Toward Optimal Learning of the Gesture in Laparoscopic Surgery: Methodology and Performance.

Classical surgical education has to face both a forensic reality and a technical issue: to train a learner in more complex techniques in an increasingly short time. Moreover, surgical training is still based on an empirical hierarchical relationship in which learners must reproduce a sequence of actions in a situation of strong emotional pressure. However, the effectiveness of learning and its quality are linked to the emotional states in which learners find themselves. Among these emotions, epistemic confusion can be found that arises in complex learning situations where there is a cognitive imbalance related to the comprehension of the task, and which results from a rupture between the pre-established patterns of the learner and the new learning task. Although one knows that confusion can have a beneficial or a negative impact on learning, depending on whether it is well regulated or not, the factors that can influence it positively are still poorly understood. Thus, the objective of this experiment is to assess the impact of confusion on the learning of a surgical procedure in an augmented reality context and to determine if this impact varies according to the feedback given to the learners and according to the occurrence of disruptive events. Medical externs were recruited (N = 15) who were required to perform a suturing task on a simulator and whose performance was measured using a Motion Capture (MoCap) system. Even though the statistical analyzes did not allow a conclusion to be reached, the protocol already established makes it possible to consider a longer-term study that will allow (by increasing the number of sessions and the number of participants) more significant results to be obtained in order to develop new surgical learning protocols. This preliminary study opens a new field of research on the influence of epistemic emotions, and more particularly of confusion, which is likely to upset traditional surgical teaching, and is based on negative conditioning and strong emotions with negative valence as well as stress and coercion.

Here's looking at you: eye gaze and collaborative recall.

In everyday life, we remember together often. Surprisingly, research reliably shows costs of collaboration. People remember less in groups than the same number of individuals remember separately. However, there is evidence that some groups are more successful than others, depending on factors such as group relationship and verbal communication strategies. To understand further the characteristics of more successful vs. less successful collaborative groups, we examined whether non-verbal eye gaze behaviour was associated with group outcomes. We used eye tracking glasses to measure how much collaborating dyads looked at each other during collaborative recall, and examined whether individual differences in eye- and face-directed gaze were associated with collaborative performance. Increased eye- and face-directed gaze was associated with higher collaborative recall performance, more explicit strategy use, more post-collaborative benefits, and increased memory overlap. However, it was also associated with pre-collaborative recall, indicating that gaze during collaboration may at least partially reflect pre-existing abilities. This research helps elucidate individual differences that underlie the outcomes of collaborative recall, and suggests that non-verbal communication differentiates more vs. less successful collaborative groups.

Puzzle-Solving Activity as an Indicator of Epistemic Confusion.

When students perform complex cognitive activities, such as solving a problem, epistemic emotions can occur and influence the completion of the task. Confusion is one of these emotions and it can produce either negative or positive outcomes, according to the situation. For this reason, considering confusion can be an important factor for educators to evaluate students' progression in cognitive activities. However, in digital learning environments, observing students' confusion, as well as other epistemic emotions, can be problematic because of the remoteness of students. The study reported in this article explored new methodologies to assess emotions in a problem-solving task. The experimental task consisted of the resolution of logic puzzles presented on a computer, before, and after watching an instructional video depicting a method to solve the puzzle. In parallel to collecting self-reported confusion ratings, human-computer interaction was captured to serve as non-intrusive measures of emotions. The results revealed that the level of self-reported confusion was negatively correlated with the performance on solving the puzzles. In addition, while comparing the pre- and post-video sequences, the experience of confusion tended to differ. Before watching the instructional video, the number of clicks on the puzzle was positively correlated with the level of confusion whereas the correlation was negatively after the video. Moreover, the main emotions reported before the video (e.g., confusion, frustration, curiosity) tended to differ from the emotions reported after the videos (e.g., engagement, delight, boredom). These results provide insights into the ambivalent impact of confusion in problem-solving task, illustrating the dual effect (i.e., positive or negative) of this emotion on activity and performance, as reported in the literature. Applications of this methodology to real-world settings are discussed.

