By Jorge Ruiz, MD; and Allen D. Andrade, MD
Jorge Ruiz, MD, is the director of the Laboratory of E-learning and Multimedia Research and the associate director for Education and Evaluation. Allen D. Andrade, MD, is the associate director of the Laboratory of E-learning and Multimedia Research and GRECC Investigator, and both are at the Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida.

Adherence to self-management behaviors is linked to better health care outcomes in patients with chronic illness. Despite the benefits, however, nonadherence remains a significant problem. Though interventions to improve adherence to self-management behaviors have shown some success, in most cases these interventions are resource intensive and may not be available to most patients. Computer-based interventions may constitute cost-effective ways to improve access to evidence-based self-management. We have seen that avatars (digital representations of people) are widely used in Internet environments to facilitate social interactions and communication. Compared with a computer program without avatars, one with an avatar could establish a relationship with a participant that is more engaging, persuasive, and long-term.

By Ellen T. Thatcher, GNP-C, CHPN
Ellen T. Thatcher, GNP-C, CHPN is a certified geriatric, hospice, and palliative care nurse practitioner and community hospice care coordinator at the Bay Pines VA Healthcare System in Bay Pines, Florida. 

We often hear experiences that are metaphoric. (http://www.fedprac.com/Article.aspx?ArticleId=Uccpqfs5dug=.)The dying person may report seeing an angel, a deceased relative, or a deceased beloved pet from the past, or talk about going on a trip. Oftentimes they may do busy work, pick at the air, or look like they’re pulling a rope or packing. Sometimes they become restless, get a burst of energy, try to get out of bed and possibly fall. When questioned, they often talk about their metaphoric experience.