Cognitive components of aging-related increase in word-finding difficulty.

Word-finding difficulty (WFD) is a common cognitive complaint in aging, manifesting both in natural speech and in controlled laboratory tests. Various theories of cognitive aging have addressed WFD, and understanding its underlying mechanisms can help to clarify whether it has diagnostic value for neurodegenerative disease. Two influential "information-universal" theories attribute it to rather broad changes in cognition. The processing speed theory posits a general slowdown of all cognitive processes, while the inhibitory deficit hypothesis (IDH) predicts a specific problem in suppressing irrelevant information. One "information specific" theory of language production, the transmission deficit hypothesis (TDH), posits a breakdown in retrieval of phonological word forms from a corresponding lemma. To adjudicate between these accounts, we administered an online gamified covert naming task featuring picture-word interference (PWI), previously validated to elicit similar semantic interference and phonological facilitation effects as overt naming tasks. 125 healthy adults aged 18 to 85 completed the task, along with a battery of executive function tasks and a naturalistic speech sample to quantify WFD in connected speech. PWI effects provided strong support for the TDH but limited support for IDH, in that semantic interference increased and phonological facilitation decreased across the lifespan. However, neither of these effects on single-word retrieval associated with WFD measured in connected speech. Rather, overall reaction time for word retrieval (controlling for psychomotor slowing) was the best predictor of spontaneous WFD and executive function decline, suggesting processing speed as the key factor, and that verbal reaction time may be an important clinical measure.

In what ways does user experience design improve printed educational materials?

We report on a series of four studies that investigated how user experience design (UXD) can improve printed educational materials (PEMs). We examined the perceived usability of an existing PEM for breast cancer screening and observed the usability problems associated with it (Study 1). We then compared a breast cancer screening PEM created by user experience designers with two other breast cancer screening PEMS, finding that the PEM based on UXD had higher perceived usability, and lower mentions of usability problems, than the other two PEMs (Study 2). We next examined the impact of individual differences in design expertise on perceived usability, this time including a PEM on cervical cancer screening as well as one on breast cancer screening (Study 3). Our concluding study (Study 4) then examined the impacts of UXD on learnability of PEM content as defined by answers to a knowledge questionnaire about screening administered before and after reading the PEM, and by intention to screen for cancer after reading the PEM. The first three studies showed that the involvement of UXD improved the perceived usability of PEMs, and Study 3 showed that designers differ in their ability to create useable PEMs. Study 4 failed to find a corresponding improvement in learnability or intention to screen when UXD was used to improve perceived usability. We conclude that a user experience design approach that incorporates graphic design can improve the perceived usability of PEMs in some situations (e.g., when the PEM material is not too lengthy or complex, and when the graphic designer is sufficiently skilled). However, we found no evidence that lack of perceived usability accounted for the failure of PEMS (found in previous research) to improve knowledge or intention to screen.

TAG-ME again: A serious game for measuring working memory.

BrainTagger (demo version: researcher-demo.braintagger.com) is a suite of Target Acquisition Games for Measurement and Evaluation (TAG-ME). Here we introduce TAG-ME Again, a serious game modeled after the well-established N-Back task, to assess working memory ability across three difficulty levels corresponding to 1-, 2-, and 3-back conditions. We also report on two experiments aimed at assessing convergent validity with the N-Back task. Experiment 1 examined correlations with N-Back task performance in a sample of adults (n = 31, 18-54 years old) across three measures: reaction time; accuracy; a combined RT/accuracy metric. Significant correlations between game and task were found, with the strongest relationship being for the most difficult version of the task (3-Back). In Experiment 2 (n = 66 university students, 18-22 years old), we minimized differences between the task and the game by equating stimulus-response mappings and spatial processing demands. Significant correlations were found between game and task for both the 2-Back and 3-Back levels. We conclude that TAG-ME Again is a gamified task that has convergent validity with the N-Back Task.

Effects of Unit Census and Patient Acuity Levels on Discussions During Patient Rounds.

