Acceptance Survey Research Articles

Understanding the operational, organisational and financial challenges in telehealth adoption through multi-disciplinary collaborative research

Introduction: Further understanding of the challenges in the adoption of technology enabled care services is required if these are ever to transcend their current status as an NHS England policy aspiration. Accordingly, this research aimed to explore the operational, organisational and financial barriers to using telehealth in community health settings. Aims and objectives: The overall aim of this multi-disciplinary collaborative research study was to document the key barriers to, and facilitators of telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure, with a particular focus on (1) staff, patient and carer perspectives; (2) business models and organisational design; and (3) cost-effectiveness. Methods: This mixed-methods longitudinal research was completed in two phases within four community health sites in the Yorkshire and Humber region over two years. During phase 1, qualitative interviews with 21 healthcare managers, 84 frontline staff, 40 patients and 12 carers were completed to build up detailed case studies of the local telehealth services, which were subsequently developed in several ways for the next phase. Phase 2 involved action research with staff to create and evaluate solutions to identified operational barriers, creative workshops to generate future telehealth business models, the production of a patient acceptance questionnaire and survey (n=266), and the development of financial and health economic models for telehealth (which is also based on a meta-analysis of clinical effectiveness and analysis of large-scale healthcare utilisation data). Results: Looking across the programme of research, it is evident that wider adoption of telehealth is hindered by several interrelated factors, all of which must also be considered within the context of enormous change currently affecting the NHS. The key findings include the following: (1) The stakeholder map for telehealth is complex, varies between community services and is changeable over time; (2) There are a number of competing rationales for investment in telehealth and its use in clinical practice; (3) There are ongoing difficulties in demonstrating evidence of benefit; (4) Discordance between who pays for and who potentially benefits from telehealth services creates complexity in the design of business models; (5) Uncertainty amongst clinical staff about the benefits of telehealth and how this can be integrated into practice is important, especially where frontline nurses act as gatekeepers to patients; and (6) There is an absence of clear clinical pathways for telehealth and appropriate support at key stages of implementation and delivery. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116513– http://www.ijic.org/ International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. Conclusion: There needs to be greater recognition of the complexity and interrelatedness of operational, organisational and financial barriers to the expansion of technology enabled care services. This is a critical first step in designing service models that can overcome this intricate web of barriers and make the policy aspirations a reality within the NHS.

Acceptance Survey of GM Food in China

The safety issue of genetically modified (GM) food has been controversial for several decades. China is a major GM food import, production and consumption country which accounts for almost 20% of the world's population. This article analyzes the present situation of China's GM food based on domestic consumer behavior, market behavior and government behavior. A wide range of public polls and markets research were taken to collect data of GM food. The roots of GM food develop and some improvements are also discussed in this study.

Student Perceptions of Using a SCORM-Compliant Learning Object (SCLO) for Learning in an ODL Environment

The sharable content object reference model (SCORM) has become one of the important specifications forcontent packaging and platform development in open and distance learning (ODL). SCORM-compliant learning objects(SCLO) areknowledge repositories that have been meta-tagged for SCORMcompliance.SCLO can be easily interoperated among different learning management systems (LMS) without being tied to a single content provider or authoring tool. The content can last longer because it is easier to justify ongoing compatibility with standard content. The purpose of this research is to examine student acceptance of SCLO. The involvement of students wasimportant for a successful content delivery process. Therefore,students'acceptance behavior should be assessed as this reflects whethertheywill eventually adopt SCLO in their learning. Data were collected through Davis's extended technology acceptance survey instrument. The data collected werefurther analysed and evaluated. The results of thisstudy are useful for instructors and course designers with respect to the use of SCLO in their respective courses or anycontent deliveryprocess.

