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Systematic review of applied usability metrics within usability evaluation methods for hospital electronic healthcare record systems: Metrics and Evaluation Methods for eHealth Systems.
BACKGROUND AND OBJECTIVES: Electronic healthcare records have become central to patient care. Evaluation of new systems include a variety of usability evaluation methods or usability metrics (often referred to interchangeably as usability components or usability attributes). This study reviews the breadth of usability evaluation methods, metrics, and associated measurement techniques that have been reported to assess systems designed for hospital staff to assess inpatient clinical condition. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Open Grey from 1986 to 2019. For included studies, we recorded usability evaluation methods or usability metrics as appropriate, and any measurement techniques applied to illustrate these. We classified and described all usability evaluation methods, usability metrics, and measurement techniques. Study quality was evaluated using a modified Downs and Black checklist. RESULTS: The search identified 1336 studies. After abstract screening, 130 full texts were reviewed. In the 51 included studies 11 distinct usability evaluation methods were identified. Within these usability evaluation methods, seven usability metrics were reported. The most common metrics were ISO9241-11 and Nielsen's components. An additional "usefulness" metric was reported in almost 40% of included studies. We identified 70 measurement techniques used to evaluate systems. Overall study quality was reflected in a mean modified Downs and Black checklist score of 6.8/10 (range 1-9) 33% studies classified as "high-quality" (scoring eight or higher), 51% studies "moderate-quality" (scoring 6-7), and the remaining 16% (scoring below five) were "low-quality." CONCLUSION: There is little consistency within the field of electronic health record systems evaluation. This review highlights the variability within usability methods, metrics, and reporting. Standardized processes may improve evaluation and comparison electronic health record systems and improve their development and implementation.
Human factors in escalating acute ward care: a qualitative evidence synthesis.
BACKGROUND: Identifying how human factors affect clinical staff recognition and managment of the deteriorating ward patient may inform process improvements. We systematically reviewed the literature to identify (1) how human factors affect ward care escalation (2) gaps in the current literature and (3) critique literature methodologies. METHODS: We undertook a Qualitative Evidence Synthesis of care escalation studies. We searched MEDLINE, EMBASE and CINHAL from inception to September 2019. We used the Critical Appraisal Skills Programme and the Grading of Recommendations Assessment-Development and Evaluation and Confidence in Evidence from Reviews of Qualitative Research tool to assess study quality. RESULTS: Our search identified 24 studies meeting the inclusion criteria. Confidence in findings was moderate (20 studies) to high (4 studies). In 16 studies, the ability to recognise changes in the patient's condition (soft signals), including skin colour/temperature, respiratory pattern, blood loss, personality change, patient complaint and fatigue, improved the ability to escalate patients. Soft signals were detected through patient assessment (looking/listening/feeling) and not Early Warning Scores (eight studies). In contrast, 13 studies found a high workload and low staffing levels reduced staff's ability to detect patient deterioration and escalate care. In eight studies quantifiable deterioration evidence (Early Warning Scores) facilitated escalation communication, particularly when referrer/referee were unfamiliar. Conversely, escalating concerning non-triggering patients was challenging but achieved by some clinical staff (three studies). Team decision making facilitated the clinical escalation (six studies). CONCLUSIONS: Early Warning Scores have clinical benefits but can sometimes impede escalation in patients not meeting the threshold. Staff use other factors (soft signals) not captured in Early Warning Scores to escalate care. The literature supports strategies that improve the escalation process such as good patient assessment skills. PROSPERO REGISTRATION NUMBER: CRD42018104745.
How human factors affect escalation of care: a protocol for a qualitative evidence synthesis of studies.
