Computer-based Program Research Articles

Assessing the link between modified ‘Teach Back’ method and improvement in knowledge of the medical regimen among youth with kidney transplants: The application of digital media

ObjectiveThe objective of this study was to facilitate functional health literacy (FHL) with a modified “Teach Back” method. A computer-based program was developed for adolescent and young adult kidney transplant recipients (KTR) to knowledgeably answer questions about their medical condition, medications, and create a simple synopsis of their personal health record with the help of the heath care provider (HCP). MethodsIn a pre-post quasi-experimental design, 16 patients received the computer intervention in which they navigated questionnaires and brief informational video clips. Knowledge scores were assessed at baseline and 3 months. The binomial sign test was used to evaluate change in knowledge and purpose of medications. ResultsMean age was 17.3 ± 2.4 years and 94% were non-Caucasian. Seven of 16 patients were academically below grade level. Twelve of 16 patients improved their overall knowledge (P = 0.0002) and purpose of medications (P = 0.0017). ConclusionsA Modified “Teach Back” during clinic visits was associated with improvements in FHL. Practice ImplicationsThis modified ‘teach back’ program has the potential to improve FHL which could contribute to long-term preservation of kidney transplants.

Innovations in Professional Inpatient Diabetes Education.

In the rapidly evolving and complex field of inpatient diabetes, complex care teams of physicians, nurse practitioners, physician assistants, nurses, and pharmacists are challenged to remain well informed of the latest clinical treatments and health care trends. Traditional continuing medical education (CME) and continuing education unit (CEU) strategies that require travel and/or time away from work pose a major barrier. With advancements in technology, there are media and other electronic strategies for delivering CME/ CEU that may overcome these current challenges. Electronic and internet-based formats are growing due to their convenience, ease of use, lower cost, and ready access to large audiences. Some formats are already being used such as computer-based programs, simulations, and mobile CMEs and CEUs. Other strategies could be further explored including hospital credentialing, stewardship programs, and interdisciplinary health care professional education. However, there is little data on the utilization and efficacy of these newer formats. While traditional CME/CEU meetings prevail, there is a need and an emerging trend using electronic and internet based strategies that are particularly suited for inpatient diabetes education. These methods show great potential and deserve further exploration and development.

Defining the Aesthetic Range of Normal Symmetry for Lip and Nose Features in 5-Year-Old Children Using the Computer-Based Program SymNose.

Objective:To provide a normal comparison group against which to judge symmetry results after cleft surgery and to introduce the thin lip correction (TLC) feature in SymNose. A lip–aspect ratio algorithm has been added to the latest version of SymNose to compensate for the higher degree of overlap in thicker lips when compared to thin lips.Design:Retrospective analysis of symmetry in healthy participants, using the computer-based program SymNose on both anteroposterior (AP) and base view images. Photographs of 91 noncleft children were traced twice by 3 independent investigators experienced with SymNose.Participants:Five-year-old healthy participants from a local state school in Tavistock (West Devon, United Kingdom).Main Outcome Measure:Asymmetry expressed as the perimeter mismatch percentage for nose and lip features on AP view images and for nose features on base view images.Results:The perimeter mismatch reference range for the nose (AP view) was 2.65% to 30.91%, for the lip 2.13% to 15.44%, for the nose (base view) 1.69% to 14.84%, for the nostrils 4.68% to 26.6%, and for the width–height ratio 1.15% to 1.80%. The perimeter mismatch percentage for the lip without TLC was significantly higher compared to the perimeter mismatch percentage with TLC (P < .001).Conclusion:This article provides a noncleft reference range for all perimeters drawn from SymNose against which to compare results after cleft surgery at 5 years of age. Furthermore, it shows the importance of correcting for variance in lip volume per child.

Risk behaviors screening in Thai adolescents with acute and chronic illnesses.

Adolescence is considered as a transition period from childhood to adulthood. This transition leads to various types of risk behaviors. Ten percent of adolescents suffer from a chronic illness that can limit their daily activities and which may exhibit higher rates of risk behaviors than those without chronic illnesses. To evaluate the prevalence of risk behaviors in chronically ill adolescents compared to adolescents without chronic illnesses and their associated risk factors. We enrolled 312 patients aged 10-20 years who visited Ramathibodi Hospital from January 2015 to December 2017. There were 161 adolescents with chronic illnesses and 151 without a chronic illness. We used a computer-based program for the Youth Risk Behaviors Survey as well as a confidentiality interview. Statistical analyses included the chi-squared (χ2) and Student's t-tests as appropriate. The risk behaviors in chronically ill adolescents were the following: learning problems, 86.3%; excessive screen time, 62.3%; unintentional injuries, 60.2%; depression, 38.5%; low self-esteem, 18.1%; substance abuse, 13% and sexual behavior, 6.2%. Youths with a chronic illness were more likely to report significantly higher risk of excessive screen time (62.3% vs. 48%, p = 0.01), depression (38.5% vs. 15.9%, p < 0.01) and, also low self-esteem (18.1% vs. 8.6%, p = 0.01) compared to those without chronic illness. These results indicated that adolescents with chronic illnesses engage more in health risk behaviors and are prone to mental health and learning problems. These data emphasize the importance of health risk behavior screening and preventive counseling for young patients with chronic illnesses where these risks might worsen their disease.