The effects of training impulse control on simulated driving.

There is growing interest in young driver training that addresses age-related factors, including incompletely developed impulse control. Two studies investigated whether training of response inhibition can reduce risky simulated driving in young drivers (aged 16-24 years). Each study manipulated aspects of response inhibition training then assessed transfer of training using simulated driving measures including speeding, risky passing, and compliance with traffic controls. Study 1 (n = 65) used a Go/No-go task, Stop Signal Task and a Collision Detection Task. Designed to promote engagement, learning, and transfer, training tasks were driving-relevant and adaptive (i.e. difficulty increased as performance improved), included performance feedback, and were distributed over five days. Control participants completed matching "filler" tasks. Performance on trained tasks improved with training, but there was no significant improvement in simulated driving. Study 2 enhanced response inhibition training using Go/No-go and SST tasks, with clearer performance feedback, and 10 days of training. Control participants completed testing only, in order to avoid any possibility of training response inhibition in the filler tasks. Again performance on trained tasks improved, but there was no evidence of transfer of training to simulated driving. These findings suggest that although training of sufficient interest and duration can improve response inhibition task performance, a training schedule that is likely to be acceptable to the public does not result in improvements in simulated driving. Further research is needed to investigate whether response inhibition training can improve risky driving in the context of real-world motivations for risky driving.

Theoretical approaches of online social network interventions and implications for behavioral change: a systematic review.

RATIONAL, AIMS AND OBJECTIVES: The aim of this review was to identify general theoretical frameworks used in online social network interventions for behavioral change. To address this research question, a PRISMA-compliant systematic review was conducted. METHODS: A systematic review (PROSPERO registration number CRD42014007555) was conducted using 3 electronic databases (PsycINFO, Pubmed, and Embase). Four reviewers screened 1788 abstracts. RESULTS: 15 studies were selected according to the eligibility criteria. Randomized controlled trials and controlled studies were assessed using Cochrane Collaboration's "risk-of-bias" tool, and narrative synthesis. Five eligible articles used the social cognitive theory as a framework to develop interventions targeting behavioral change. Other theoretical frameworks were related to the dynamics of social networks, intention models, and community engagement theories. Only one of the studies selected in the review mentioned a well-known theory from the field of health psychology. CONCLUSION: Conclusions were that guidelines are lacking in the design of online social network interventions for behavioral change. Existing theories and models from health psychology that are traditionally used for in situ behavioral change should be considered when designing online social network interventions in a health care setting.

"Why Didn't it Work?" Lessons From a Randomized Controlled Trial of a Web-based Personally Controlled Health Management System for Adults with Asthma.

BACKGROUND: Personally controlled health management systems (PCHMS), which may include a personal health record (PHR), health management tools, and information resources, have been advocated as a next-generation technology to improve health behaviors and outcomes. There have been successful trials of PCHMS in various health settings. However, there is mixed evidence for whether consumers will use these systems over the long term and whether they ultimately lead to improved health outcomes and behaviors. OBJECTIVE: The aim was to test whether use of a PCHMS by consumers can increase the uptake or updating of a written asthma action plan (AAP) among adults with asthma. METHODS: A 12-month parallel 2-group randomized controlled trial was conducted. Participants living with asthma were recruited nationally in Australia between April and August 2013, and randomized 1:1 to either the PCHMS group or control group (online static educational content). The primary outcome measure was possession of an up-to-date written AAP poststudy. Secondary measures included (1) utilizing the AAP; (2) planned or unplanned visits to a health care professional for asthma-related concerns; (3) severe asthma exacerbation, inadequately controlled asthma, or worsening of asthma that required a change in treatment; and (4) number of days lost from work or study due to asthma. Ancillary analyses examined reasons for adoption or nonadoption of the intervention. Outcome measures were collected by online questionnaire prestudy, monthly, and poststudy. RESULTS: A total of 330 eligible participants were randomized into 1 of 2 arms (intervention: n=154; control: n=176). Access to the PCHMS was not associated with a significant difference in any of the primary or secondary outcomes. Most participants (80.5%, 124/154) did not access the intervention or accessed it only once. CONCLUSIONS: Despite the intervention being effective in other preventive care settings, system use was negligible and outcome changes were not seen as a result. Consumers must perceive the need for assistance with a task and assign priority to the task supported by the eHealth intervention. Additionally, the cost of adopting the intervention (eg, additional effort, time spent learning the new system) must be lower than the benefit. Otherwise, there is high risk consumers will not adopt the eHealth intervention. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite® at http://www.webcitation.org/6dMV6hg4A).