Application of the Analytic Hierarchy Process for the selection of wastewater reuse targets

Purpose – The purpose of this paper is to investigate the principles on how to reuse the reclaimed wastewater in urban areas and furthermore, to determine appropriate reuse targets and optimize the selection of reuse targets on wastewater. Design/methodology/approach – Use Analytic Hierarchy Process (AHP) to suggest the assessment criteria and subject weights of wastewater reuse. Candidate reclaimed wastewater reuse targets in this study includes “agriculture irrigation,” “industrial use,” “environmental use,” “urban use,” “groundwater recharge,” “life-use water,” and “infusion reservoir.” Findings – The analysis results of the pairwise comparison of the water targets under different assessment criteria level show that in all water targets, agriculture irrigation is more important than industrial use under the “public acceptance” at first. Then, the order results were used to suggest the future wastewater reuse targets under different assessment criteria levels and conducted an acceptance survey on the people of the urban areas. Originality/value – The results of this study can be a useful information for the system analysis of wastewater reclamation and reuse.

The development of an automated device for asthma monitoring for adolescents: methodologic approach and user acceptability.

BackgroundMany adolescents suffer serious asthma related morbidity that can be prevented by adequate self-management of the disease. The accurate symptom monitoring by patients is the most fundamental antecedent to effective asthma management. Nonetheless, the adequacy and effectiveness of current methods of symptom self-monitoring have been challenged due to the individuals’ fallible symptom perception, poor adherence, and inadequate technique. Recognition of these limitations led to the development of an innovative device that can facilitate continuous and accurate monitoring of asthma symptoms with minimal disruption of daily routines, thus increasing acceptability to adolescents.ObjectiveThe objectives of this study were to: (1) describe the development of a novel symptom monitoring device for teenagers (teens), and (2) assess their perspectives on the usability and acceptability of the device.MethodsAdolescents (13-17 years old) with and without asthma participated in the evolution of an automated device for asthma monitoring (ADAM), which comprised three phases, including development (Phase 1, n=37), validation/user acceptability (Phase 2, n=84), and post hoc validation (Phase 3, n=10). In Phase 1, symptom algorithms were identified based on the acoustic analysis of raw symptom sounds and programmed into a popular mobile system, the iPod. Phase 2 involved a 7 day trial of ADAM in vivo, and the evaluation of user acceptance using an acceptance survey and individual interviews. ADAM was further modified and enhanced in Phase 3.ResultsThrough ADAM, incoming audio data were digitized and processed in two steps involving the extraction of a sequence of descriptive feature vectors, and the processing of these sequences by a hidden Markov model-based Viterbi decoder to differentiate symptom sounds from background noise. The number and times of detected symptoms were stored and displayed in the device. The sensitivity (true positive) of the updated cough algorithm was 70% (21/30), and, on average, 2 coughs per hour were identified as false positive. ADAM also kept track of the their activity level throughout the day using the mobile system’s built in accelerometer function. Overall, the device was well received by participants who perceived it as attractive, convenient, and helpful. The participants recognized the potential benefits of the device in asthma care, and were eager to use it for their asthma management.ConclusionsADAM can potentially automate daily symptom monitoring with minimal intrusiveness and maximal objectivity. The users’ acceptance of the device based on its recognized convenience, user-friendliness, and usefulness in increasing symptom awareness underscores ADAM’s potential to overcome the issues of symptom monitoring including poor adherence, inadequate technique, and poor symptom perception in adolescents. Further refinement of the algorithm is warranted to improve the accuracy of the device. Future study is also needed to assess the efficacy of the device in promoting self-management and asthma outcomes.

