We demonstrate that a Maintenance of Certification QI project sponsored by a children's hospital can facilitate evidence-based pediatric care and decrease the rate of unnecessary CT use in a community setting.

We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.

Objective To examine the correlation of numerical skills used in patients’ self-management of asthma with asthma-related quality of life (AQOL). Methods Adults with moderate-severe asthma completed the Asthma Numeracy Questionnaire (ANQ), assessments of reading comprehension and self-efficacy, and the mini-Asthma Quality of Life Questionnaire (miniAQLQ). The numeracy-AQOL relationship was evaluated in the context of potential confounders (demographic variables) and mediators (e.g. income and self-efficacy), using tests of correlation then multivariable models to assess for confounders and mediators. Results 80 adults with moderate or severe asthma were evaluated. Mean ANQ score was 2.3 ± 1.2 (range 0−4). ANQ was correlated with miniAQLQ (ρ=0.24, p=0.03). This association associated with AQOL (age, Latino ethnicity). The ANQ-miniAQLQ association was mediated by household income; the correlation was reduced by 81% when adjusting for income (ρ=0.05, p=0.65). In contrast, self-efficacy less strongly mediated this association; the correlation was reduced by 26% when controlled for self-efficacy (ρ=0.20, p=0.80). Conclusion Numerical skills needed for asthma self-management influence AQOL primarily through their impact on income and, to a lesser extent, on self-efficacy. Practice Implications Adults with asthma will benefit from self-management instructions employing the simplest mathematical constructs whose understanding is confirmed by clinicians.

This study investigated whether age-related sensitivity to self-relevance may benefit perspective taking, despite generally poorer perspective-taking capacity in older adults. In one perceptual matching task and two visual perspective-taking paradigms, we examined age differences in sensitivity to avatars representing self and other. In the matching task, older (60-83 years) and younger (18-20 years) adults were similarly biased toward the self- versus other-associated avatar. In the perspective-taking tasks, participants viewed these avatars within a virtual room. Task-relevant perspectives were either the same (i.e., congruent) or different (i.e., incongruent). In the 3PP-3PP task, both avatars were present, and participants adopted the perspective of one or the other. As in the matching task, young and old were similarly biased toward the self-associated avatar. However, age differences emerged in the 1PP-3PP task, which presented only one avatar per trial (varying between self and other), and participants responded based on their own first-person perspective or the avatar's. In summary, age modulated the ability to take perspectives primarily when participants' own first-person perspective was task relevant. Relative to younger adults, older adults prioritized the self (vs. other) avatar more during initial perspective computation and the first-person (vs. third-person) perspective more when selecting between incongruent perspectives.

BACKGROUND: Inaccurate diagnosis of appendicitis leads to increased costs and morbidity. Ultrasound costs less than computed tomography (CT) or MRI but has lower sensitivity and may not visualize the appendix. METHODS: We conducted a cost-effectiveness analysis using a decision-analytic model of 10 imaging strategies for suspected appendicitis in a hypothetical cohort of patients: no imaging with discharge or surgery; CT only; MRI only; or staged approach with CT or MRI after 1) negative ultrasound result or ultrasound without appendix visualization, 2) ultrasound without appendix visualization, or 3) ultrasound without appendix visualization but with secondary signs of inflammation. Inputs were derived from published literature and secondary data (quality-of-life and cost data). Sensitivity analyses varied risk of appendicitis and proportion of visualized ultrasound. Outcomes were effectiveness (quality-adjusted lifeyears [QALYs]), total direct medical costs, and cost-effectiveness (cost per QALY gained). RESULTS: The most cost-effective strategy for patients at moderate risk for appendicitis is initial ultrasound, followed by CT if the appendix is not visualized but secondary signs are present (cost of $4815.03; effectiveness of 0.99694 QALYs). Other strategies were well above standard willingness-to-pay thresholds or were more costly and less effective. Cost-effectiveness was sensitive to patients' risk of appendicitis but not the proportion of visualized appendices. CONCLUSIONS: Tailored approaches to imaging based on patients' risk of appendicitis are the most cost-effective. Imaging is not cost-effective in patients with a probability ,16% or .95%. For moderate-risk patients, ultrasound without secondary signs of inflammation is sufficient even without appendix visualization.