OBJECTIVES: PICU teams adapt the duration of patient rounding discussions to accommodate varying contextual factors, such as unit census and patient acuity. Although studies establish that shorter discussions can lead to the omission of critical patient information, little is known about how teams adapt their rounding discussions about essential patient topics (i.e., introduction/history, acute clinical status, care plans) in response to changing contexts. To fill this gap, we examined how census and patient acuity impact time spent discussing essential topics during individual patient encounters. DESIGN: Observational study. SETTING: PICU at a university-affiliated children's hospital, Toronto, ON, Canada. SUBJECTS: Interprofessional morning rounding teams. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We observed 165 individual patient encounters during morning rounds over 10 weeks. Regardless of census or patient acuity, the duration of patient introductions/history did not change. When census was high versus low, acute clinical status discussions significantly decreased for both low acuity patients (00 min:50 s high census; 01 min:39 s low census; -49.5% change) and high acuity patients (01 min:10 s high census; 02 min:02 s low census; -42.6% change). Durations of care plan discussions significantly reduced as a function of census (01 min:19 s high census; 02 min:52 s low census; -54.7% change) for low but not high acuity patients. CONCLUSIONS: Under high census and patient acuity levels, rounding teams disproportionately shorten time spent discussing essential patient topics. Of note, while teams preserved time to plan the care for acute patients, they cut care plan discussions of low acuity patients. This study provides needed detail regarding how rounding teams adapt their discussions of essential topics and establishes a foundation for consideration of varying contextual factors in the design of rounding guidelines. As ICUs are challenged with increasing census and patient acuity levels, it is critical that we turn our attention to these contextual aspects and understand how these adaptations impact clinical outcomes to address them.

Enhancing cybersecurity situation awareness through visualization: A USB data exfiltration case study.

Employees who have legitimate access to an organization's data may occasionally put sensitive corporate data at risk, either carelessly or maliciously. Ideally, potential breaches should be detected as soon as they occur, but in practice there may be delays, because human analysts are not able to recognize data exfiltration behaviors quickly enough with the tools available to them. Visualization may improve cybersecurity situation awareness. In this paper, we present a dashboard application for investigating file activity, as a way to improve situation awareness. We developed this dashboard for a wide range of stakeholders within a large financial services company. Cybersecurity experts/analysts, data owners, team leaders/managers, high level administrators, and other investigators all provided input to its design. The use of a co-design approach helped to create trust between users and the new visualization tools, which were built to be compatible with existing work processes. We discuss the user-centered design process that informed the development of the dashboard, and the functionality of its three inter-operable monitoring dashboards. In this case three dashboards were developed covering high-level overview, file volume/type comparison, and individual activity, but the appropriate number and type of dashboards to use will likely vary according to the nature of the detection task). We also present two use cases with usability results and preliminary usage data. The results presented examined the amount of use that the dashboards received as well as measures obtained using the Technology Acceptance Model (TAM). We also report user comments about the dashboards and how to improve them.

Boosting Delirium Identification Accuracy With Sentiment-Based Natural Language Processing: Mixed Methods Study.

BACKGROUND: Delirium is an acute neurocognitive disorder that affects up to half of older hospitalized medical patients and can lead to dementia, longer hospital stays, increased health costs, and death. Although delirium can be prevented and treated, it is difficult to identify and predict. OBJECTIVE: This study aimed to improve machine learning models that retrospectively identify the presence of delirium during hospital stays (eg, to measure the effectiveness of delirium prevention interventions) by using the natural language processing (NLP) technique of sentiment analysis (in this case a feature that identifies sentiment toward, or away from, a delirium diagnosis). METHODS: Using data from the General Medicine Inpatient Initiative, a Canadian hospital data and analytics network, a detailed manual review of medical records was conducted from nearly 4000 admissions at 6 Toronto area hospitals. Furthermore, 25.74% (994/3862) of the eligible hospital admissions were labeled as having delirium. Using the data set collected from this study, we developed machine learning models with, and without, the benefit of NLP methods applied to diagnostic imaging reports, and we asked the question "can NLP improve machine learning identification of delirium?" RESULTS: Among the eligible 3862 hospital admissions, 994 (25.74%) admissions were labeled as having delirium. Identification and calibration of the models were satisfactory. The accuracy and area under the receiver operating characteristic curve of the main model with NLP in the independent testing data set were 0.807 and 0.930, respectively. The accuracy and area under the receiver operating characteristic curve of the main model without NLP in the independent testing data set were 0.811 and 0.869, respectively. Model performance was also found to be stable over the 5-year period used in the experiment, with identification for a likely future holdout test set being no worse than identification for retrospective holdout test sets. CONCLUSIONS: Our machine learning model that included NLP (ie, sentiment analysis in medical image description text mining) produced valid identification of delirium with the sentiment analysis, providing significant additional benefit over the model without NLP.