English

Given strong research support for improvement of students’ conceptual understanding with multiple representations, it is important to understand effects of different representations on student achievement. In this study, an online manipulative tool (OMT) was introduced to students to support their study of rational number operations. The purpose is to compare different representational aspects of OMT and to estimate OMT’s effects on achievement and technology acceptance when compared to traditional classroom activities. Elementary- and middle-grade students were randomly assigned to the control group (N = 14) or one of the following three treatment groups: (a) audiovisual (N = 14), (b) virtual-kinesthetic (N = 15), and (c) dual-mode (virtual-kinesthetic and audiovisual combined) groups (N = 11). When the control group was compared with experimental groups, pre- and post-test results suggested OMT was more effective than traditional classroom activities in improving students’ understanding of rational number operations. When students’ achievement on pre- and post-tests among experimental groups was compared, no substantial difference was found. However, students in the dual-mode group scored the highest on technology acceptance survey. The results suggest learning can be facilitated by virtual manipulatives. However, students’ acceptances of technology should be considered when implementing new technologies

Participation in virtual academic communities of practice under the influence of technology acceptance and community factors. A learning analytics application

Participation in virtual communities of practice (vCoP) can be influenced at the same time by technology acceptance and by community factors. To overcome methodological issues connected with the analysis of these influences, learning analytics were applied. Based on a recent vCoP model, the collaborative dialogue comprising 4040 interventions in 1981 messages created by a vCoP located at a US American online university was automatically analyzed. The text-based asynchronous online discussions were scored using a cohesion-based participation and collaboration analysis. Additionally, a sample of N=133 vCoP participants responded a technology acceptance survey. Thus, a combined research model including the vCoP model and an established technology acceptance model was verified. The results confirmed the vCoP model entirely, and the acceptance model only partially. As consequence for educational research, the CoP model was confirmed and extended to vCoP settings, while the acceptance model appears to need reconsideration. For academic practice, the study initiates the development of assessment tools fostering knowledge sharing through dialogue in vCoP. Also, it suggests how virtual classrooms can be extended to open spaces where value creation takes place through social learning. Learning analytics proved thus successful, provides information that impacts both theory and practice of technology-enhanced learning.

The Impact of Technology Dependency on Device Acceptance and Quality of Life in Persons With Implantable Cardioverter Defibrillators

The impact of implantable cardioverter defibrillator (ICD) technology on the quality of life (QOL) experienced by recipients has been a major focus of recent research. Numerous studies have found psychological distress to be important in determining QOL in persons receiving ICDs, yet the source of psychological distress is not well understood. The aim of this study was to determine the impact of technology dependency on psychological outcomes in ICD recipients. With the use of a cross-sectional design, 161 ICD recipients from 1 device clinic were mailed self-administered questionnaires, including the Dependency on Technology Scale, Brief Illness Perception Questionnaire, Florida Shock Anxiety Scale, Florida Patient Acceptance Survey, and Short Form-12 (SF-12). Hierarchical multiple regressions and analyses of variance were performed. The final sample size was 101 participants. Mean (SD) age was 68 (13) years; 72% of the participants were men, 99% were white, and 30% reported receiving a shock(s). A total of 80% reported positive attitudes toward technology dependency; 14%, neutral; and 6%, negative (Dependency on Technology Scale). Illness perceptions were positive (Brief Illness Perception Questionnaire; mean[SD], 34.5 [12.6]), shock anxiety was elevated (Florida Shock Anxiety Scale; mean [SD], 16.5 [6.7]), and device acceptance was good (Florida Patient Acceptance Survey; mean [SD], 74.9 [17.0]). Physical health QOL was low (SF-12; mean [SD], 38.6 [11.3]) and mental health QOL was moderate (SF-12; mean [SD], 50.6 [10.0]). Attitudes toward technology dependency significantly accounted for the variance seen in device acceptance and mental health QOL beyond age, gender, number of shocks, illness perceptions, and shock anxiety by 5.7% (P = .001) and 3.3% (P = .04), respectively. Significant differences were seen in device acceptance between those with negative and neutral attitudes (P = .001) and those with negative and positive attitudes (P < .001) and in shock anxiety and mental health QOL between those with negative and those with positive attitudes (P < .001). Attitudes toward technology dependency is significantly associated with psychological outcomes and may explain the psychological distress in some ICD recipients. Degree of positivity toward technology dependency influences these outcomes. Research evaluating attitudes toward technology dependency and testing of interventions focusing on these attitudes is warranted.

