Family Relationships and Alzheimer's Disease: A Systematic Review.

BACKGROUND: Family caregivers of people with Alzheimer's disease are the most important support in concrete personal and economic terms. Family dynamics play a fundamental role in the provision of informal caregiving benefits. OBJECTIVE: This review aims to identify factors related to the family caregiving of relatives with Alzheimer's disease, taking specifically into account the construct of coping and expressed emotion. METHODS: This is a systematic review including articles selected using search terms including "caregivers," "Alzheimer's," "family," and "relationship" in research databases. Findings were synthesized and categorized into themes. RESULTS: A total of 454 abstracts were identified. Following screening, lateral searches, and quality appraisal, 36 studies were included for synthesis. A total of 5 themes were identified: burden; demographics; coping strategies; caregiver mental health; and family dynamics and expressed emotions. CONCLUSION: The quality and level of evidence supporting each theme varied. We need further research into family dynamics ameliorating the caregiving and how to measure it.

Sharing Emotions Contributes to Regulating Collaborative Intentions in Group Problem-Solving.

Collaborative problem-solving has been gaining attention as more and more students and employees work together all around the world to find solutions to complex problems. This trend goes hand in hand with a growing interest in the role of affective processes in learning and problem-solving fields. However, the comprehension of real-time dynamics between emotional sharing and collaborative exchanges (what we propose to call "collaborative act") still needs to be deepened. The challenge is especially on understanding the interplay between real-time changes in epistemic and relational dimensions. In this study, we propose to explore this question in dyadic creative problem-solving. Eleven pairs of participants used an argument graph tool to co-create a slogan against violence at school. The tool was used to write down slogans and build a joint map of the group argumentation. During the collaboration, they had access to an emotion awareness tool, allowing them to share emotional labels in real time. An indicator of real-time use was computed to track ongoing changes in collaborative acts during collaboration. Then, using both inferential and descriptive statistics, we first investigated whether emotional sharing induces real-time adaptation of both emitter's and receiver's collaborative acts. Second, we looked at privileged relationships between emitter's collaborative acts, emitter's emotion sharing, and receiver's collaborative acts. The preliminary results obtained (1) confirm that emotional sharing regulates emitter's and receiver's collaborative acts and (2) strongly suggest that specific emotions mark specific patterns of collaboration in different collaborative phases, implying both the epistemic and the relational spaces of collaboration. These results highlight the value of studying emotional sharing for a deeper comprehension of the factors regulating collaborative problem-solving. Perspectives in educational psychology and computer science are considered, with the will to understand and promote better self- and co-regulation of collaborative problem-solving through emotional sharing.

Cross-Representational Signaling and Cohesion Support Inferential Comprehension of Text-Picture Documents.

Learning from a text-picture multimedia document is particularly effective if learners can link information within the text and across the verbal and the pictorial representations. The ability to create a mental model successfully and include those implicit links is related to the ability to generate inferences. Text processing research has found that text cohesion facilitates the generation of inferences, and thus text comprehension for learners with poor prior knowledge or reading abilities, but is detrimental for learners with good prior knowledge or reading abilities. Moreover, multimedia research has found a positive effect from adding visual representations to text information, particularly when implementing signaling, which consists of verbal or visual cues designed to guide attention to the pictorial representation of relevant information. We expected that, as with text-only documents, struggling readers would benefit from high text cohesion (Hypothesis 1) and that signaling would foster inference generation as well (Hypothesis 2). Further, we hypothesized that better learning outcomes would be observed when text cohesion was low and signaling was present (Hypothesis 3). Our first experimental study investigated the effect of those two factors (cohesion and signaling) on three levels of comprehension (text based, local inferences, global inferences). Participants were adolescents in prevocational schools (n = 95), where some of the students are struggling readers. The results showed a trend in favor of high cohesion, but with no significant effect, a significant positive effect of cross-representational signaling (CRS) on comprehension from local inferences, and no interaction effect. A second experiment focused on signaling only and attention toward the picture, with collection of eye-tracking data in addition to measures of offline comprehension. As this study was conducted with university students (n = 47), who are expected to have higher reading abilities and thus are less likely to benefit from high cohesion, the material was presented in its low cohesive version. The results showed no effect of conditions on comprehension performances but confirmed differences in processing behaviors. Participants allocated more attention to the pictorial representation in the CRS condition than in the no signaling condition.

How Regrouping Alerts in Computerized Physician Order Entry Layout Influences Physicians' Prescription Behavior: Results of a Crossover Randomized Trial.

