An Evaluation of the Usability of a Computerized Decision Support System for Nursing Homes

Background: Computerized decision support systems (CDSSs) have the potential to significantly improve the quality of nursing care of older people by enhancing the decision making of nursing personnel. Despite this potential, health care organizations have been slow to incorporate CDSSs into nursing home practices. Objective: This study describes facilitators and barriers that impact the ability of nursing personnel to effectively use a clinical CDSS for planning and treating pressure ulcers (PUs) and malnutrition and for following the suggested risk assessment guidelines for the care of nursing home residents. Methods: We employed a qualitative descriptive design using varied methods, including structured group interviews, cognitive walkthrough observations and a graphical user interface (GUI) usability evaluation. Group interviews were conducted with 25 nursing personnel from four nursing homes in southern Norway. Five nursing personnel participated in cognitive walkthrough observations and the GUI usability evaluation. Text transcripts were analyzed using qualitative content analysis. Results: Group interview participants reported that ease of use, usefulness and a supportive work environment were key facilitators of CDSS use. The barriers identified were lack of training, resistance to using computers and limited integration of the CDSS with the facility’s electronic health record (EHR) system. Key findings from the usability evaluation also identified the difficulty of using the CDSS within the EHR and the poorly designed GUI integration as barriers. Conclusion: Overall, we found disconnect between two types of nursing personnel. Those who were comfortable with computer technology reported positive feedback about the CDSS, while others expressed resistance to using the CDSS for various reasons. This study revealed that organizations must invest more resources in educating nursing personnel on the seriousness of PUs and poor nutrition in the elderly, providing specialized CDSS training and ensuring that nursing personnel have time in the workday to use the CDSS

Is Social Media a Threat or Can It Be a Trusted Agent?

There is a prevailing belief within the United States Department of Defense (DOD) that social media is a threat to national security, leading to restrictions in workplace use of social-media applications. However, instead of dismissing social media as a threat, leaders should be asking whether or not the information received via social media can be trusted, thus leveraging the information-sharing capabilities of social media. This article presents a theoretical case for quantifying social media trustworthiness by exploring the factors that influence trust in social media and proposing a trust framework to be used to quantify trustworthiness

Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game

Background Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. Aims This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. Methods A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom’s taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. Results The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user–computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. Conclusions Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user–computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process

Reciprocal links between anxiety sensitivity and obsessive-compulsive symptoms in youth: a longitudinal twin study

Background: Anxiety sensitivity, the tendency to fear the symptoms of anxiety, is a key risk factor for the development anxiety disorders. Although obsessive-compulsive disorder was previously classified as an anxiety disorder, the prospective relationship between anxiety sensitivity and obsessive-compulsive symptoms (OCS) has been largely overlooked. Furthermore, a lack of genetically-informative studies means the aetiology of the link between anxiety sensitivity and OCS remains unclear. Methods: Adolescent twins and siblings (N=1,579) from the G1219 study completed self-report questionnaires two years apart assessing anxiety sensitivity, OCS, anxiety and depression. Linear regression models tested prospective associations between anxiety sensitivity and OCS, with and without adjustment for anxiety and depressive symptoms. A phenotypic cross-lagged model assessed bidirectional influences between anxiety sensitivity and OCS over time, and a genetic version of this model examined the aetiology of these associations. Results: Anxiety sensitivity was prospectively associated with changes in OCS, even after controlling for comorbid anxiety and depressive symptoms. The longitudinal relationship between anxiety sensitivity and OCS was bidirectional, and these associations were predominantly accounted for by non-shared environmental influences. Conclusions: Our findings are consistent with the notion that anxiety sensitivity is a risk factor for OCS during adolescence, but also suggest that experiencing OCS confers risk for heightened anxiety sensitivity. The reciprocal links between OCS and anxiety sensitivity over time are likely to be largely mediated by non-shared environmental experiences, as opposed to common genes. Our findings raise the possibility that interventions aimed at ameliorating anxiety sensitivity could reduce risk for OCS, and vice versa

The genetic relationship between neuroticism and autonomic function in female twins

Background. Neuroticism is widely used as an explanatory concept in etiological research of psychopathology. In order to clarify what neuroticism actually represents, we investigated the genetic association between neuroticism and cardiovascular measures. Method. In 125 female twin pairs (18-30 years), electrocardiogram and continuous finger blood pressure were assessed during two rest and two mental stress conditions. Mean values for baroreflex sensitivity (BRS), heart rate variability (HRV) and inter-beat interval (IBI) were calculated for each condition. Neuroticism was assessed by multiple questionnaires. Multivariate genetic model-fitting analyses were used to investigate the genetic correlation between latent neuroticism and the cardiovascular autonomic nervous system (ANS) measures. Results. Neuroticism was negatively correlated to BRS and HRV. Neuroticism was not correlated to IBI. For BRS, this phenotypical relation was entirely determined by shared genetic influences. For HRV, the genetic contribution to the phenotypical correlation was not significant, but the proportions of explained covariance showed a trend of more genetic than environmental influences on the phenotypical relationship. Conclusions. High neuroticism is associated with a deregulated ANS. Pleiotropic genetic effects may be partly responsible for this effect