PCV132 - Health Related Quality of Life and Device-Acceptance in Patients with Implantable Cardioverter-Defibrillators and Telemonitoring

HEALTH RELATED QUALITY OF LIFE AND DEVICE-ACCEPTANCE IN PATIENTS WITH IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS AND TELEMONITORING Florian Leppert, Johannes Siebermair, Stefan Kaab, Wolfgang Greiner OBJECTIVES: Telemedical systems (TMS) and data management for implantable cardioverter-defibrillators (ICD) promise to reduce costs and optimize patient care. Depressive symptoms are common among patients with an ICD and the health related quality of life (HRQoL) is affected by the underlying disease and the implanted device, respectively. TMS might improve the HRQoL of patients and ICDs acceptance due to a closer monitoring and, thereby, an increased level of perceived safety. In this study, changes in the level of depression, HRQoL and device acceptance over a period of six months after ICD-implantation were investigated. METHODS: In this randomized controlled trial, 161 (80.7% male; age: 64,1 ± 14,6; 82% with coronary disease, 11% with dilated cardiomyopathy) patients with an ICD were randomized at the day of implantation into intervention (n=82) or control group (n=79). Patients in the intervention group were equipped with a telemonitoring system that transferred device data (e.g. critical events, status of battery, heart function) from the patients’ home to the medical practitioner via internet. The control group received regular care. Patients were asked to fill out three questionnaires (the generic EQ-5D, the depression specific Hospital Anxiety and Depression Scale (HADS) and the device specific Florida Patient Acceptance Survey (FPAS)); the follow-up period was six month, with postal surveys on a monthly basis (7 times in total). Collected data were analyzed in a pseudonymized manner. Datasets with missing values were filled by applying the Expectation-Maximization (EM) method. RESULTS: Nine patients dropped out before survey completion at month six for different reasons (e.g. draw back consent or death). Of the remaining 152 patients 140 patients filled out at least two sets of questionnaires and were included in the analyses. After six months the mean improvement in the health related quality of life (EQ-5D-Index) in the telemonitoring group was 10.7 points compared to baseline (p=.006) while the mean change in HRQoL in the control group was 5.5 points (p=.138). FPAS and HADS-D showed small but non-significant advantage for the telemonitoring group concerning acceptance and level of depression, respectively. CONCLUSIONS: Preliminary results suggest that telemonitoring systems have the ability to improve the health related quality of life of patients with implantable cardioverter-defibrillators. Results on effects towards the level of depression and anxiety and the enhancement of ICDs acceptance are also promising. Since ICDs are used in chronic heart diseases a longer follow-up period seems to be required to validate the effects.

The Registry Evaluating Functional Outcomes of Resynchronization Management (REFORM): Quality of Life and Psychological Functioning in Patients Receiving Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) that improves cardiac, functional, and quality of life (QoL) outcomes. This study was designed to examine the effect of the addition of CRT (CRTD) to the implantable cardioverter defibrillator (ICD) on psychological functioning. Overall, 99 participants completed batteries before and 9 months after ICD or CRTD implantation in a registry of HF patients receiving device treatment in 3 US centers. Measures included validated indices of mental health (State Trait Anxiety Inventory, Patient Health Questionnaire: Depression) and generic and disease/device-specific QoL (Medical Outcomes Study-Short Form-12, Kansas City Cardiomyopathy Questionnaire, Florida Patient Acceptance Survey, Florida Shock Anxiety Scale). Mixed between-within analyses of covariance were employed to compare device groups on each outcome controlling for cardiac and demographic covariates. Clinically significant anxiety was elevated in both groups at both time points (57% CRTD at baseline, 29% CRTD 9 months, 44% ICD at baseline, 45% ICD 9 months). Clinically significant depressive symptoms were high at baseline (38% CRTD, 31% ICD), but dropped at follow-up (16% CRTD, 7% ICD; P = 0.01). Participants with CRTD had improved mental component and disease-specific QoL following CRT; however, CRTD patients had worse QoL, worse mental component QoL at baseline, and worse device acceptance at 9-month follow-up than patients with ICDs (all P < 0.05). Evidence of low QoL, psychological functioning, and device acceptance provides the impetus to increase research on well-being of HF patients being implanted with CRTD in research and clinical work.

