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BackgroundPatient Priorities Care (PPC) is a model of care that aligns health care recommendations with priorities of older adults who have multiple chronic conditions. Following identification of patient priorities, this information is documented in the patient’s electronic health record (EHR). ObjectiveOur goal is to develop and validate a natural language processing (NLP) model that reliably documents when clinicians identify patient priorities (ie, values, outcome goals, and care preferences) within the EHR as a measure of PPC adoption. MethodsThis is a retrospective analysis of unstructured National Veteran Health Administration EHR free-text notes using an NLP model. The data were sourced from 778 patient notes of 658 patients from encounters with 144 social workers in the primary care setting. Each patient’s free-text clinical note was reviewed by 2 independent reviewers for the presence of PPC language such as priorities, values, and goals. We developed an NLP model that utilized statistical machine learning approaches. The performance of the NLP model in training and validation with 10-fold cross-validation is reported via accuracy, recall, and precision in comparison to the chart review. ResultsOf 778 notes, 589 (75.7%) were identified as containing PPC language (kappa=0.82, P

We partnered with veteran-serving nonprofits in order to identify distressed rural veterans and provide them with a mental health workshop in community-based settings. Community organizations helped recruit veterans and provided space for 1-day (5-h) Acceptance and Commitment Therapy (ACT) group workshops conducted in rural locations. Qualitative interviews were conducted at 1- and 3-months post-intervention to assess acceptability. Quantitative measures were conducted at baseline, 1- and 3-months post-intervention to measure effectiveness. We successfully engaged community partners throughout every stage of the research and delivered workshops to thirty-one veterans in rural community-based locations. Veterans appreciated the structure, content, and environment of the workshops; most implemented ACT skills into their daily lives and some initiated new treatment following workshop participation. Quantitative measures showed improvements in functioning (Cohen's d ranging from .27 to .40), reintegration (Cohen's d = .45), meaning and purpose (Cohen's d = .40), and reductions in distress (Cohen's d ranging from .28 to .40) 3-months following workshop participation. Collaborating with rural veteran-serving nonprofit organizations holds promise for engaging hard-to-reach distressed veterans in mental health care., Author(s): Lilian Dindo [sup.1] [sup.2] [sup.3] , McKenzie K. Roddy [sup.4] , Derrecka Boykin [sup.5] [sup.4] , Ken Woods [sup.2] [sup.5] , Merlyn Rodrigues [sup.2] [sup.3] , Tracey L. Smith [...]

Objective Collisions between bicycles and motor vehicles are one of the leading risk factors for injury and death in childhood and adolescence. We examined longitudinal and concurrent effortful control (EC) as predictors of risky bicycling behavior in early- to mid-adolescence, with age and gender as moderators. We also examined whether EC was associated with parent-reported real-world bicycling behavior and all lifetime unintentional injuries. Methods Parent-reported EC measures were collected when children (N  =   85) were 4 years old and when they were either 10 years (N  =   42) or 15 years (N  =   43) old. We assessed risky bicycling behavior by asking the adolescents to bicycle across roads with high-density traffic in an immersive virtual environment. Parents also reported on children's real-world bicycling behavior and lifetime unintentional injuries at the time of the bicycling session. Results We found that both longitudinal and concurrent EC predicted adolescents' gap choices, though these effects were moderated by age and gender. Lower parent-reported early EC in younger and older girls predicted a greater willingness to take tight gaps (3.5 s). Lower parent-reported concurrent EC in older boys predicted a greater willingness to take gaps of any size. Children lower in early EC started bicycling earlier and were rated as less cautious bicyclists as adolescents. Adolescents lower in concurrent EC were also rated as less cautious bicyclists and had experienced more lifetime unintentional injuries requiring medical attention. Conclusion Early measures of child temperament may help to identify at-risk populations who may benefit from parent-based interventions. [ABSTRACT FROM AUTHOR]

The broad personality trait of disinhibition reflects the tendency to behave in an underconstrained versus overconstrained manner and is associated with externalizing psychopathology and risk-taking behaviors. This article describes the development and initial validation of the Disinhibition Inventory (DIS-I), a multifaceted measure of disinhibition that helps explicate the nature of this important higher-order dimension more fully. Factor analyses of an initial item pool resulted in five content-distinct, yet correlated scales measuring both high (Manipulativeness, Distractibility, Risk Taking) and low (Prosociality, Orderliness) levels of disinhibition that cross-validated in an independent sample. Evidence for the construct validity of the DIS-I is presented, including convergent and discriminant relations with Big-Three and Big-Five/five-factor model measures of personality. Results indicate that the DIS-I scales are associated most strongly with other measures of disinhibition, but that the DIS-I additionally contains content absent in extant adult measures of disinhibition that may prove useful in the assessment of externalizing psychopathology. (Contains 7 tables and 6 notes.)

Little research has compared item functioning of the Patient-Reported Outcomes Measurement Information System (PROMIS®) anxiety short form 6a and the generalized anxiety disorder 7-item scale using item response theory models. This was a secondary analysis of self-reported assessments from 67 at-risk U.S. military veterans. The two measures performed comparably well with data fitting adequately to models, acceptable item discriminations, and item and test information curves being unimodal and symmetric. The PROMIS® anxiety short form 6a performed better in that item difficulty estimates had a wider range and distributed more evenly and all response categories had less floor effect, while the third category in most items of the generalized anxiety disorder 7-item scale were rarely used. While both measures may be appropriate, findings provided preliminary information supporting use of the PROMIS® anxiety short form 6a as potentially preferable, especially for veterans with low-to-moderate anxiety. Further testing is needed in larger, more diverse samples. [ABSTRACT FROM AUTHOR]