Investigating the Effectiveness and Efficiency of Simulation-Based EHR Training: Media Naturalness Theory Perspective

Increased use of Electronic Health Records (EHRs) systems has resulted in the need to provide quality EHR training to healthcare professionals. In this paper, we investigate the role of computer-based simulation training (Lateef, 2010; Bell et al., 2008). In simulation-based training (SBT), typical instruction is replaced with tasks that are designed to replicate real-world events or settings and manage an individual\u27s experience in an “artificial” environment (Lateef, 2010; Salas et al., 2009; Bell et al., 2008). SBT can provide students with an improved learning experience that reduces perceived stress and improves EHR task efficiency and performance. This study uses media naturalness and compensatory adaptation theories to explain why, although computer-based training may be considered less natural, it is expected to have a positive effect on performance. While participants may struggle with less natural media at the beginning of a task, they can adapt and compensate for the missing naturalness, resulting in similar or improved performance (Kock, 2005; Kock & DeLuca, 2007). We develop a research model that describes how simulation-based EHR training can mitigate perceived participant stress and augment task efficiency by reducing time to complete EHR tasks, which, in turn, has a positive effect on task-based performance. We will empirically test the model with a unique dataset created from an EHR lab assessment and questionnaires completed by two third-year cohorts of medical students. The measurement instrument was developed based on previously validated instruments and demonstrated appropriate validity and reliability in this study (Kock et al., 2018). To test our research model, we will use partial least squares (PLS), a second-generation variance-based structural equation modeling technique (Chin 1998; Haenlein and Kaplan 2004; Kock 2010). We expect the results to show that simulation-based EHR training enables healthcare providers to reduce perceived stress and complete EHR tasks more efficiently, both of which would have a positive effect on task performance. The findings of this study will help to enhance our understanding of the positive role of simulation-based training, which stimulates individuals to achieve higher levels of efficiency, less stress, and increased levels of performance through the lens of the media naturalness and compensatory adaptation theories. The findings of this study will not only help academics explain theoretical relationships between simulation-based training and performance but also assist practitioners in achieving higher efficiency and effective performance, which are critical for better healthcare outcomes. This study also will enhance our understanding of the role of EHR use experience in modifying the relationship between simulation-based training and performance. This research will make several key contributions. First, the study in this research emphasizes the EHR-enabled performance-related benefits of simulation-based training. Second, this study identifies how (e.g., mediation of stress and efficiency) simulation-based training impacts performance. Third, to the best of our knowledge, this research presents the first study to incorporate the context (i.e., the moderating role of EHR use experience) under which simulation-based EHR training impacts performance. In summary, this study contributes important practical implications by demonstrating an improved method of training health care professionals in the use of EHRs, which will allow them to experience reduced levels of stress, and in turn, provide better care to patients. Keywords electronic health records, simulation, stress, efficiency, time, EHR task performance, healthcare provider

Unraveling the Link between Simulation EHR Training and Task Performance: The Mediation Role of Stress

Past research has explored the link between computer-mediated communication (CMC) and task performance, but it remains unclear how (i.e., under what mechanisms) CMC impacts task performance. Drawing on media naturalness theory and the stimulus-organism-response model as our theoretical framework, we develop a research model and describe how simulation-based EHR training (a type of CMC) can improve EHR-based task performance by mitigating stress. We empirically test the model with a unique experimental dataset from EHR lab assessment and questionnaires that 225 participants completed. The structural equation modeling analysis results show that simulation EHR training helped improve EHR-based task performance (both effectiveness and efficiency) by reducing perceived stress. We discuss theoretical and practical implications, limitations, and future research

Unraveling the Link between Simulation EHR Training and Task Performance: The Mediation Role of Stress

Past research has explored the link between computer-mediated communication (CMC) and task performance, but it remains unclear how (i.e., under what mechanisms) CMC impacts task performance. Drawing on media naturalness theory and the stimulus-organism-response model as our theoretical framework, we develop a research model and describe how simulation-based EHR training (a type of CMC) can improve EHR-based task performance by mitigating stress. We empirically test the model with a unique experimental dataset from EHR lab assessment and questionnaires that 225 participants completed. The structural equation modeling analysis results show that simulation EHR training helped improve EHR-based task performance (both effectiveness and efficiency) by reducing perceived stress. We discuss theoretical and practical implications, limitations, and future research