The relationship between perceived support from healthcare professionals, shock anxiety and device acceptance in implantable cardioverter defibrillator recipients

Purpose: The recipients acceptance of the implantable cardioverter defibrillator (ICD) can be influenced by several factors. One factor is perceived support from healthcare professionals during regular follow-up visits. Another factor is shock anxiety, i.e. the recipients concerns and fear related to possible future shocks. However, little is known about the relationship between perceived support from healthcare professionals, shock anxiety and device acceptance among the recipients. The purpose of this study is 1) to investigate the extent to which shock anxiety and perceived support from healthcare professional support is related to device acceptance and 2) to determine to what degree perceived support from health care professional moderates the relationship between shock anxiety and device acceptance in ICD recipients. Methods: A cross-sectional study comprising recipients (N-167, 80% male, mean age = 64 years) attending an outpatient device clinic completed standardized and validated questionnaires assessing perceived support from healthcare professionals, shock anxiety (the Florida Shock Anxiety Scale) and device acceptance (the Florida Patient Acceptance Survey). Demographic and clinical data were collected by self-report and from medical records in September-October 2010. The statistical analyses included descriptive statistics and multiple regression analyses. Results: The descriptive results indicated that 84.4% of the recipients reported high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance (p<0.05) and moderated the negative relationship between shock anxiety and device acceptance (p<0.05). Non-constructive support and shock anxiety were statistically negatively associated with device acceptance (p<0.01). Conclusions: Healthcare professionals represent a valuable constructive support system that can enhance device acceptance among ICD recipients, partly by preventing shock anxiety from leading to poor device acceptance. On the other hand, the findings suggest that non-constructive communication on the part of healthcare professionals could hinder device acceptance.

Disease-Specific Quality of Life—Patient Acceptance

Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance. A total of 101 ICD patients (mean age, 65 ± 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida shock anxiety scale, ENRICHD social support instrument, hospital anxiety and depression scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit. All multiple-item scales demonstrated good internal consistency reliability, with Cronbach α values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity (β = .10, P = .15), age (β = .01, P = .90), and number of comorbidities (β = .19, P = .003) in a hierarchical multiple regression, shock anxiety (β = .31, P < .001), knowledge of the device (β = .23, P = .001), social support (β = .13, P = .08), Hospital Anxiety and Depression Scale anxiety (β = .06, P = .51) and depression (β = .25, P = .01), and importance of religion (β = .17, P = .01) explained 46.8% of the variance in FPAS scores. Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.

Submammary Device Implantation in Women: A Step‐by‐Step Approach

The frequency of device implantation is increasing in younger patients as our ability to diagnose long-QT syndrome, hypertrophic cardiomyopathy, Brugada Syndrome, and other life-threatening disorders earlier has improved. Similarly, use of cardiac resynchronization therapy and ICD therapies has increased in cardiomyopathy patients. Device implantation in young women has unique considerations. Standard pectoral implants lead to excessive scar formation due to skin tension and interfere with purse straps, bra straps, and seat belts. There are also privacy and body image concerns as the subclavian region is exposed with many contemporary fashions. Over an 11-year period, we implanted pacemakers, implantable converter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices (defibrillators or pacemakers) in 60 women, aged 13-70 years, using a 2-incision submammary approach. Follow-up surveys were performed using the Florida Patient Acceptance Survey (FPAS). Women with submammary device placement reported significantly greater device acceptance (M = 92.41, SD = 6.46) than women with standard implant technique (M = 70.29, SD = 17.85); t (54) =-6.08, P < 0.001, on the FPAS. Across subscales on the FPAS, women with submammary device placement also reported significantly less body image concern (P < 0.001), less device-related emotional distress (P < 0.001), and greater confidence in returning to life appropriately (P = 0.01) than women with standard device placement. We present here our technique for submammary device implantation.

