for various terrain types. The separation technique developed in this paper can be readily applied to existing height-gain data if the system geometry is known.

A single adult female bottlenose dolphin was tested in a series of perceptual studies. On each trial, 4 sine-wave tones were presented that contained a falling frequency contour or some other contour. There were several frequency-transposed exemplars of each contour type in each experiment. The dolphin discriminated contours at a level significantly greater than chance in all experiments. In the 1st 2 experiments, the dolphin demonstrated only modest transfer to novel stimuli and a sensitivity to the absolute frequency of stimuli. In the 3rd experiment, there was no effect of the absolute frequency of stimuli; in the 4th experiment, the dolphin successfully transferred the discrimination to novel stimuli drawn from the octave above the previously heard range. These results demonstrate dolphins' capability to perceive frequency contours, which may underlie the recognition of conspecific whistles.

Abstract Background Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care.