Physician Experience Design (PXD): More Usable Machine Learning Prediction for Clinical Decision Making.

Delirium is an acute neurocognitive disorder, which is difficult to identify and predict. Using GEMINI, Canada's largest hospital data and analytics study, we had a labeled sample of around 4,000 cases with approximately 25% of cases being labeled as having delirium. Based on this labeled data, we developed machine learning (ML) models and interacted with physicians to interpret the ML models and their predictions. We developed a preliminary Explainable Artificial Intelligence (XAI) framework for physician experience design (PXD) to improve the uptake of ML models by improving the transparency of model results, thereby increasing physician trust in models as well as the uptake of model results for clinical decision making. We developed our PXD approach first with Conceptual Investigation to collect and extract physicians' feedback on ML models and their evaluation requirements. We carried out a case study, working closely with the physicians in a participatory design process to develop a dashboard that presents ML delirium identification results interactively based on physician selections and inputs. In this approach a physician-preferred ML model for clinical decision making is selected through PXD evaluation.

Prevalence, management and outcomes of unrecognized delirium in a National Sample of 1,493 older emergency department patients: how many were sent home and what happened to them?

BACKGROUND: Retrospective studies estimate Emergency Department (ED) delirium recognition at <20%; few prospective studies have assessed delirium recognition and outcomes for patients with unrecognized delirium. OBJECTIVES: To prospectively measure delirium recognition by ED nurses and physicians, document their confidence in diagnosis and disposition, actual dispositions, and patient outcomes. METHODS: Prospective observational study of people ≥65 years. We assessed delirium using the Confusion Assessment Method, then asked ED staff if the patient had delirium, confidence in their assessment, if the patient could be discharged, and contacted patients 1 week postdischarge. We report proportions and 95% confidence intervals (Cls). RESULTS: We enrolled 1,493 participants; mean age was 77.9 years; 49.2% were female, 79 (5.3%, 95% CI 4.2-6.5%) had delirium. ED nurses missed delirium in 43/78 cases (55.1%, 95% CI 43.4-66.4%). Nurses considered 12/43 (27.9%) patients with unrecognized delirium safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 7.0/10. Physicians missed delirium in 10/20 (50.0%, 95% CI 27.2-72.8) cases and considered 2/10 (20.0%) safe to discharge. Median confidence in their delirium diagnosis for patients with unrecognized delirium was 8.0/10. Fifteen patients with unrecognized delirium were sent home: 6.7% died at 1 week follow-up vs. none in those with recognized delirium and 1.1% in the rest of the cohort. CONCLUSION: Delirium recognition by nurses and physicians was sub-optimal at ~50% and may be associated with increased mortality. Research should explore root causes of unrecognized delirium, and novel strategies to systematically improve delirium recognition and patient outcomes.

Longitudinal analysis of sustained performance on gamified cognitive assessment tasks.

Serious games aim to provide cognitive assessments that are more enjoyable and easier to self-administer, potentially leading to more frequent assessments. We carried out two studies examining the relationship between game-playing enjoyment, game difficulty, and cognitive (game) performance. In the first study, 16 participants played three serious games once a week over four weeks as part of an undergraduate course, but with relatively minor motivation in terms of course credits. In the second study, 14 participants played serious games over six sessions in a period of three weeks. Participants included graduate students receiving credit for the course project (a major component of the grade) and friends and family that they recruited. Performance in the more difficult tasks tended to improve over time in the second study, but not in the first. Participants from the first study showed an overall negative sentiment toward the games. However, participants from the second study enjoyed the majority of games except for the more difficult games that required players to temporarily hold and memorize information. Participants got significantly better in the more difficult working memory games, even though these games were less popular than the simpler games. Our interpretation of the results is that enjoyability is important in encouraging people to keep playing cognitive assessment games as time progresses, and that enjoyability helps in maintaining performance in easy games. Higher motivation on the other hand played a significant role in facilitating learning effects in difficult games as well as in maintaining enjoyability.

A meta-review of psychological resilience during COVID-19.