General and Disease-Specific Psychosocial Adjustment in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy With Implantable Cardioverter Defibrillators: A Large Cohort Study

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by frequent life-threatening ventricular arrhythmias, diagnosed on average in the teens to mid-50s and commonly treated by implantable cardioverter defibrillators (ICDs). As younger age and high frequency of ICD discharges are risk factors for difficulties in psychosocial adjustment, we developed a study to assess psychosocial adjustment among patients with ARVD/C and to determine risk factors for poor adjustment in this high-risk population. Eighty-six adults enrolled in the Johns Hopkins ARVD Registry (38 male; mean age, 45.4±12.9 years), with an ICD in place for a median 3.2 years (range, 0.2 to 20.1 years), completed a set of questionnaires measuring ICD-specific anxiety (Florida Shock Anxiety Scale), device acceptance (Florida Patient Acceptance Survey), anxiety and depression (Hospital Anxiety and Depression Scale), and functional capacity (Duke Activity Status Index). Although overall device acceptance (Florida Patient Acceptance Survey mean, 76.7±15.3) was normative, patients with ARVD/C had substantially elevated body image concerns (Florida Patient Acceptance Survey subscale mean, 17.9±23.5) and device-related distress (subscale mean, 26.5±19.2), particularly among younger patients (P<0.01). Patients with ARVD/C had elevated ICD-specific (Florida Shock Anxiety Scale mean, 22.9±7.8) and general clinical anxiety (Hospital Anxiety and Depression Scale anxiety subscale mean, 6.2±3.9). Device-specific anxiety (Florida Shock Anxiety Scale) was predicted by younger age (P<0.0001), poorer functional capacity (P=0.016), having an ICD shock (P=0.003), and shorter time since ICD implant (P=0.007). Participants with poor device adjustment had an increased likelihood of clinically significant anxiety (P=0.006) and depression (P=0.008). Patients with ARVD/C are at elevated risk for anxiety, and young patients face challenges with device acceptance. Risk factors for poor device adjustment may be used clinically to identify patients at high-risk of psychological distress.

GIS and the Analytic Hierarchy Process for Regional Landfill Site Selection in Transitional Countries: A Case Study From Serbia

The Serbian National Waste Management Strategy for the Period 2010-2019, harmonized with the European Union Directives, mandates new and very strict requirements for landfill sites. To enable analysis of a number of required qualitative and quantitative factors for landfill site selection, the traditional method of site selection must be replaced with a new approach. The combination of GIS and the Analytic Hierarchy Process (AHP) was selected to solve this complex problem. The Srem region in northern Serbia, being one of the most environmentally sensitive areas, was chosen as a case study. Seventeen factors selected as criteria/sub-criteria were recognized as most important, divided into geo-natural, environmental, social and techno-economic factors, and were evaluated by experts from different fields using an AHP extension in Arc GIS. Weighted spatial layers were combined into a landfill suitability map which was then overlapped with four restriction maps, resulting in a final suitability map. According to the results, 82.65% of the territory of Srem is unsuitable for regional landfill siting. The most suitable areas cover 9.14%, suitable areas 5.24%, while areas with low and very low suitability cover 2.21 and 0.76% of the territory, respectively. Based on these findings, five sites close to two large urban agglomerations were suggested as possible locations for a regional landfill site in Srem. However, the final decision will require further field investigation, a public acceptance survey, and consideration of ownership status and price of the land.

