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BackgroundMedication management among older adults continues to be a challenge, and innovative electronic medication adherence products have been developed to address this need. ObjectiveThe aim of this study is to examine user experience with electronic medication adherence products, with particular emphasis on features, usefulness, and preferences. MethodsOlder adults, caregivers, and health care providers tested the usability of 22 electronic medication adherence products. After testing 5 products, participants were invited to participate in a one-on-one interview to investigate their perceptions and experiences with the features, usefulness, and preference for electronic medication adherence products tested. The interviews were audio recorded, transcribed, and analyzed using exploratory inductive coding to generate themes. The first 13 interviews were independently coded by 2 researchers. The percentage agreement and Cohen kappa after analyzing those interviews were 79% and 0.79, respectively. A single researcher analyzed the remaining interviews. ResultsOf the 37 participants, 21 (57%) were older adults, 5 (14%) were caregivers, and 11 (30%) were health care providers. The themes and subthemes generated from the qualitative analysis included product factors (subthemes: simplicity and product features, including availability and usability of alarms, portability, restricted access to medications, and storage capacity) and user factors (subthemes: sentiment, affordability, physical and cognitive capability, and technology literacy and learnability). ConclusionsElectronic medication adherence products have the potential to enable independent medication management in older adults. The choice of a particular product should be made after considering individual preferences for product features, affordability, and the sentiment of the users. Older adults, caregivers, and health care providers prefer electronic medication adherence products that are simple to set up and use, are portable, have easy-to-access medication compartments, are secure, and have adequate storage capacity.

BackgroundA decreased capacity to self-manage medications results in nonadherence, medication errors, and drug-related problems in older adults. Previous research identified 80 electronic medication adherence products available to assist patients with self-management of medications. Unfortunately, the usability and workload of these products are unknown. ObjectiveThis study aimed to examine the usability and workload of a sample of electronic medication adherence products. MethodsIn a prospective, mixed methods study, a sample of older adults, health care professionals, and caregivers tested the usability and workload of 21 electronic medication adherence products. Each participant tested 5 products, one at a time, after which they completed the system usability scale (SUS) and NASA-task load index (NASA-TLX), instruments that measure the usability and workload involved in using a product. Higher SUS scores indicate more user-friendliness, whereas lower NASA-TLX raw scores indicate less workload when using a product. ResultsElectronic medication adherence products required a mean of 12.7 steps (range 5-20) for the appropriate use and took, on average, 15.19 min to complete the setup tasks (range 1-56). Participants were able to complete all steps without assistance 55.3% of the time (103 out of the 186 tests were completed by 39 participants; range 0%-100%). The mean SUS and NASA-TLX raw scores were 52.8 (SD 28.7; range 0-100) and 50.0 (SD 25.7; range 4.2-99.2), respectively, revealing significant variability among the electronic medication adherence products. The most user-friendly products were found to be TimerCap travel size (mean 78.67, SD 15.57; P=.03) and eNNOVEA Weekly Planner with Advanced Auto Reminder (mean 78.13, SD 14.13; P=.049) as compared with MedReady 1700 automated medication dispenser (mean 28.63, SD 21.24). Similarly, MedReady (72.92, SD 18.69) was found to be significantly more work intensive when compared with TimerCap (29.35, SD 20.35; P=.03), e-pill MedGlider home medication management system (28.43, SD 20.80; P=.02), and eNNOVEA (28.65, SD 14.97; P=.03). The e-pill MedTime Station automatic pill dispenser with tipper (71.77, SD 21.98) had significantly more workload than TimerCap (P=.04), MedGlider (P=.03), and eNNOVEA (P=.04). ConclusionsThis study demonstrated that variability exists in the usability and workload of different electronic medication adherence products among older adults, caregivers, and clinicians. With few studies having investigated the usability and workload of electronic medication adherence products, no benchmarks exist to compare the usability and workload of these products. However, our study highlights the need to assess the usability and workload of different products marketed to assist with medication taking and provides guidance to clinicians regarding electronic medication adherence product recommendations for their patients. Future development of electronic medication adherence products should ensure that the target populations of patients are able to use these products adequately to improve medication management.