BACKGROUND: As demonstrated in several publications, low positive predictive value alerts in computerized physician order entry (CPOE) induce fatigue and may interrupt physicians unnecessarily during prescription of medication. Although it is difficult to increase the consideration of medical alerts by physician through an improvement of their predictive value, another approach consists to act on the way they are presented. The interruption management model inspired us to propose an alternative alert display strategy of regrouping the alerts in the screen layout, as a possible solution for reducing the interruption in physicians' workflow. OBJECTIVE: In this study, we compared 2 CPOE designs based on a particular alert presentation strategy: one design involved regrouping the alerts in a single place on the screen, and in the other, the alerts were located next to the triggering information. Our objective was to evaluate experimentally whether the new design led to fewer interruptions in workflow and if it affected alert handling. METHODS: The 2 CPOE designs were compared in a controlled crossover randomized trial. All interactions with the system and eye movements were stored for quantitative analysis. RESULTS: The study involved a group of 22 users consisting of physicians and medical students who solved medical scenarios containing prescription tasks. Scenario completion time was shorter when the alerts were regrouped (mean 117.29 seconds, SD 36.68) than when disseminated on the screen (mean 145.58 seconds, SD 75.07; P=.045). Eye tracking revealed that physicians fixated longer on alerts in the classic design (mean 119.71 seconds, SD 76.77) than in the centralized alert design (mean 70.58 seconds, SD 33.53; P=.001). Visual switches between prescription and alert areas, indicating interruption, were reduced with centralized alerts (mean 41.29, SD 21.26) compared with the classic design (mean 57.81, SD 35.97; P=.04). Prescription behavior (ie, prescription changes after alerting), however, did not change significantly between the 2 strategies of display. The After-Scenario Questionnaire (ASQ) that was filled out after each scenario showed that overall satisfaction was significantly rated lower when alerts were regrouped (mean 4.37, SD 1.23) than when displayed next to the triggering information (mean 5.32, SD 0.94; P=.02). CONCLUSIONS: Centralization of alerts in a table might be a way to motivate physicians to manage alerts more actively, in a meaningful way, rather than just being interrupted by them. Our study could not provide clear recommendations yet, but provides objective data through a cognitive psychological approach. Future tests should work on standardized scenarios that would enable to not only measure physicians' behavior (visual fixations and handling of alerts) but also validate those actions using clinical criteria.

How spatial abilities and dynamic visualizations interplay when learning functional anatomy with 3D anatomical models.

The emergence of dynamic visualizations of three-dimensional (3D) models in anatomy curricula may be an adequate solution for spatial difficulties encountered with traditional static learning, as they provide direct visualization of change throughout the viewpoints. However, little research has explored the interplay between learning material presentation formats, spatial abilities, and anatomical tasks. First, to understand the cognitive challenges a novice learner would be faced with when first exposed to 3D anatomical content, a six-step cognitive task analysis was developed. Following this, an experimental study was conducted to explore how presentation formats (dynamic vs. static visualizations) support learning of functional anatomy, and affect subsequent anatomical tasks derived from the cognitive task analysis. A second aim was to investigate the interplay between spatial abilities (spatial visualization and spatial relation) and presentation formats when the functional anatomy of a 3D scapula and the associated shoulder flexion movement are learned. Findings showed no main effect of the presentation formats on performances, but revealed the predictive influence of spatial visualization and spatial relation abilities on performance. However, an interesting interaction between presentation formats and spatial relation ability for a specific anatomical task was found. This result highlighted the influence of presentation formats when spatial abilities are involved as well as the differentiated influence of spatial abilities on anatomical tasks.

A qualitative analysis of prescription activity and alert usage in a computerized physician order entry system.

Medical alerts in CPOE are overridden in most cases. The need for alerting systems that are better adapted to physicians' needs and work processes is recognized. Our study aims to shed some light on how medical alerts are used and how they are integrated in the work process. Work analysis and interviews resulted in a hierarchical task analysis of prescription during ward rounds at the University Hospitals of Geneva. The results indicate that non-modal medical alerts are appreciated as an "insurance" for drugs that are out of the routine set. In the case of drugs that are often prescribed, alerts are ignored as physicians feel comfortable prescribing them. Non-interrupting alerts do not cognitively overcharge physicians, but the question is how to display the numerous alerts so that they are easily accessible when needed. Further, inexperienced physicians lack a mental representation of what evaluations the system is doing with the prescriptions and when alerts are triggered. This may lead to lack of trust or overconfidence, both of them potentially harmful.