The Impact of Technology Dependency on Device Acceptance and Quality of Life in Persons with Implantable Cardioverter Defibrillators

BACKGROUND: The impact of implantable cardioverter defibrillator (ICD) technology on the quality of life (QOL) experienced by recipients has been a major focus of recent research. Numerous studies have found psychological distress to be important in determining QOL in persons receiving ICDs, yet the source of psychological distress is not well understood. OBJECTIVE: The aim of this study was to determine the impact of technology dependency on psychological outcomes in ICD recipients. METHODS: With the use of a cross-sectional design, 161 ICD recipients from 1 device clinic were mailed self-administered questionnaires, including the Dependency on Technology Scale, Brief Illness Perception Questionnaire, Florida Shock Anxiety Scale, Florida Patient Acceptance Survey, and Short Form-12 (SF-12). Hierarchical multiple regressions and analyses of variance were performed. RESULTS: The final sample size was 101 participants. Mean (SD) age was 68 (13) years; 72% of the participants were men, 99% were white, and 30% reported receiving a shock(s). A total of 80% reported positive attitudes toward technology dependency; 14%, neutral; and 6%, negative (Dependency on Technology Scale). Illness perceptions were positive (Brief Illness Perception Questionnaire; mean[SD], 34.5 [12.6]), shock anxiety was elevated (Florida Shock Anxiety Scale; mean [SD], 16.5 [6.7]), and device acceptance was good (Florida Patient Acceptance Survey; mean [SD], 74.9 [17.0]). Physical health QOL was low (SF-12; mean [SD], 38.6 [11.3]) and mental health QOL was moderate (SF-12; mean [SD], 50.6 [10.0]). Attitudes toward technology dependency significantly accounted for the variance seen in device acceptance and mental health QOL beyond age, gender, number of shocks, illness perceptions, and shock anxiety by 5.7% (P = .001) and 3.3% (P = .04), respectively. Significant differences were seen in device acceptance between those with negative and neutral attitudes (P = .001) and those with negative and positive attitudes (P < .001) and in shock anxiety and mental health QOL between those with negative and those with positive attitudes (P < .001). CONCLUSIONS: Attitudes toward technology dependency is significantly associated with psychological outcomes and may explain the psychological distress in some ICD recipients. Degree of positivity toward technology dependency influences these outcomes. Research evaluating attitudes toward technology dependency and testing of interventions focusing on these attitudes is warranted.

Longitudinal Investigation of Patient Centric Outcomes: Comparisons between CRT-D vs. ICD Patients

Introduction: The addition of cardiac resynchronization therapy (CRT) to the ICD has demonstrated significant symptomatic, QOL and mortality benefit in heart failure patients. However, comparisons of the psychosocial impact of CRT-D vs ICD alone have not been examined. The purpose of this study was to investigate differences in patient centric outcomes between patients receiving either an ICD or a CRT-D. Methods: 98 ICD patients (49 had CRT-D) were enrolled at 3 centers. QOL (KCCQ and SF-12), depression (PHQ-9), and stress (Spielberger State-Trait Anxiety Inventory) were assessed at baseline and 9 months post-implant while shock anxiety (Florida Shock Anxiety Scale) and device acceptance (Florida Shock Anxiety Scale and Florida Patient Acceptance Survey) were assessed at 3 and 9 months. Results: Defibrillator patient groups (CRT-D vs ICD) were demographically similar at baseline (80 vs 90% Caucasian, 66 vs 64 years old, 51 vs 48% ischemic) with the exception of gender (41 vs 19% female), NYHA class III (87 vs 40%), LVESV (185 vs 44ml), KCCQ (49+25 vs 60+26) and QRS duration (146 vs 111 ms). Comparisons between CRT-D and ICD patient groups on study measures at each time point revealed no significant differences. Within group comparisons over time indicated that CRT patients had significant improvement in KCCQ (21% change from 49 baseline score), SF-12 mental score (12% change from 48), depression (31% change from 8.5) and stress (12% change from 31.5), while ICD patients without CRT did not have any significant changes in psychosocial status (p!.05). Shock anxiety and device acceptance were similar between groups, and there were no significant changes from 3 to 9 months. Conclusions: Patients implanted with defibrillators capable of providing CRT had psychosocial improvement in terms of QOL, depression, and stress, while patients with defibrillators without CRT were unchanged. These results demonstrate potential additional benefit of CRT in patient centric outcomes following CRT-D implantation.