INTRODUCTION: Failure to rescue is defined as mortality after complications during hospital care. Incidence ranges 10.9%-13.3% and several national reports such as National Confidential Enquiry into Patient Outcomes and Death and National Institute of Clinical Excellence CG 50 highlight failure to rescue as a significant problem for safe patient care.To avoid failure to rescue events, there must be successful escalation of care. Studies indicate that human factors such as situational awareness, team working, communication and a culture promoting safety contribute to avoidance of failure to rescue events. Understanding human factors is essential to developing work systems that mitigate barriers and facilitate prompt escalation of care. This qualitative evidence synthesis will identify and synthesise what is known about the human factors that affect escalation of care. METHODS AND ANALYSIS: We will search MEDLINE (Ovid), EMBASE (Ovid) and CINAHL, between database inception and 2018, for studies describing human factors affecting failure to rescue and/or care escalation. A search strategy was developed by two researchers and a medical librarian. Only studies exploring in-hospital (ward) populations using qualitative data collection methods will be included. Screening will be conducted by two researchers. We are likely to undertake a thematic synthesis, using the Thomas and Harden framework. Selected studies will be assessed for quality, rigour and limitations. Two researchers will extract and thematically synthesise codes using a piloted data extraction tool to develop analytical themes. ETHICS AND DISSEMINATION: The qualitative evidence synthesis will use available published literature and no ethical approval is required. This synthesis will be limited by the quality of studies, rigour and reproducibility of study findings. Results will be published in a peer-reviewed journal, publicised at conferences and on social media. PROSPERO REGISTRATION NUMBER: CRD42018104745.
Systematic Review and Meta-Analysis: Risks of Anxiety Disorders in Offspring of Parents With Mood Disorders.
OBJECTIVE: To examine the risk of anxiety disorders in offspring of parents with mood disorders. METHOD: We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors. RESULTS: A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders. CONCLUSION: Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context. DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. STUDY PREREGISTRATION INFORMATION: Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.
Translated and culturally adapted internet-delivered cognitive therapy for social anxiety disorder in Japanese clinical settings: study protocol for a randomised controlled trial.
BACKGROUND: Cognitive therapy for social anxiety disorder (CT-SAD) has extensive empirical support and is recommended in several national guidelines. However, ensuring access to evidence-based psychological therapies such as CT-SAD remains a global challenge. An internet-delivered version of this treatment protocol (iCT-SAD) has recently been developed in the UK as a way to overcome this challenge, demonstrating comparable outcomes to face-to-face CT-SAD whilst requiring less therapist time per client. Initial findings also suggest its cross-cultural transferability, but the previous studies in other cultural settings used the English language programme and only included English-fluent participants as a second language. It is not yet known what outcomes can be achieved once the programme has been translated and adapted for a different cultural context. Therefore, this trial aims to evaluate the clinical efficacy of Japanese iCT-SAD when combined with treatment as usual (TAU) in clients with SAD. METHODS: This two-arm, parallel-group, superiority randomised controlled trial will recruit 60 Japanese participants with SAD, randomly assigning them to either Japanese iCT-SAD + TAU or TAU alone at a ratio of 1:1. The primary outcome measure is the self-report Liebowitz Social Anxiety Scale, and secondary.outcomes include other measures of social anxiety symptoms and processes, general mood and functioning, and response to treatment. We will also assess treatment acceptability and gather participant feedback. Assessments will take place at baseline (week 0), mid-treatment (week 8), and post-treatment (week 15), with a further 3-month follow-up (week 27) for the iCT-SAD + TAU arm. The primary analyses will be conducted on an intent-to-treat basis, comparing the primary and secondary outcome measures between groups using linear mixed-effect models, along with additional mediation analysis. DISCUSSION: Investigating the efficacy of translated and culturally adapted iCT-SAD in different cultural contexts is an important step in evaluating the global reach of internet interventions. This trial will provide valuable insights into the effects of iCT-SAD combined with usual care, and how this treatment could be delivered in routine clinical settings in Japan. TRIAL REGISTRATION: International Standard Randomized Controlled Trials (ISRCTN), ISRCTN82859645, registered on January 19, 2024. UMIN Clinical Trials Registry (UMIN-CTR), UMIN000052702, registered on November 6, 2023.
When visual metacognition fails: widespread anosognosia for visual deficits.