Psychological resilience has emerged as a key factor in mental health during the global COVID-19 pandemic. However, no work to date has synthesised findings across review work or assessed the reliability of findings based on review work quality, so as to inform public health policy. We thus conducted a meta-review on all types of review work from the start of the pandemic (January 2020) until the last search date (June 2021). Of an initial 281 papers, 30 were included for review characteristic reporting and 15 were of sufficient review quality for further inclusion in strategy analyses. High-level strategies were identified at the individual, community, organisational, and governmental levels. Several specific training and/or intervention programmes were also identified. However, the quality of findings was insufficient for drawing conclusions. A major gap between measuring the psychological resilience of populations and evaluating the effectiveness of strategies for those populations was revealed. More empirical work, especially randomised controlled trials with diverse populations and rigorous analyses, is strongly recommended for future research.

Psychological resilience during COVID-19: a meta-review protocol.

INTRODUCTION: The global COVID-19 pandemic continues to have wide-ranging implications for health, including psychological well-being. A growing corpus of research reviews has emerged on the topic of psychological resilience in the context of the pandemic. However, this body of work has not been systematically reviewed for its quality, nor with respect to findings on the effectiveness of tools and strategies for psychological resilience. To this end, a meta-review protocol is proposed with the following objectives: (1) identify review work on the topic of psychological resilience during COVID-19; (2) assess the quality of this review work using A MeaSurement Tool to Assess systematic Reviews; (3) assess the risk of bias in this work; (4) generate a narrative summary of the key points, strengths and weaknesses; (5) identify the psychological resilience strategies that have been reviewed; (6) identify how these strategies have been evaluated for their effectiveness; (7) identify what outcomes were measured and (8) summarise the findings on strategies for psychological resilience so far, providing recommendations, if possible. METHODS AND ANALYSIS: A systematic meta-review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews for Protocols and Joanna Briggs Institute umbrella review guidelines. Electronic searches of general databases, especially Web of Science, Scopus and PubMed, will be conducted. Only results from January 2020 onwards will be considered, coinciding with the COVID-19 pandemic. Only results in English will be included. Descriptive statistics, thematic analysis and narrative summaries describing the nature of the reviewed work and evaluation of psychological resilience strategies will be carried out. ETHICS AND DISSEMINATION: Ethical approval is not needed for systematic review protocols. The results of the meta-review will be published in an international peer-reviewed journal. The raw and summarised data will be shared in the journal or other open venues. PROSPERO REGISTRATION NUMBER: CRD42021235288.

Using a serious game to measure executive functioning: Response inhibition ability.

In previous research, we developed a serious target acquisition game (with moles as targets) for assessing cognitive speed. Tong, Chignell, Tierney, and Lee demonstrated that performance on the game may be a useful screening tool for risk of delirium onset. In this study, we validate a version of the game where there are not only targets (moles) that should be hit but also distractors (butterflies, or moles with hats) that should not be hit. We hypothesized that performance on the game should be a measure of response inhibition ability, which has been implicated as a factor in many types of psychopathology. We carried out an experiment (with 30 healthy participants) to test whether the serious game does in fact measure response inhibition by comparing game performance with a standard response inhibition task (the Go/No-Go discrimination task). Our results show that, with the distractors, the game does in fact assess response inhibition ability. We discuss the implications of this work for assessing executive functions in the elderly, and for evaluating recovery in neuro-rehabilitation, and declining ability to perform activities of daily living.

Comparing immersiveness and perceptibility of spherical and curved displays.

Curved displays are believed to create a feeling of immersiveness similar to virtual reality. However systematic studies are needed to demonstrate that this is, in fact, true and under what conditions. In an experimental study 24 participants compared five different displays (concave, convex, hemisphere, sphere and a flat display) in terms of their immersiveness and perceptibility, and they also rated their overall preferences. Both immersiveness and perceptibility affected overall preference ratings. Participants gave higher preference ratings to the convex and concave displays, which were rated high in immersiveness and perceptibility, but gave lower preference ratings to the hemisphere/spherical display which had high ratings on immersiveness but low ratings on perceptibility. The study results imply that curved displays do indeed create a feeling of immersiveness. Concave and convex displays were rated highly favorably and should receive more attention for applications where visual experience and a feeling of immersiveness is particularly important.

Picture-Word Interference Effects Are Robust With Covert Retrieval, With and Without Gamification.