The Technology Acceptance Model

The purposes of this study were to determine factors and predictors that influence nurses' intention to use the eICU technology, to examine the applicability of the Technology Acceptance Model in explaining nurses' intention to use the eICU technology in healthcare settings, and to provide psychometric evidence of the measurement scales used in the study. The study involved 117 participants from two healthcare systems. The Telemedicine Technology Acceptance Model was developed based on the original Technology Acceptance Model that was initially developed by Fred Davis in 1986. The eICU Acceptance Survey was used as an instrument for the study. Content validity was examined, and the reliability of the instrument was tested. The results show that perceived usefulness is the most influential factor that influences nurses' intention to use the eICU technology. The principal factors that influence perceived usefulness are perceived ease of use, support from physicians, and years working in the hospital. The model fit was reasonably adequate and able to explain 58% of the variance (R = 0.58) in intention to use the eICU technology with the nursing sample.

Theme-Based Comprehensive Evaluation in New Product Development Using Fuzzy Hierarchical Criteria Group Decision-Making Method

One of the features of the digital ecosystem is the integration of human cognition and socio-economic themes into the process of new product development (NPD). In a socio-economic theme-based NPD, ranking a set of product prototypes that have been designed always requires the participation of multiple evaluators and consideration of multiple evaluation criteria. Using the well-being theme-based garment NPD as a background, this paper first presents a fuzzy hierarchical criteria group decision-making (FHCGDM) method which can effectively calculate final ranking results through fusing all assessment data from human beings and machines. It then presents a garment NPD comprehensive evaluation model with hierarchical criteria under the well-being theme through identifying a set of marketing tactics from a consumer acceptance survey. It further provides an establishment process for an NPD evaluation model under the digital ecosystem framework. Finally, a garment NPD case study further demonstrates the proposed well-being NPD comprehensive evaluation model and the FHCGDM method. The advantages of the proposed evaluation method include successfully handling criteria in a hierarchical structure, automatically processing both objective measurements from machines and subjective assessments from human evaluators, and using the most suitable type of fuzzy numbers to describe linguistic terms.

Quality of Life Outcomes in Chinese Patients with Implantable Cardioverter Defibrillators

Patient-centered outcomes for Chinese implantable cardioverter defibrillator (ICD) patients have not been previously studied. This study examined health-related quality of life (HRQL) and its relation with ICD shock-related anxiety, ICD shock, patient acceptance of the ICD, and demographic and clinical characteristics among a sample of Chinese ICD patients. Eighty-five ICD recipients completed the Chinese versions of the Short Form (SF-12) Health Survey, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS), and a demographic sheet during their follow-up visit. The mean scores of physical component summary and mental component summary (MCS) of ICD patients (41.7 and 46.6, respectively) were lower than the Hong Kong Chinese normative data. As expected, MCS was negatively correlated with shock anxiety (r =-0.38, P < 0.01) and positively correlated with patient acceptance (r = 0.50, P < 0.01). Shock anxiety was negatively correlated with patient acceptance of the ICD (r =-0.58, P < 0.01). Age was positively associated with FPAS (r = 0.55, P = 0.014) while negatively related with FSAS (r =-0.28, P = 0.003). The experience of ICD shock (yes/no) was not associated with any differences but shock frequency groups (no shocks, 1-2 shocks, and ≥3) and gender were significantly different on shock anxiety but not on general mental functioning. Higher ICD shock anxiety was associated with lower HRQL and lower ICD acceptance. Age, female, and clinical characteristics such as diabetes, coronary heart disease, and ICD shock experience can influence patient-centric outcomes of HRQL, FPAS, and FSAS. These results extend the evidence for increased clinical attention in Chinese patients to specific outcomes such as shock anxiety and its impact on HRQL.