Standardized classification schemes in reporting oncologic PET/CT

The imaging report is essential for the communication between physicians in patient care. The information it contains must be clear, concise with evidence-based conclusions and sufficient to support clinical decision-making. In recent years, several classification schemes and/or reporting guidelines for PET have been introduced. In this manuscript, we will review the classifications most frequently used in oncology for interpreting and reporting 18F-FDG PET imaging in lymphoma, multiple myeloma, melanoma and head and neck cancers, PSMA-ligand PET imaging for prostate cancer, and 68Ga-DOTA-peptide PET in neuroendocrine tumors (NET)

99mTc-MAA accumulation within tumor in preoperative lung perfusion SPECT/CT associated with occult lymph node metastasis in patients with clinically N0 non-small cell lung cancer

Background 99mTc-MAA accumulation within the tumor representing pulmonary arterial perfusion, which is variable and may have a clinical significance. We evaluated the prognostic significance of 99mTc-MAA distribution within the tumor in non-small cell lung cancer (NSCLC) patients in terms of detecting occult nodal metastasis and lymphovascular invasion, as well as predicting the recurrence-free survival (RFS). Methods Two hundred thirty-nine NSCLC patients with clinical N0 status who underwent preoperative lung perfusion SPECT/CT were retrospectively evaluated and classified according to the visual grading of 99mTc-MAA accumulation in the tumor. Visual grade was compared with the quantitative parameter, standardized tumor to lung ratio (TLR). The predictive value of 99mTc-MAA accumulation with occult nodal metastasis, lymphovascular invasion, and RFS was assessed. Results Eighty-nine (37.2%) patients showed 99mTc-MAA accumulation and 150 (62.8%) patients showed the defect on 99mTc-MAA SPECT/CT. Among the accumulation group, 45 (50.5%) were classified as grade 1, 40 (44.9%) were grade 2, and 4 (4.5%) were grade 3. TLR gradually and significantly increased from grade 0 (0.009 ± 0.005) to grade 1 (0.021 ± 0.005, P < 0.05) and to grade 2–3 (0.033 ± 0.013, P < 0.05). The following factors were significant predictors for occult nodal metastasis in univariate analysis: central location, histology different from adenocarcinoma, tumor size greater than 3cm representing clinical T2 or higher, and the absence of 99mTc-MAA accumulation within the tumor. Defect in the lung perfusion SPECT/CT remained significant at the multivariate analysis (Odd ratio 3.25, 95%CI [1.24 to 8.48], p = 0.016). With a median follow-up of 31.5 months, the RFS was significantly shorter in the defect group (p = 0.008). Univariate analysis revealed that cell type of non-adenocarcinoma, clinical stage II-III, pathologic stage II-III, age greater than 65 years, and the 99mTc-MAA defect within tumor as significant predictors for shorter RFS. However, only the pathologic stage remained statistically significant, in multivariate analysis. Conclusion The absence of 99mTc-MAA accumulation within the tumor in preoperative lung perfusion SPECT/CT represents an independent risk factor for occult nodal metastasis and is relevant as a poor prognostic factor in clinically N0 NSCLC patients. 99mTc-MAA tumor distribution may serve as a new imaging biomarker reflecting tumor vasculatures and perfusion which can be associated with tumor biology and prognosis.This research was supported by the National Research Foundation of Korea (NRF) and funded by the Korean government (MSIT) (No.2020M3A9B6038086

Prognostic Value of Sarcopenia and Metabolic Parameters of 18^{18}F-FDG-PET/CT in Patients with Advanced Gastroesophageal Cancer

We investigated the prognostic value of sarcopenia measurements and metabolic parameters of primary tumors derived from $^{18}$F-FDG-PET/CT among patients with primary, metastatic esophageal and gastroesophageal cancer. A total of 128 patients (26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29-91 years) with advanced metastatic gastroesophageal cancer who underwent $^{18}$F-FDG-PET/CT as part of their initial staging between November 2008 and December 2019 were included. Mean and maximum standardized uptake value (SUV) and SUV normalized by lean body mass (SUL) were measured. Skeletal muscle index (SMI) was measured at the level of L3 on the CT component of the $^{18}$F-FDG-PET/CT. Sarcopenia was defined as SMI < 34.4 cm$^{2}$/m$^{2}$ in women and <45.4 cm$^{2}$/m$^{2}$ in men. A total of 60/128 patients (47%) had sarcopenia on baseline $^{18}$F-FDG-PET/CT. Mean SMI in patients with sarcopenia was 29.7 cm$^{2}$/m$^{2}$ in females and 37.5 cm$^{2}$/m$^{2}$ in males. In a univariable analysis, ECOG (<0.001), bone metastases (p = 0.028), SMI (p = 0.0075) and dichotomized sarcopenia score (p = 0.033) were significant prognostic factors for overall survival (OS) and progression-free survival (PFS). Age was a poor prognostic factor for OS (p = 0.017). Standard metabolic parameters were not statistically significant in the univariable analysis and thus were not evaluated further. In a multivariable analysis, ECOG (p < 0.001) and bone metastases (p = 0.019) remained significant poor prognostic factors for OS and PFS. The final model demonstrated improved OS and PFS prognostication when combining clinical parameters with imaging-derived sarcopenia measurements but not metabolic tumor parameters. In summary, the combination of clinical parameters and sarcopenia status, but not standard metabolic values from $^{18}$F-FDG-PET/CT, may improve survival prognostication in patients with advanced, metastatic gastroesophageal cancer