The picture-word interference (PWI) paradigm has been used to investigate the time course of processes involved in word retrieval, but is challenging to implement online due to dependence on measurements of vocal reaction time. We performed a series of four experiments to examine picture-word interference and facilitation effects in a form of covert picture naming, with and without gamification. A target picture was accompanied by an audio word distractor that was either unrelated, phonologically-related, associatively-related, or categorically-related to the picture. Participants were instructed to judge whether the name of the target picture ended in the phoneme assigned to the block by pressing corresponding keys as quickly and accurately as possible. Experiments 1 and 2 successfully replicated categorical interference and phonological facilitation effects at different optimal stimulus-onset-asynchronies (SOAs) between words and pictures. Experiment 3 demonstrated that a key gamification feature (collecting coins) motivated faster speed at the expense of accuracy in the gamified vs. experimental format of the task. Experiment 4 adopted the optimal SOAs and verified that the gamification reveals expected interference and facilitation effects despite the speed-accuracy tradeoff. These studies confirmed that categorical interference occurs earlier than phonological facilitation, while both processes are independent from articulation and inherent to word retrieval itself. The covert PWI paradigm and its gamification have methodological value for neuroimaging studies in which articulatory artifacts obscure word retrieval processes, and may be developed into potential online word-finding assessments that can reveal word retrieval difficulties with greater sensitivity.

Challenges to Human Drivers in Increasingly Automated Vehicles.

OBJECTIVE: We examine the relationships between contemporary progress in on-road vehicle automation and its coherence with an envisioned "autopia" (automobile utopia) whereby the vehicle operation task is removed from all direct human control. BACKGROUND: The progressive automation of on-road vehicles toward a completely driverless state is determined by the integration of technological advances into the private automobile market; improvements in transportation infrastructure and systems efficiencies; and the vision of future driving as a crash-free enterprise. While there are many challenges to address with respect to automated vehicles concerning the remaining driver role, a considerable amount of technology is already present in vehicles and is advancing rapidly. METHODS: A multidisciplinary team of experts met to discuss the most critical challenges in the changing role of the driver, and associated safety issues, during the transitional phase of vehicle automation where human drivers continue to have an important but truncated role in monitoring and supervising vehicle operations. RESULTS: The group endorsed that vehicle automation is an important application of information technology, not only because of its impact on transportation efficiency, but also because road transport is a life critical system in which failures result in deaths and injuries. Five critical challenges were identified: driver independence and mobility, driver acceptance and trust, failure management, third-party testing, and political support. CONCLUSION: Vehicle automation is not technical innovation alone, but is a social as much as a technological revolution consisting of both attendant costs and concomitant benefits.

Overall Quality Performance of Long-Term Care Homes in Ontario.

In this paper, individually reported long-term care (LTC) quality indicators have been supplemented with the composite Qindex measure and applied to 614 homes in Ontario, Canada. This study (1) describes the overall quality performance of LTC homes across five years (2012-2017) and (2) determines if organizational factors impact quality performance. The results demonstrate significant, continuous sector-wide improvement in overall quality performance (as assessed by the Qindex) over time and significant differences in quality based on home size, operator size and ownership. This paper positions the Qindex, a global metric of quality, as a valuable tool for quality measurement and management in the LTC sector.

Predictive Ability of a Serious Game to Identify Emergency Patients With Unrecognized Delirium.

OBJECTIVES: Recognition of delirium in the emergency department (ED) is poor. Our objectives were to assess: (1) the diagnostic accuracy of the Predicting Emergency department Delirium with an Interactive Computer Tablet (PrEDICT) "serious game" to identify older ED patients with delirium compared to clinical recognition and (2) the feasibility of the PrEDICT application compared to existing tests of attention. DESIGN: Prospective observational study. SETTING: ED of a Canadian tertiary care center. PARTICIPANTS: We included ED patients, aged 70 years and older, with a minimum 4-hour stay. We excluded anyone with critical illness, communication barriers, and visual impairment or those unable to use a computer tablet. None had prevalent delirium by ED clinicians' routine clinical assessment. MEASUREMENTS: Participants were asked to tap targets on a tablet at four difficulty levels. Time and accuracy were automatically recorded. Other measures included the Confusion Assessment Method, the Delirium Severity Index, the Digit Vigilance Test (DVT), and the Choice Reaction Test (CRT). RESULTS: We enrolled 203 patients. Their average age was 80.6 years, 49.8% were female, and their average ED length of stay was 15.9 hours. Sixteen subjects had clinically unrecognized delirium, and 14 of them completed the PrEDICT game (87.5%). We developed a threshold score with 100% sensitivity (95% confidence interval [CI] = 76.8%-100.0%) and 59.7% specificity (95% CI = 52.3%-66.6%) to identify patients with clinically unrecognized delirium. The area under the curve was 0.86 (95% CI = 0.77-0.94). Completion rates were 196/203 (96.6%) for the PrEDICT serious game compared to 128/203 (63.1%) for the CRT and 51/203 (25.1%) for the DVT. CONCLUSION: Older ED patients were able to use our serious game, including 87.5% of those with clinically unrecognized delirium. The PrEDICT application has potential to act as a sensitive screening tool to identify older ED patients with clinically unrecognized delirium. J Am Geriatr Soc 67:2370-2375, 2019.