The influence of social networking sites on health behavior change: a systematic review and meta-analysis.

OBJECTIVE: Our aim was to evaluate the use and effectiveness of interventions using social networking sites (SNSs) to change health behaviors. MATERIALS AND METHODS: Five databases were scanned using a predefined search strategy. Studies were included if they focused on patients/consumers, involved an SNS intervention, had an outcome related to health behavior change, and were prospective. Studies were screened by independent investigators, and assessed using Cochrane's 'risk of bias' tool. Randomized controlled trials were pooled in a meta-analysis. RESULTS: The database search retrieved 4656 citations; 12 studies (7411 participants) met the inclusion criteria. Facebook was the most utilized SNS, followed by health-specific SNSs, and Twitter. Eight randomized controlled trials were combined in a meta-analysis. A positive effect of SNS interventions on health behavior outcomes was found (Hedges' g 0.24; 95% CI 0.04 to 0.43). There was considerable heterogeneity (I(2) = 84.0%; T(2) = 0.058) and no evidence of publication bias. DISCUSSION: To the best of our knowledge, this is the first meta-analysis evaluating the effectiveness of SNS interventions in changing health-related behaviors. Most studies evaluated multi-component interventions, posing problems in isolating the specific effect of the SNS. Health behavior change theories were seldom mentioned in the included articles, but two particularly innovative studies used 'network alteration', showing a positive effect. Overall, SNS interventions appeared to be effective in promoting changes in health-related behaviors, and further research regarding the application of these promising tools is warranted. CONCLUSIONS: Our study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140.

Social and self-reflective use of a Web-based personally controlled health management system.

BACKGROUND: Personally controlled health management systems (PCHMSs) contain a bundle of features to help patients and consumers manage their health. However, it is unclear how consumers actually use a PCHMS in their everyday settings. OBJECTIVE: To conduct an empirical analysis of how consumers used the social (forum and poll) and self-reflective (diary and personal health record [PHR]) features of a Web-based PCHMS designed to support their physical and emotional well-being. METHODS: A single-group pre/post-test online prospective study was conducted to measure use of a Web-based PCHMS for physical and emotional well-being needs during a university academic semester. The PCHMS integrated an untethered PHR with social forums, polls, a diary, and online messaging links with a health service provider. Well-being journeys additionally provided information to encourage engagement with clinicians and health services. A total of 1985 students and staff aged 18 and above with access to the Internet were recruited online, of which 709 were eligible for analysis. Participants' self-reported well-being, health status, health service utilization, and help-seeking behaviors were compared using chi-square, McNemar's test, and Student's t test. Social networks were constructed to examine the online forum communication patterns among consumers and clinicians. RESULTS: The two PCHMS features that were used most frequently and considered most useful and engaging were the social features (ie, the poll and forum). More than 30% (213/709) of participants who sought well-being assistance during the study indicated that other people had influenced their decision to seek help (54.4%, 386/709 sought assistance for physical well-being; 31.7%, 225/709 for emotional well-being). Although the prevalence of using a self-reflective feature (diary or PHR) was not as high (diary: 8.6%, 61/709; PHR: 15.0%, 106/709), the proportion of participants who visited a health care professional during the study was more than 20% greater in the group that did use a self-reflective feature (diary: P=.03; PHR: P<.001). CONCLUSIONS: There was variation in the degree to which consumers used social and self-reflective PCHMS features but both were significantly associated with increased help-seeking behaviors and health service utilization. A PCHMS should combine both self-reflective as well as socially driven components to most effectively influence consumers' help-seeking behaviors.