Sub-types of insomnia in adolescents: insights from a quantitative/ molecular twin study

Background: Insomnia with short sleep duration has been postulated as more severe than that accompanied by normal/long sleep length. While the short duration subtype is considered to have greater genetic influence than the other subtype, no studies have addressed this question. This study aimed to compare these subtypes in terms of: 1) the heritability of insomnia symptoms; 2) polygenic scores (PGS) for insomnia symptoms and sleep duration; 3) the associations between insomnia symptoms and a wide variety of traits/disorders. Methods: The sample comprised 4,000 pairs of twins aged 16 from the Twins Early Development Study. Twin models were fitted to estimate the heritability of insomnia in both groups. PGS were calculated for self-reported insomnia and sleep duration and compared among participants with short and normal/long sleep duration. Results: Heritability was not significantly different in the short sleep duration group (A=0.13 [95%CI=0.01, 0.32]) and the normal/long sleep duration group (A=0.35 [95%CI=0.29, 0.40]). Shared environmental factors accounted for a substantial proportion of the variance in the short sleep duration group (C=0.19 [95%CI= 0.05, 0.32]) but not in the normal/long sleep duration group (C=0.00 [95%CI=0.00, 0.04]). PGS did not differ significantly between groups although results were in the direction expected by the theory. Our results also showed that insomnia with short (as compared to normal/long) sleep duration had a stronger association with anxiety and depression (p<.05) - although not once adjusting for multiple testing. Conclusions: We found mixed results in relation to the expected differences between the insomnia subtypes in adolescents. Future research needs to further establish cut-offs for ‘short’ sleep at different developmental stages and employ objective measures of sleep

Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: A pilot RCT

Objective/Background: CBT for insomnia (CBT-I) is useful for many. It is currently unknown if those with sub-threshold insomnia also benefit. Here we assessed whether CBT-I is both feasible and acceptable in participants with sub-threshold insomnia. The primary aims were to evaluate participation rates and treatment acceptability, and to establish an effect size for symptom improvement. Patients/Methods: A total of 199 female participants (Mage 20 ± 5 years) took part. Following baseline assessments, participants were randomly allocated to either a 6-week digital CBT-I intervention or a 6-week session control group receiving puzzles. Additional assessments were performed 3-weeks, 6-weeks, and 6-months later. Results: Participation in each survey wave did not differ between the groups (ps > .140), though adherence to weekly tasks was lower in the CBT-I group, p = .02. Treatment acceptability was high (M (SD) = 33.61 (4.82), range 6 – 42). The CBT-I group showed greater improvement in insomnia symptoms at the end of the intervention compared to the control group (p = .013, d = 0.42), with significant variation in outcome (M = 4.69, SD = 5.41). Sub-threshold participants showed a similar pattern of results, whilst those meeting insomnia criteria showed a smaller between-group difference. CBT-I led to improvements in anxiety, paranoia and perceived stress between baseline and end of intervention. Changes in insomnia symptoms were mediated by cognitions about sleep and somatic pre-sleep arousal. Conclusions: CBT-I provides a benefit even in sub-threshold insomnia. CBT-I may be useful as an early preventative intervention to tackle sleep problems before they manifest as chronic insomnia

Wide-range Angle-sensitive Plasmonic Color Printing on Lossy-Resonator Substrates

We demonstrate a sustainable, lithography-free process for generating non fading plasmonic colors with a prototype device that produces a wide range of vivid colors in red, green, and blue (RGB) ([0-1], [0-1], [0-1]) color space from violet (0.7, 0.72, 1) to blue (0.31, 0.80, 1) and from green (0.84, 1, 0.58) to orange (1, 0.58, 0.46). The proposed color-printing device architecture integrates a semi-transparent random metal film (RMF) with a metal back mirror to create a lossy asymmetric Fabry-P\'erot resonator. This device geometry allows for advanced control of the observed color through the five-degree multiplexing (RGB color space, angle, and polarization sensitivity). An extended color palette is then obtained through photomodification process and localized heating of the RMF layer under various femtosecond laser illumination conditions at the wavelengths of 400 nm and 800 nm. Colorful design samples with total areas up to 10 mm2 and 100 {\mu}m resolution are printed on 300-nm-thick films to demonstrate macroscopic high-resolution color generation. The proposed printing approach can be extended to other applications including laser marking, anti-counterfeiting and chromo-encryption

Customer relationship management: digital transformation and sustainable business model innovation

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