Physiotherapists' and Physiotherapy Students' Perspectives on the Use of Mobile or Wearable Technology in Their Practice.

Purpose: Although extensive research has been carried out on the determinants of mobile or wearable health care technology (mHealth), as well as on its acceptance by patients and other health care providers, very little research has been done on physiotherapists' perspectives on the use of mHealth in their current or future practice. The aims of this study were to (1) explore the attitudes of physiotherapists toward mHealth using a modified technology acceptance model questionnaire, (2) understand the applications and delivery paradigms that are most desirable, and (3) assess the content validity of the questionnaire. Method: The questionnaire was administered online. Participants (n=76) were recruited using snowball and convenience sampling. Data were analyzed using factor analysis and partial least-squares path modelling. Results: Results indicate that perceived usefulness and perceived ease of use were related to early adoptive behaviour among participants. We found no evidence that age, gender, experience, or practice setting influenced early adoptive behaviour. Participants demonstrated favourable attitudes toward mHealth tools in clinical practice. Conclusions: This article provides initial insights into factors that are likely to be significant determinants of adoption of mHealth among physiotherapists. Further work, including qualitative research, will help to identify personal and institutional factors that will improve the acceptance of mHealth.

Objectif : même si des recherches approfondies ont porté sur les déterminants de la technologie de santé mobile et portable (santé mobile) et sur leur acceptation par les patients et les professionnels de la santé, rares sont celles qui traitent des perspectives des physiothérapeutes à l'égard de l'utilisation de la santé mobile dans leur pratique actuelle et future. La présente étude visait à 1) explorer les attitudes des physiothérapeutes à l'égard de la santé mobile au moyen d'un modèle d'acceptation technologique modifié, 2) comprendre les applications et les paradigmes de prestation les plus souhaitables et 3) évaluer la validité du contenu du questionnaire. Méthodologie : les chercheurs ont publié le questionnaire en ligne. Ils ont recruté les sujets (n=76) par échantillonnage en boule de neige et par échantillonnage de commodité. Ils ont analysé les données à l'aide d'une analyse des facteurs et d'un modèle de régression des moindres carrés partiels. Résultats : d'après les résultats, la perception de l'utilité et de la facilité d'utilisation dépend du comportement d'adoption rapide des participants. Aucune donnée n'indique que l'âge, le sexe, l'expérience ou le lieu de pratique influe sur un comportement d'adoption rapide. Les participants avaient des attitudes favorables envers les outils de santé mobile en pratique clinique. Conclusion : le présent article donne des points de vue initiaux sur les facteurs susceptibles d'être des déterminants importants de l'adoption de la santé mobile par les physiothérapeutes. D'autres travaux, y compris des recherches qualitatives, contribueront à déterminer les facteurs personnels et institutionnels qui favoriseront l'acceptation de la santé mobile.

Monitoring Health Status in Long Term Care Through the Use of Ambient Technologies and Serious Games.

New technologies, such as serious games and ambient activities, are being developed to address problems of under-stimulation, anxiety, and agitation in millions of people living with dementia in long term care homes. Frequent interactions with instrumented versions of these technologies may not only be beneficial for long term care residents, but may also provide a valuable new set of multifaceted data related to the health status of residents over time. In this paper, we develop a model for health monitoring in healthcare environments and we report on two studies that show how medically relevant data can be collected from elderly residents and emergency department patients in an unobtrusive way. The first study shows how data related to cognitive abilities can be collected from elderly emergency department patients and the second study shows how detailed data on a range of factors can be collected from ambient activity units designed to provide engaging interactions for long term care residents. In summary, this paper proposes the use of new technologies to transform long term care from a data poor to a data rich environment, where the health status of long term care residents and elderly patients is more closely monitored.

Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study.

BACKGROUND: Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. METHODS: A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. RESULTS: Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1-7) and content (Mdn = 4; IQR = 3; range = 1-7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). CONCLUSIONS: HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.