Alzheimer's Disease: Special Focus on the Efficacy of Computer-Based Training Programs - A Mini-Review.

At present, the number of older people is growing, especially in the developed countries where the living conditions enable a longer life expectancy. However, the higher age may result in the aging diseases such as dementia out which Alzheimer's disease (AD) is the most frequent. Nevertheless, to maintain them both physically and mentally active, more assistance is required. The purpose of this study is to discuss the efficacy of the use of modern information technologies, especially computer-based training programs, on people with Alzheimer's disease (AD). Although the results from the selected studies do not indicate that the computer-based training programs are effective in the delay of cognitive decline is concerned, they suggest that these computerbased training programs are at least appropriate for the improvement of their behavioural symptoms and progression of the disease. Generally, these technological devices may contribute to the reduction of patients´ and their caregivers´ costs and certain flexibility, and thus the improvement of the quality of their life.

The Effectiveness of Home Blood Pressure on 24-Hour Blood Pressure Control: A Randomized Controlled Trial.

Home blood pressure monitoring (HBPM) is cited as an effective approach for improving blood pressure control. The objective of this study was to determine the effectiveness of HBPM combined with a health education session in reducing blood pressure and improving medication adherence among adults with hypertension. Two hundred thirteen participants were enrolled in a 3-month study and randomized to receive HBPM or usual care. Participants were also randomized to receive an educational session delivered using a pamphlet or a computer-based program. Topics of the educational session included preventing hypertension, managing weight, staying active, and cutting down on salt and fat. At the 3-month follow-up, there was a reduction in ambulatory blood pressure among the HBPM group. However, the differences found within the HBPM group were no greater than those found among the control group. We did not detect a statistically significant difference in adherence to medication when comparing the HBPM to the usual care group. HBPM and educational session did not lower blood pressure or improve medication adherence in our sample. A greater effect may have been seen if coupled with an enhanced educational intervention and if blood pressure measures were shared with the provided. The findings of this study provide useful insights for future HBPM studies.

Using human and computer-based text analysis of clinical notes to understand military service members’ experiences with therapeutic writing

Background: Therapeutic writing has been shown to improve both physical health and emotional well-being. This paper examines the usefulness of clinical notes as a data source, and presents two different analyses of individual clinical notes of therapeutic writing group sessions: analysis performed by a person and analysis by a computer-based program (Pennebaker et al., 2015). The therapeutic writing sessions were offered during the second week of treatment at the National Intrepid Center of Excellence (NICoE) as part of an integrative care model for service members (SMs) with traumatic brain injury and underlying psychological conditions to include post-traumatic stress disorder (PTSD).Method: Therapeutic writing sessions were facilitated in the art therapy studio at the NICoE. The sessions were documented in the military healthcare system’s patient record application by the art therapist and art therapy interns at the NICoE. Clinical notes were informed by SM self-report surveys and clinician observations. Notes from May 2012 to 2015 and were pulled and coded manually for emerging themes, then separately analyzed by a computer software text content analysis program (Pennebaker et al., 2015).Results: Overall, SMs reported more positive than negative, neutral, or mixed emotions during and after the therapeutic writing experience. Some reported a change from negative to positive emotions through the writing process, and many described experiencing relief during and after sessions. SMs wrote on a wide range of topics. Most SMs kept their writing pieces, although some destroyed them or shared them with others, and a few SMs gifted the pieces. Computerized-based analysis (Pennebaker et al., 2015) indicated that work and social were the most prominent content theme areas. It also showed that positive emotions were more evident than negative emotions in the clinical notes and that the focus of the writing pieces was primarily on the present rather than on the past or the future.Implications: Many SMs perceived the therapeutic writing experience as therapeutic, a relevant coping skill, and enjoyable. Some, however, preferred to work on art therapy projects they had begun in previous sessions (such as mask-making) during the writing sessions. The computer-based analysis of the clinical notes took much less time than the human analysis, but it did not produce results of comparable richness or nuance. Computer-based analysis of the actual therapeutic writing pieces may provide deeper insights into the content and themes that emerged during this therapeutic intervention.

