IntroductionPsychosocial and rehabilitation interventions are increasingly used to attenuate disability and improve health-related quality of life (HRQL) in chronic diseases, but are typically not available for patients with rare diseases. Conducting rigorous, adequately powered trials of these interventions for patients with rare diseases is difficult. The Scleroderma Patient-centered Intervention Network (SPIN) is an international collaboration of patient organisations, clinicians and researchers. The aim of SPIN is to develop a research infrastructure to test accessible, low-cost self-guided online interventions to reduce disability and improve HRQL for people living with the rare disease systemic sclerosis (SSc or scleroderma). Once tested, effective interventions will be made accessible through patient organisations partnering with SPIN.Methods and analysisSPIN will employ the cohort multiple randomised controlled trial (cmRCT) design, in which patients consent to participate in a cohort for ongoing data collection. The aim is to recruit 1500–2000 patients from centres across the world within a period of 5 years (2013–2018). Eligible participants are persons ≥18 years of age with a diagnosis of SSc. In addition to baseline medical data, participants will complete patient-reported outcome measures every 3 months. Upon enrolment in the cohort, patients will consent to be contacted in the future to participate in intervention research and to allow their data to be used for comparison purposes for interventions tested with other cohort participants. Once interventions are developed, patients from the cohort will be randomly selected and offered interventions as part of pragmatic RCTs. Outcomes from patients offered interventions will be compared with outcomes from trial-eligible patients who are not offered the interventions.Ethics and disseminationThe use of the cmRCT design, the development of self-guided online interventions and partnerships with patient organisations will allow SPIN to develop, rigourously test and effectively disseminate psychosocial and rehabilitation interventions for people with SSc.

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Although there are some differences, the SPIN Cohort is broadly comparable with other large prevalent SSc cohorts, increasing confidence that insights gained from the SPIN Cohort should be generalizable, although it should be noted that all three cohorts include primarily White participants.

Social media and collaboration technologies are viewed as valuable tools for creating a new reality of collaborative learning, particularly in higher education facing millennials growing up with various technologies in their daily lives. Using the example of an undergraduate course taught on-campus, this study examines how millennial students in higher education use social media and other collaboration technologies in their collaborative learning activities to co-create new knowledge through the application of existing knowledge and the sharing of ideas. A semi-structured survey-based qualitative research method is used to reveal the primary decision factors driving students' technology choice for use in their collaborative learning tasks and to assess the impact of the use of such technologies on their learning experience and performance.The analysis reveals convenience as an important decision factor impacting millennial students' choice of social media and collaborative technologies to use in their team-based collaborative learning interactions. In particular, the three salient types of convenience emerge that matter to millennial students: convenient to everybody in the team, convenient to access and use, and convenient to collaborate with each other privately within the team. The analysis suggests that the use of social media and collaboration technologies chosen by students in their collaborative learning activities is more likely to result in students with positive collaborative learning experience than otherwise. In addition, a moderately strong correlation (r = 0.425, p < 0.01) is found between students' learning performance and their perception on the impact of the use of the technologies of their choice on learning experience. Based on the analysis, this study proposes a student-engaged, technology-choice-and-impact framework that captures the relationship between millennial students' convenience-driven technology choice and its impact on collative learning experience and performance. Further efforts should focus on investigating pedagogic designs that engage students in technology choice for improved collaborative learning experience and performance. The results of this study can inform educators and education technology providers in tailoring their approaches to incorporating technologies with learners in mind, thus turning their engagement into improved learning experience and performance.

BackgroundThe use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices.ObjectiveGuided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment.MethodsGiven the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems.ResultsWe collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months.ConclusionsWe found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices.