Although there are many reasons that widespread adoption of healthcare information systems has not transpired, one reason is a failure to take into account the cognitive needs of the users.
To ...understand the cognitive needs of nurses and physicians and determine how these needs should influence the design of healthcare interfaces.
A qualitative and quantitative study that compares how nurses and physicians comprehend patient information.
Twenty-four registered nurses and twenty-four physicians working in the specialties of gastrointestinal or internal medicine.
Each clinician reviewed two mock electronic medical records and summarized the cases using a think-aloud protocol. All verbalizations were coded for medical and conceptual information.
The nurses included a larger mean proportion (
p
<
0.001) of recalls than did the physicians. As compared to the nurses, the physicians included a statistically significant (
p
<
0.001) larger mean proportion of inferences, conditional statements, and interventions. The nurses concentrated on functional problems, whereas the physicians focused on diagnosis, treatment, and management.
The main cognitive differences between the physicians and the nurses are explained through the differences in their practice models. Therefore, healthcare IT must develop separate interfaces for each discipline to address their unique needs.
Migraine Headaches: Diagnosis and Management Moloney, Margaret F.; Johnson, Constance J.
Journal of midwifery & women's health,
05/2011, Letnik:
56, Številka:
3
Journal Article
Recenzirano
Odprti dostop
In spite of the fact that migraines are 1 of the major problems seen by primary care providers, almost half of people with migraines do not obtain appropriate diagnosis and/or treatment. Migraine ...occurs in about 18% of women, and is often aggravated by hormonal shifts occurring around women's menses, during pregnancy, and during perimenopause. Quality of life with migraines is often greatly diminished, and many women miss work days and/or are less productive with migraines. Women's health care providers are very likely to see women with poorly managed migraines, but are often not comfortable diagnosing and treating their patients with headaches. A variety of self‐care treatments, acute care prescription and non‐prescription headache medications, and preventive medications are available and if used by a knowledgeable provider can provide relief for many women who might not otherwise receive appropriate care.
Learning is an active, social process. However, many distance education programs are flat and asynchronous with limited interaction. Virtual environments may be best equipped to foster an active ...social learning environment that provides optimal distance education. This study explored how nursing informatics students perceived the strengths and limitations of three different online modalities of learning: Learning Management System, Webinar, and Virtual Environments. Student perceptions of nine learning and instructional technology domains were explored using the Student Assessment of Learning Gains instrument (Seymour, Wiese, Hunter, & Daffinrud, 2000) with additional, open-ended question. Two concurrent themes arose from the three platforms: technical challenges and students showing preference for synchronous web-based learning. Virtual Environments emerged as the favored distance based education. As the availability and use of these technologies proliferates, educators are challenged to understand the effects of these technologies on student learning outcomes to optimize student learning.
Individuals with type 2 diabetes have an increased risk for comorbidities such as heart disease, lower limb amputations, stroke, and renal failure. Multiple factors influence development of ...complications in a person living with type 2 diabetes; however, an individual's self-management behaviors may delay the onset of, or lessen the severity of, these complications. Social support provides personal, informal advice and knowledge that helps individuals initiate and sustain self-management and adherence.
Our aim was to gain an understanding of type 2 diabetes social interaction in a virtual environment, one type of computer-mediated environment (CME), and the social support characteristics that increase and sustain self-management in adults living with chronic illness.
This study is a secondary analysis of longitudinal data collected in a CME study, Second Life Impacts Diabetes Education & Self-Management (1R21-LM010727-01). This virtual environment replicated a real-life community where 6 months of naturalistic synchronous voice conversations, emails, and text chats were recorded among participants and providers. This analysis uses a mixed-methods approach to explore and compare qualitative and quantitative findings. This analysis is guided by two theories: Strong/Weak Ties Theory and Social Penetration Theory. Qualitative data will be analyzed using content analysis, and we will complete descriptive statistics on the quantified variables (eg, average number of ties). Institutional review board approval was obtained in June 2016.
This study is in progress.
Interventions provided through virtual environments are a promising solution to increasing self-management practices. However, little is known of the depth, breadth, and quality of social support that is exchanged and how interaction supports self-management and relates to health outcomes. This study will provide knowledge that will help guide clinical practice and policy to enhance social support for chronic illness via the Internet.
Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including ...Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes.
Literature was identified in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, EBSCO, the Cochrane Library, and the Web of Science databases through searches using the following terms: "type 2 diabetes AND internet/web based AND education" and "type 2 diabetes AND diabetes self-management education (DSME) AND web-based/internet OR technology assisted education." The search was limited to English language articles published in the last 10 years. The search yielded 111 articles; of these, 14 met criteria for inclusion in this review. Nine studies were randomized controlled trials, and study lengths varied from 2 weeks to 24 months, for a total of 2,802 participants.
DSME delivered via the Internet is effective at improving measures of glycemic control and diabetes knowledge compared with usual care. In addition, results demonstrate that improved eating habits and increased attendance at clinic appointments occur after the online DSME, although engagement and usage of Internet materials waned over time. Interventions that included an element of interaction with healthcare providers were seen as attractive to participants.
Internet-delivered diabetes education has the added benefit of easier access for many individuals, and patients can self-pace themselves through materials. More research on the cost-benefits of Internet diabetes education and best methods to maintain patient engagement are needed, along with more studies assessing the long-term impact of Internet-delivered DSME.
Pregnancy and the risk of stroke Kittner, S J; Stern, B J; Feeser, B R ...
The New England journal of medicine,
09/1996, Letnik:
335, Številka:
11
Journal Article
Recenzirano
Odprti dostop
It is widely believed that pregnancy increases the risk of stroke, but there are few data available to quantify that risk.