The superiority of three‐dimensional physical models to two‐dimensional computer presentations in anatomy learning

Although several studies (Anat Sci Educ, 8 [6], 525, 2015) have shown that computer-based anatomy programs (three-dimensional visualisation technology [3DVT]) are inferior to ordinary physical models (PMs), the mechanism is not clear. In this study, we explored three mechanisms: haptic feedback, transfer-appropriate processing and stereoscopic vision. The test of these hypotheses required nine groups of 20 students: two from a previous study (Anat Sci Educ, 6 [4], 211, 2013) and seven new groups. (i) To explore haptic feedback from physical models, participants in one group were allowed to touch the model during learning; in the other group, they could not; (ii) to test 'transfer-appropriate processing' (TAP), learning ( PM or 3DVT) was crossed with testing (cadaver or two-dimensional display of cadaver); (iii) finally, to examine the role of stereo vision, we tested groups who had the non-dominant eye covered during learning and testing, during learning, or not at all, on both PM and 3DVT. The test was a 15-item short-answer test requiring naming structures on a cadaver pelvis. A list of names was provided. The test of haptic feedback showed a large advantage of the PM over 3DVT regardless of whether or not participants had haptic feedback: 67% correct for the PM with haptic feedback, 69% for PM without haptic feedback, versus 41% for 3DVT (p<0.0001). In the study of TAP, the PM had an average score of 74% versus 43% for 3DVT (p<0.0001) regardless of two-dimensional versus three-dimensional test outcome. The third study showed that the large advantage of the PM over 3DVT (28%) with binocular vision nearly disappeared (5%) when the non-dominant eye was covered for both learning and testing. A physical model is superior to a computer projection, primarily as a consequence of stereoscopic vision with the PM. The results have implications for the use of digital technology in spatial learning.

Implementation and Use of a Client-Facing Web-Based Shared Decision-Making System (MyCHOIS-CommonGround) in Two Specialty Mental Health Clinics

Electronic shared-decision making programs may provide an assistive technology to support physician–patient communication. This mixed methods study examined use of a web-based shared decision-making program (MyCHOIS-CommonGround) by individuals receiving specialty mental health services, and identified qualitative factors influencing adoption during the first 18 months of implementation in two Medicaid mental health clinics. T-tests and χ2 analyses were conducted to assess differences in patient use between sites. Approximately 80% of patients in both clinics created a MyCHOIS-CommonGround user profile, but marked differences emerged between clinics in patients completing shared decision-making reports (79% vs. 28%, χ2(1) = 109.92, p < .01) and average number of reports (7.20 vs. 3.60, t = − 3.64, p < .01). Results suggest high penetration of computer-based programs in specialty mental health services is possible, but clinic implementation factors can influence patient use including leadership commitment, peer staff funding to support the program, and implementation strategy, most notably integration of the program within routine clinical workflow.

Efficacy of a computer-based cognitive training program to enhance planning skills in 5 to 7-year-old normally-developing children

We designed and evaluated the efficacy of a computer-based cognitive training program (Executive Function Enhancement Program [EFEP]) to stimulate executive functions through enhancing planning in normally-developing children. A total of 111 Colombian children participated in the study. Fifty-nine (53%) of the children were assigned to the experimental condition (application of the EFEP program) with two levels of planning performance, and fifty-two (47%) to the waiting list control condition with the same two levels of planning. The training program was applied three times a week over six weeks, with post-intervention assessment two weeks after the end of training. A follow-up assessment was carried out three months later. Results showed that the intervention program was particularly effective in the children with lower pre-intervention performance in planning, demonstrating that the program is an efficient therapeutic instrument for enhancing the executive function of planning in children between 5 and 7 years old.

Working memory training and language outcomes in children with cochlear implants

ObjectiveThe aim of this study is to provide information on whether improvements in language skills might be achieved by improving working memory capacity in cochlear-implanted children.Patients and MethodsThis study was carried out on 30 prelingual cochlear-implanted children at the Hearing and Speech Institute. They were divided into two groups: group I received communicative therapy plus a working memory training program. Group II received communicative therapy only. Post-therapy evaluation was carried out after 6 months using the Modified Preschool Language Scale-4 for assessing language and the working memory subtests measures of the Stanford–Binet Intelligence Scale ‘5th Arabic version‘ for the assessment of working memory.ResultsThe results of this study showed an improvement in verbal working memory capacity, nonverbal working memory capacity, and the total working memory in the group of children with cochlear implants (CIs) who received 6 months of a working memory training program in addition to communicative therapy. The findings indicate that there is an improvement in the verbal and nonverbal working memory in the participants following the training on certain tasks in the computer-based working memory training program. This will lead to an improvement in the language skills as well.ConclusionWorking memory training may improve some memory and language skills for children with CIs. As a result, interventions specifically designed to address the basic underlying verbal working memory deficits of children with CIs may be expected to have wide-ranging effects that generalize well beyond the trained working memory tasks and stimuli themselves and show transfer to nontrained language perception and memory tasks.