O processo de participação e a Educação Popular na Economia Solidária: o caso do Projeto Esperança/Cooesperança

This study aimed to identify the predominant methodology of participation in the Esperança/ Cooesperança Project, according to the model proposed by Pretty et al. (1997), as well as to get to know the process of popular education in that project. The focus of the study was on the horticultural sector of a weekly market (“Feirão Colonial”) composed of 15 groups of farmers. The main results showed that although the group has characteristics of other participatory models, such as consultative and consultative, the functional participation model is predominant, for the farmers participate by forming groups to meet predetermined objectives. In terms of popular education, the educator in the project tends to be more of a conductive type, because although there are spaces for participants and the coordination to interact and reflect collectively, some decisions are centralized.Keywords: Solidarity Economy, participation, Popular Education.Este trabalho objetivou identificar a metodologia de participação predominante no Projeto Esperança/Cooesperança, conforme o modelo proposto por Pretty et al. (1997), bem como conhecer o processo de Educação Popular no Projeto. O foco do estudo se deu no setor de hortifrutigranjeiros do Feirão Colonial, que é composto por 15 grupos de produtores rurais. Os principais resultados apontaram que, embora o grupo apresente características de outros modelos participativos, como passivo e consultivo, tem predominância do modelo de participação funcional, pois os agricultores participam formando grupos para atender objetivos predeterminados. Em se tratando de Educação Popular, o educador no Projeto tende a ser do tipo mais condutor, pois, mesmo existindo espaços para que participantes e coordenação possam interagir e refletir coletivamente, algumas decisões são centralizadas.Palavras-chave: Economia Solidária, participação, Educação Popular.Este trabalho objetivou identificar a metodologia de participação predominante no Projeto Esperança/Cooesperança, conforme o modelo proposto por Pretty et al. (1997), bem como conhecer o processo de Educação Popular no Projeto. O foco do estudo se deu no setor de hortifrutigranjeiros do Feirão Colonial, que é composto por 15 grupos de produtores rurais. Os principais resultados apontaram que, embora o grupo apresente características de outros modelos participativos, como passivo e consultivo, tem predominância do modelo de participação funcional, pois os agricultores participam formando grupos para atender objetivos predeterminados. Em se tratando de Educação Popular, o educador no Projeto tende a ser do tipo mais condutor, pois, mesmo existindo espaços para que participantes e coordenação possam interagir e refletir coletivamente, algumas decisões são centralizadas.Palavras-chave: Economia Solidária, participação, Educação Popular

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Strong peak immunogenicity but rapid antibody waning following third vaccine dose in older residents of care homes

Third-dose coronavirus disease 2019 vaccines are being deployed widely but their efficacy has not been assessed adequately in vulnerable older people who exhibit suboptimal responses after primary vaccination series. This observational study, which was carried out by the VIVALDI study based in England, looked at spike-specific immune responses in 341 staff and residents in long-term care facilities who received an mRNA vaccine following dual primary series vaccination with BNT162b2 or ChAdOx1. Third-dose vaccination strongly increased antibody responses with preferential relative enhancement in older people and was required to elicit neutralization of Omicron. Cellular immune responses were also enhanced with strong cross-reactive recognition of Omicron. However, antibody titers fell 21–78% within 100 d after vaccine and 27% of participants developed a breakthrough Omicron infection. These findings reveal strong immunogenicity of a third vaccine in one of the most vulnerable population groups and endorse an approach for widespread delivery across this population. Ongoing assessment will be required to determine the stability of immune protection