PURPOSE: To evaluate the performance of a biopsy decision support algorithmic model, the intelligent-augmented breast cancer risk calculator (iBRISK), on a multicenter patient dataset. MATERIALS AND METHODS: iBRISK was previously developed by applying deep learning to clinical risk factors and mammographic descriptors from 9700 patient records at the primary institution and validated using another 1078 patients. All patients were seen from March 2006 to December 2016. In this multicenter study, iBRISK was further assessed on an independent, retrospective dataset (January 2015-June 2019) from three major health care institutions in Texas, with Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions. Data were dichotomized and trichotomized to measure precision in risk stratification and probability of malignancy (POM) estimation. iBRISK score was also evaluated as a continuous predictor of malignancy, and cost savings analysis was performed. RESULTS: The iBRISK models accuracy was 89.5%, area under the receiver operating characteristic curve (AUC) was 0.93 (95% CI: 0.92, 0.95), sensitivity was 100%, and specificity was 81%. A total of 4209 women (median age, 56 years [IQR, 45-65 years]) were included in the multicenter dataset. Only two of 1228 patients (0.16%) in the low POM group had malignant lesions, while in the high POM group, the malignancy rate was 85.9%. iBRISK score as a continuous predictor of malignancy yielded an AUC of 0.97 (95% CI: 0.97, 0.98). Estimated potential cost savings were more than $420 million. CONCLUSION: iBRISK demonstrated high sensitivity in the malignancy prediction of BI-RADS 4 lesions. iBRISK may safely obviate biopsies in up to 50% of patients in low or moderate POM groups and reduce biopsy-associated costs.Keywords: Mammography, Breast, Oncology, Biopsy/Needle Aspiration, Radiomics, Precision Mammography, AI-augmented Biopsy Decision Support Tool, Breast Cancer Risk Calculator, BI-RADS 4 Mammography Risk Stratification, Overbiopsy Reduction, Probability of Malignancy (POM) Assessment, Biopsy-based Positive Predictive Value (PPV3) Supplemental material is available for this article. Published under a CC BY 4.0 license.See also the commentary by McDonald and Conant in this issue.

BackgroundAdherence to evidence-based therapies such as medications and exercise remains poor among patients after a myocardial infarction (MI). Text message reminders have been shown to improve rates of adherence to medication and exercise, but the existing studies have been of short duration. ObjectiveTwo single-center randomized controlled pilot trials were conducted to evaluate the impact of text message reminders over 12 months on adherence to cardiac medications and exercise among patients receiving cardiac rehabilitation after hospitalization for MI. MethodsIn the medication adherence trial, 34 patients were randomized to receive usual care alone or usual care plus daily text message reminders delivered at the time of day at which medications were to be taken. In the exercise adherence trial, 50 patients were randomized to receive usual care alone or usual care plus 4 daily text messages reminding them to exercise as directed. ResultsThe text message reminders led to a mean 14.2 percentage point improvement in self-reported medication adherence over usual care (P

Context: Since the Canadian legalization of recreational cannabis use in 2018, cannabis use has increased, including during pregnancy, although prevalence rates are difficult to determine. The evidence of clinical harm of prenatal cannabis use is still emerging, with some signals that prenatal cannabis use is associated with pre-term birth, small for gestational age, and some neurodevelopmental outcomes in childhood. However, many pregnant people perceive benefit to their cannabis use, and wish to continue using during pregnancy. Objective: Describe the motivations and decision-making processes of pregnant people who use cannabis. Study Design and Analysis: We used Constructivist Grounded Theory to conduct semi-structured interviews with pregnant or lactating people who made a decision about prenatal cannabis use. Setting or Dataset: All participants lived in Canada Population Studied: Pregnant or lactating people, 19 years of age or older who made a decision about ceasing, continuing, or initiating cannabis use. Intervention/Instrument: Semi-structured interviews Outcome Measures: Qualitative perceptions, experiences, opinions and beliefs. Results: We interviewed 52 pregnant and lactating people who spoke about their cannabis use decisions in their current and previous pregnancies. They perceived that cannabis use during pregnancy may carry risk to their fetus, although few were able to specifically articulate what that risk was. Those who perceived benefit to their cannabis use made deliberate and thoughtful decisions about how to balance that risk and benefit, using information gleaned online and from known sources. Those who continued to use cannabis during pregnancy were motivated by a desire to manage symptoms and secondarily, to cope with the unpleasant aspects of life. After giving birth, they were more likely to endorse recreational reasons for using cannabis. Conclusions: Participants considered cannabis use during pregnancy and lactation as two separate decisions. They were clear that their motivation to use cannabis was prompted by the benefits they perceived in relation to symptom management and coping with the unpleasant aspects of life. They made careful decisions, informed by the information that was available to them, although they often judged this information to be insufficient. They desire clear and comprehensive, evidence-based information to help them balance the risks and benefits of perinatal cannabis use., Presenters Meredith Vanstone, PhD, Janelle Panday, MSc, Devon Greyson, PhD, Shipra Taneja, Liz Darling, PhD, RM, Tejal Patel, MD, BSc, MSc, CCFP, Sarah McDonald, MD, [...]

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) caused by Haemophilus parainfluenzae is a rare but serious condition if not diagnosed and treated promptly. In this article, we describe a patient with H. parainfluenzae IE who initially presented with non-specific symptoms but subsequently developed multiple sequelae of IE. The diagnosis of IE was made based on clinical, echocardiographic, radiological and microbiological findings. He was treated successfully with a mitral valve replacement along with 4weeks of intravenous antibiotic therapy. Our case highlights the importance of obtaining a thorough history and a complete physical examination to ensure an early diagnosis of IE. [ABSTRACT FROM AUTHOR]