Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination.

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Purpose: Patient education is critical for management of advanced cancer pain, yet the benefits of psychoeducational interventions have been modest. We used mobile health (mHealth) technology to better meet patients' needs.Methods: Using the Agile and mHealth Development and Evaluation Frameworks, a multidisciplinary team of clinicians, researchers, patients, and design specialists followed a four-phase iterative process to develop comprehensive, tailored, multimedia cancer pain education for a patient-facing smartphone application. The target population reviewed the content and provided feedback. Results:The resulting application provides comprehensive cancer pain education spanning pharmacologic and behavioral aspects of self-management. Custom graphics, animated videos, quizzes, and audio-recorded meditations complemented written content. Computable algorithms based upon daily symptom surveys were used to deliver brief, tailored motivational messages that linked to more comprehensive teaching. Patients found the combination of pharmacologic and behavioral support to be engaging and helpful. Conclusion:Digital technology can be used to provide cancer pain education that is engaging, and tailored to individual needs. A replicable interdisciplinary and patient-centered approach to intervention development was advantageous. MHealth interventions may be a scalable approach to improve cancer pain. Frameworks that merge software and research methodology can be useful in developing interventions.

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We studied whether children with severe developmental disabilities (SDDs) who have a comorbid behavioral disorder also have higher rates of special healthcare needs (SHCNs). We used a matched-comparison control group design to establish whether SHCNs were higher in children with SDDs with behavioral disorders versus children with SDDs without behavioral disorders. Thirty-six children were matched for age (mean 12y 6mo; range 5y 2mo-18y 8mo), sex (24 males, 12 females), ethnicity (22 non-white), mental retardation level (22 moderate, eight severe, six profound), and Diagnostic and Statistical Manual of Mental Disorders, 4th edition axis I diagnosis (18 autism spectrum disorder, 10 specified syndrome, eight mental retardation not otherwise specified). Measures included the Achenbach Child Behavior Checklist, behavioral observation, health status examination, and Childhood Health Questionnaire (CHQ). Children with SDDs with behavioral disorders had significantly higher levels of SHCN, as measured by the CHQ and health status examination. Children with SDDs with behavioral disorders had a twofold higher incidence of SHCNs than children with SDDs without behavioral disorders. No difference was observed in the number or types of prescription medication that children received. The findings suggest that SHCNs contribute to the occurrence and/or intensity of behavioral disorders in children with SDD and may require interdisciplinary care coordination.Severe developmental disabilities (SDDs) can include autism spectrum disorder, Down syndrome, and mental retardation,* among other conditions. The defining characteristics of SDDs are moderate, severe, or profound mental retardation and significant impairments in adaptive behavior that are expected to persist throughout the life-span. 1,2 Approximately 1 to 2% of children have an SDD requiring intensive, ongoing support from healthcare professionals, educators, related services professionals, and care providers. 3 Although quality-of-life outcomes can be positive for this population, such results depend on sufficient, long-term support by professionals and care providers. 4 A key moderator of quality-of-life outcomes for children with SDDs is the presence of a behavioral disorder. 5 In this population, behavioral disorders are typically expressed as self-injurious behavior, aggression toward others, and/or destruction of property. 6 Estimates of prevalence for behavioral disorders range from 14 to 17% of children with SDDs and are consistently associated with more restrictive services such as institutionalization. 7 The treatment of behavioral disorders among children with SDDs is typically environmentally-focused and related to impaired communication. 8,9 However, there is accumulating evidence from controlled experimental case studies that special healthcare needs (SHCNs) also play a role in increasing the severity and intensity of behavioral disorders in this population. [10][11][12][13] For example, sleep disorders, recurrent infections, seasonal allergies, and gastroeso...

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The purpose of this article is to share one institution's intervention to improve oral chemotherapy patient education. The overall aim was to provide clinicians with a single source of educational materials that would meet a diverse group of patients' educational needs and be consistent with published guidelines.
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Tennessee is the only state in the United States that has regularly published a document monitoring men’s health and assessing men’s health disparities. Vanderbilt University, Vanderbilt University Medical Center, the Tennessee Department of Health, Meharry Medical College, Tennessee Men’s Health Network, and health providers and advocates across the state have come together to publish a set of indicators as the Tennessee Men’s Health Report Card (TMHRC). This article describes the origins, structure, development, and lessons learned from publishing report cards in 2010, 2012, 2014, and 2017. The report card highlights statistically significant changes in trends over time, identifies racial, ethnic, age, and geographic differences among men, highlights connections to regional and statewide public health initiatives, and suggests priorities for improving men’s health in Tennessee. State data were compared to Healthy People 2020 Objectives and graded based on the degree of discrepancy between the goal and the current reality for Tennessee men. Over the four iterations of the report card, the TMHRC team has made significant adjustments to the ways they analyze and present the data, utilize grades and graphics, consider the implications of the data for the economic well-being of the state, and disseminate the findings across the state to different stakeholders. It is important to go beyond creating a summary of information; rather, data should be shared in ways that are easily understood, actionable, and applicable to different audiences. It is also critical to highlight promising policy and programmatic initiatives to improve men’s health in the state.