An internet intervention to improve asthma management: rationale and protocol of a randomized controlled trial.

BACKGROUND: Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients' asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults. OBJECTIVE: A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). METHODS: The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted. RESULTS: The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work. CONCLUSIONS: This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions. TRIAL REGISTRATION: Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW).

Consumers' online social network topologies and health behaviours.

Personally controlled health management systems (PCHMS) often consist of multiple design features. Yet, they currently lack empirical evidence on how consumers use and engage with a PCHMS. An online prospective study was designed to investigate how 709 consumers used a web-based PCHMS to manage their physical and emotional wellbeing over five months. The web-based PCHMS, Healthy.me, was developed at UNSW and incorporates an untethered personal health record, consumer care pathways, forums, polls, diaries, and messaging links with healthcare professionals. The two PCHMS features that consumers used most frequently, found most useful, and engaging were the social features, i.e. forum and poll. Compared to participants who did not use any PCHMS social feature, those who used either the poll or the forum were 12.3% more likely to visit a healthcare professional (P=0.001) during the study. Social network analysis of forums revealed a spectrum of social interaction patterns - from question-and-answer structures to community discussions. This study provides a basis for understanding how a PCHMS can be used as a socially-driven intervention to influence consumers' health behaviours.

Which bundles of features in a Web-based personally controlled health management system are associated with consumer help-seeking behaviors for physical and emotional well-being?

BACKGROUND: Personally controlled health management systems (PCHMS), which include a personal health record (PHR), health management tools, and consumer resources, represent the next stage in consumer eHealth systems. It is still unclear, however, what features contribute to an engaging and efficacious PCHMS. OBJECTIVE: To identify features in a Web-based PCHMS that are associated with consumer utilization of primary care and counselling services, and help-seeking rates for physical and emotional well-being concerns. METHODS: A one-group pre/posttest online prospective study was conducted on a university campus to measure use of a PCHMS for physical and emotional well-being needs during a university academic semester (July to November 2011). The PCHMS integrated an untethered personal health record (PHR) with well-being journeys, social forums, polls, diaries, and online messaging links with a health service provider, where journeys provide information for consumer participants to engage with clinicians and health services in an actionable way. 1985 students and staff aged 18 and above with access to the Internet were recruited online. Logistic regression, the Pearson product-moment correlation coefficient, and chi-square analyses were used to associate participants' help-seeking behaviors and health service utilization with PCHMS usage among the 709 participants eligible for analysis. RESULTS: A dose-response association was detected between the number of times a user logged into the PCHMS and the number of visits to a health care professional (P=.01), to the university counselling service (P=.03), and help-seeking rates (formal or informal) for emotional well-being matters (P=.03). No significant association was detected between participant pre-study characteristics or well-being ratings at different PCHMS login frequencies. Health service utilization was strongly correlated with use of a bundle of features including: online appointment booking (primary care: OR 1.74, 95% CI 1.01-3.00; counselling: OR 6.04, 95% CI 2.30-15.85), personal health record (health care professional: OR 2.82, 95% CI 1.63-4.89), the poll (health care professional: OR 1.47, 95% CI 1.02-2.12), and diary (counselling: OR 4.92, 95% CI 1.40-17.35). Help-seeking for physical well-being matters was only correlated with use of the personal health record (OR 1.73, 95% CI 1.18-2.53). Help-seeking for emotional well-being concerns (including visits to the university counselling service) was correlated with a bundle comprising the poll (formal or informal help-seeking: OR 1.03, 95% CI 1.00-1.05), diary (counselling: OR 4.92, 95% CI 1.40-17.35), and online appointment booking (counselling: OR 6.04, 95% CI 2.30-15.85). CONCLUSIONS: Frequent usage of a PCHMS was significantly associated with increased consumer health service utilization and help-seeking rates for emotional health matters in a university sample. Different bundles of PCHMS features were associated with physical and emotional well-being matters. PCHMS appears to be a promising mechanism to engage consumers in help-seeking or health service utilization for physical and emotional well-being matters.