Anosognosia for visual deficits - cases where significant visual deficits go unnoticed - challenges the view that our own conscious experiences are what we know best. We review these widespread and striking failures of awareness. Anosognosia can occur with total blindness, visual abnormalities induced by brain lesions, and eye diseases. We show that anosognosia for visual deficits is surprisingly widespread. Building on previous accounts, we introduce a framework showing how apparently disparate forms of anosognosia fit together. The central idea is that, to notice a deficit, individuals need to form expectations about normal vision, compare expectations and visual input, and judge any mismatch at the metacognitive level. A failure in any of these three steps may lead to unawareness of visual deficits.
The relevance of the unique anatomy of the human prefrontal operculum to the emergence of speech.
Identifying the evolutionary origins of human speech remains a topic of intense scientific interest. Here we describe a unique feature of adult human neuroanatomy compared to chimpanzees and other primates that may provide an explanation of changes that occurred to enable the capacity for speech. That feature is the Prefrontal extent of the Frontal Operculum (PFOp) region, which is located in the ventrolateral prefrontal cortex, adjacent and ventromedial to the classical Broca's area. We also show that, in chimpanzees, individuals with the most human-like PFOp, particularly in the left hemisphere, have greater oro-facial and vocal motor control abilities. This critical discovery, when combined with recent paleontological evidence, suggests that the PFOp is a recently evolved feature of human cortical structure (perhaps limited to the genus Homo) that emerged in response to increasing selection for cognitive and motor functions evident in modern speech abilities.
Longitudinal stability and Autism Diagnostic Observation Scale-2 predictors of the Childhood Joint Attention Rating Scale
A recent study suggests that parent report on the Social Symptom and Prosocial scales of the Childhood Joint Attention Rating Scale provides useful information about differences in the social development of school-aged autistic children. The current study provides additional psychometric data on the Childhood Joint Attention Rating Scale regarding the longitudinal stability of its scales, its construct validity, and its sensitivity to differences in the social development of clinical samples of children. The study included 64 autistic children without co-occurring intellectual disability, 27 children with symptoms of attention deficit/hyperactivity disorder, and 36 neurotypical children between the ages of 10 and 18 years. Results indicated that scores from parent report on the Childhood Joint Attention Rating Scale were stable across a 15-month period in middle childhood for the three groups and groups received significantly different Childhood Joint Attention Rating Scale scores. Finally, construct validity was supported by the observation of correlations between tester observations of items on Autism Diagnostic Observation Scale-2 Social Affect and subsequent parent report on the Childhood Joint Attention Rating Scale. These results provide further evidence that the Childhood Joint Attention Rating Scale provides meaningful and potentially unique information about prosocial and social symptom development of school-aged autistic children. Lay abstract This study tested a measure designed to capture social development in childhood and adolescence called the Childhood Joint Attention Rating Scale. This is important to study as most measures of social behavior are for preschool-aged children. We asked parents of 64 autistic children, 27 children with attention deficit/hyperactivity disorder, and 36 neurotypical children to fill out a new parent questionnaire designed to assess social skills. Specifically, our measure asks about both strengths and difficulties their child has with sharing experiences, engaging in cooperative efforts with others, and more. It is important to have strengths included in measures, as many autism measures only take difficulties into account. The findings of this study show that this new measure can assess social skill strengths and difficulties in children and adolescents. This measure may be useful in future research to help us understand how strengths and challenges in social behaviors develop or change throughout childhood and adolescence in autistic people.
Sustained EEG responses to rapidly unfolding stochastic sounds reflect Bayesian inferred reliability tracking.
How does the brain track and process rapidly changing sensory information? Current computational accounts suggest that our sensations and decisions arise from the intricate interplay between bottom-up sensory signals and constantly changing expectations regarding the statistics of the surrounding world. A significant focus of recent research is determining which statistical properties are tracked by the brain as it monitors the rapid progression of sensory information? Here, by combining EEG (three experiments N≥22 each) and computational modelling, we examined how the brain processes rapid and stochastic sound sequences that simulate key aspects of dynamic sensory environments. Passively listening participants were exposed to structured tone-pip arrangements that contained transitions between a range of stochastic patterns. Predictions were guided by a Bayesian predictive inference model. We demonstrate that listeners automatically track the statistics of unfolding sounds, even when these are irrelevant to behaviour. Transitions between sequence patterns drove an increase of the sustained EEG response. This was observed to a range of distributional statistics, and even in situations where behavioural detection of these transitions was at floor. These observations suggest that the modulation of the EEG sustained response reflects a process of belief updating within the brain. By establishing a connection between the outputs of the computational model and the observed brain responses, we demonstrate that the dynamics of these transition-related responses align with the tracking of "precision" - the confidence or reliability assigned to a predicted sensory signal - shedding light on the intricate interplay between the brain's statistical tracking mechanisms and its response dynamics.