We identified all female patients 15 through 44 years of age in central ...Maryland and Washington, D.C., who were discharged from any of 46 hospitals in the study area in 1988 or 1991. Two neurologists reviewed each case, using data from the women's medical records. We determined whether the women had been pregnant at the time of the stroke or up to six weeks before it occurred. For purposes of this analysis, the six-week period after pregnancy could begin with an induced or spontaneous abortion or with the delivery of a live or stillborn child.
Seventeen cerebral infarctions and 14 intracerebral hemorrhages occurred in women who were or had recently been pregnant (pregnancy-related strokes), and there were 175 cerebral infarctions and 48 intracerebral hemorrhages that were not related to pregnancy. For cerebral infarction, the relative risk during pregnancy, adjusted age and race, was 0.7 (95 percent confidence interval, 0.3 to 1.6), but it increased to 8.7 for the postpartum period (after a live birth or stillbirth) (95 percent confidence interval, 4.6 to 16.7). For intracerebral hemorrhage, the adjusted relative risk was 2.5 during pregnancy (95 percent confidence interval, 1.0 to 6.4) but 28.3 for the postpartum period (95 percent confidence interval, 13.0 to 61.4). Overall, for either type of stroke during or within six weeks after pregnancy, the adjusted relative risk was 2.4 (95 percent confidence interval, 1.6 to 3.6), and the attributable, or excess, risk was 8.1 strokes per 100,000 pregnancies (95 percent confidence interval, 6.4 to 9.7).
The risks of both cerebral infarction and intracerebral hemorrhage are increased in the six weeks after delivery but not during pregnancy itself.
Effectively designing risk information for the public is challenging and selecting the appropriate medium to deliver disease risk information is crucial. In a usability evaluation of a colon cancer ...risk website, we evaluated the public's understanding and interpretation of graphical displays of risk information (2 bar graphs). Results from this study suggest that many people do not understand risk and often misinterpret graphical displays of risk and associated terminology. This work shows the importance of not only including representational analysis within user-centered design of consumer health websites, but also evaluating the health and numerical literacy levels of these websites as an aspect of usability testing.
To analyze the concept of patient voice and discuss implications for clinical care of individuals with metastatic cancer.
The diagnosis of metastatic cancer requires increased patient support and ...healthcare resource utilization. The patient voice should be heard and incorporated into care planning to improve the overall experience of individual with metastatic cancer.
Concept analysis.
Dictionary definitions and scientific literature from electronic databases, including PubMed.
Using Walker and Avant's method of concept analysis, we identified attributes, antecedents, and consequences.
Patient voice is defined as verbal or written communication by the patient to their healthcare partner to positively influence their quantity and quality of life. Attributes of patient voice include context, healthcare partner, safety, time, active listening, communication, and incorporation. Antecedents to patient voice include patient, baseline knowledge, continuing education, medical system culture, and emotional intelligence, and consequences include improved quality of life, adherence to treatment plan, overall satisfaction, and sense of control. Every instance of patient voice prepares the individual for future experiences that can positively impact their care.
The concept of patient voice is vital to integrate into care to ensure individual's wishes and goals are incorporated in advanced disease populations. Systematically incorporating the patient voice into the care of individuals with metastatic cancer will allow patients to experience treatment and the progression to end-of-life care according to their preferences.
Background:
Increasing and sustaining the engagement of participants in clinical research studies is a goal for clinical investigators, especially for studies that require long-term or frequent ...involvement of participants. Technology can be used to reduce barriers to participation by providing multiple options for clinical data entry and form submission. However, electronic systems used in clinical research studies should be user-friendly while also ensuring data quality. Directly involving study participants in evaluating the effectiveness and usability of electronic tools may promote wider adoption, maintain involvement, and increase user satisfaction of the technology. While developers of healthcare applications have incorporated user-centered designs, these methods remain uncommon in the design of clinical study tools such as patient-reported outcome surveys or electronic data capture digital health tools.
Methods:
Our study evaluated whether the clinical research setting may benefit from implementing user-centered design principles. Study participants were recruited to test the web-based form for the Measurement to Understand the Reclassification of Disease of Cabarrus/Kannapolis (MURDOCK) Study Community Translational Population Health Registry and Biorepository that would enable them to complete their study forms electronically. The study enrollment form collects disease history, conditions, smoking status, medications, and other information. The system was initially evaluated by the data management team through traditional user-acceptance testing methods. During the tool evaluation phase, a decision was made to incorporate a small-scale usability study to directly test the system.
Results:
Results showed that a majority of participants found the system easy to use. Of the eight required tasks, 75% were completed successfully. Of the 72 heuristics violated, language was the most frequent violation.
Conclusion:
Our study showed that user-centered usability methods can identify important issues and capture information that can enhance the participant’s experience and may improve the quality of study tools.
Usability is a critical but often overlooked factor in the design and development of healthcare information technology systems. One system increasingly being leveraged as a research and quality ...improvement tool is an online research portal that allows self-service access to electronic health record (EHR) data. We discuss the usability testing of such a portal through a low-cost usability inspection method: heuristic evaluation. Using heuristic evaluation methods, we identified 20 usability errors: 15.0% (3/20) were cosmetic, 35.0% (7/20) were minor, 40.0% (8/20) were major, and 10.0% (2/20) were catastrophic. Our heuristic evaluation demonstrates an affordable and efficient method to identify and correct a significant number of problems, thus improving the system using limited effort and resources. A user-friendly environment that follows accepted heuristics for good interface design is essential for ensuring accessibility and usability of data extracted from EHRs for quality improvement and research projects.
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