Perception Metaphors
Metaphor allows us to think and talk about one thing in terms of another, ratcheting up our cognitive and expressive capacity. It gives us concrete terms for abstract phenomena, for example, ideas become things we can grasp or let go of. Perceptual experience—characterised as physical and relatively concrete—should be an ideal source domain in metaphor, and a less likely target. But is this the case across diverse languages? And are some sensory modalities perhaps more concrete than others? This volume presents critical new data on perception metaphors from over 40 languages, including many which are under-studied. Aside from the wealth of data from diverse languages—modern and historical; spoken and signed—a variety of methods (e.g., natural language corpora, experimental) and theoretical approaches are brought together. This collection highlights how perception metaphor can offer both a bedrock of common experience and a source of continuing innovation in human communication.
The Dialectical Relationship Between Burnout and Work Engagement: A Network Approach
ABSTRACTBased on previous empirical evidence, scholars have argued for a dialectical relationship between burnout and work engagement. However, these conclusions largely rely on latent variable models, which have inherent limitations due to strong hierarchical assumptions about data. As a result, previous findings should be considered preliminary indications rather than conclusive evidence. In this study, we introduce network analysis to investigate the relationship between burnout and work engagement. We demonstrate its utility by comparing the fit indices of the network model and three factor models in a cross‐national sample with 2469 employees from Norway and 879 employees from the US and UK. Based on theory and fit indices, we conclude that the network model was preferred in both samples. Using this model, we uncovered positive relationships between two work engagement variables and the exhaustion component of burnout. Theoretically, this study broadens our understanding and show support for the dialectical relationship between burnout and work engagement. Furthermore, by introducing the network model to empirical research, we provide a novel approach that contribute to nuance and ideas for research on burnout and work engagement. Practically, our results offer insightful data on possible points for intervention between burnout and work engagement variables.
EXPRESS: How stable are taste-shape crossmodal correspondences over time?
The present research investigates the stability of taste-shape crossmodal correspondences (that is, how people non-randomly associate tastes and visual shapes, such as sweetness matched to roundness) over time, exploring the temporal dimension of crossmodal interactions. While previous research has established the existence of various taste-shape crossmodal correspondences, this study addresses their consistency over time through a test-retest paradigm. Drawing parallels with the concept of synesthesia, in which stability is used as a criterion, the research focuses on taste-shape associations, a domain not previously explored for temporal stability. Participants rated the perceived curvature and symmetry that they associated with taste words (sweet, umami, sour, salty, and bitter) and their liking of tastes and shapes. The same participants performed this task three times over a two-week period. The results consistently replicated previous findings, revealing that sweet tastes were perceived as significantly more curved and symmetrical than other tastes, and umami was rated as more curved and symmetrical than sour, salty, and bitter tastes. Notably, the study found moderate-to-substantial test-retest reliability for the majority of the taste-shape correspondences, indicating robust stability over time. Analyses suggested that differences in assessments between test and retest sessions were primarily due to random error, with no systematic biases. However, a small subset of participants showed significant differences from other participants in their associations, particularly for umami-related correspondences. This research contributes to our understanding of taste-shape correspondences by demonstrating their temporal stability, offering insights into the dynamics of taste, curvature, symmetry, and liking. We posit that consistency might be used as a criterion supporting the existence of a given crossmodal correspondence. The findings have implications for product design and marketing, emphasizing the importance of considering temporal aspects when capitalizing on crossmodal correspondences in creating product expectations and experiences.