Development and evaluation of a computer-based auditory training program for rehabilitation of children with decoding deficit

Background and Aim: Decoding deficit is the most common central auditory processing disorder (CAPD). Given the benefits of computer-based auditory training programs for treatment of central disorders and the lack of such programs in Persian language, this study aimed to develop a computer-based auditory training program for decoding skill. We also evaluated this program in 8 to12 year old children with CAPD.Methods: The first stage of research was to develop a computer-based auditory training program. This program consists of three levels of phonological discrimination, syllable discrimination, and word discrimination. The second stage was to determine the content and face validity of the program. The third stage was to assess the program effect on five children with decoding deficit. The research method was interventional and had a pretest and post-test design with another five children as control group. The staggered spondaic word, phonemic synthesis (PS) and speech in noise tests was used to assess the children performance before and after training.Results: Mean scores of staggered spondaic word (SSW) and PS tests of the experimental group were significantly difference before and after the auditory training (p&lt;0.05) as compared to control group. However, there was no significant difference with regard to the speech-in-noise test results (p&gt;0.05).Conclusion: This computer-based auditory training program can be considered as a preliminary tool for the rehabilitation and treatment of decoding deficits in children with CAPD.

Attention Bias Modification for Social Anxiety Disorder: A Randomized Controlled Trial

Background: Social anxiety disorder, one of the most common anxiety disorders, is known as a chronic psychiatric disorder. Objectives: The present study is aimed at investigating the effects of computer-based attention training on attention bias modification for social anxiety disorder. Methods: This randomized controlled trial was performed on 30 students who suffered from social anxiety disorder. All of them filled out the social phobia inventory (SPIN; Connor et al.), Hamilton depression rating scale (HDRS), and social anxiety disorder severity questionnaire (SCSQ) and attended a clinical interview. The participants were randomly assigned to an experimental group (n = 15) and a control group (n = 15), and then they took part in a computer-based pretest program of attention bias measurement (ABM). The experimental group attended 10 sessions of computer-based attention control training program. Both of the groups participated in a computer-based posttest program of ABM. The data were analyzed using the analysis of covariance. Results: Our findings indicated that the computer-based attention control training contributed to reducing attention bias towards the angry (Eta Square = 0.34), surprised (Eta Square = 0.23), and happy (Eta Square = 0.19) expressions, while it did not have any effects on disgusted, fearful, and sad expressions. Conclusions: Attention training program is an effective method to modify attention bias towards some of the emotional effects and can be employed in therapeutic interventions.

Opinions and evaluations of stakeholders in the implementation of the public-private partnership (PPP) model in integrated health campuses (city hospitals) in Turkey.

This study aimed to define the public-private partnership (PPP) model, eliciting the views and assessments of stakeholders and identifying associated health policies and planning issues. It uses qualitative research methods to examine the extent to which PPPs promote or interfere with the provision of health services, equality, efficiency, quality, health tourism, and initiatives to strengthen the national economy. Having selected an appropriate sample, researchers approached bureaucrats and experts from the Ministry of Health, Social Security Institution, Ministry of Development, Ministry of Finance, NGOs, and other state institutions and organizations. A total of 83 people were asked to complete a semi-structured questionnaire. The qualitative research data were analyzed using a descriptive-analysis method; a content analysis was carried out using a computer-based qualitative research program, MAXQDA Versions 11. The majority of participants expressed positive opinions about PPPs, their applicability in Turkey, and the financial viability and scope of PPPs in the health sector. They also commented on the aims, advantages, and disadvantages of such partnerships. The majority of participants believed that a PPP was an appropriate finance model for the integrated health-campus substructure of Turkey's health sector. The most positive views were expressed by public and private sector-stakeholders, while some negative views were voiced by NGO representatives. This study identified and assessed integrated health-campus projects to determine the aim, suitability, advantages, and disadvantages of the model in the health sector, particularly in relation to the cost, quality, and availability of health services. This study discusses the current positive and negative effects of integrated health-campus implementation.

Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach.

BackgroundA national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder.ObjectiveThe objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC.MethodsAn iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration.ResultsKey stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement.ConclusionsThe development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.

Current possibilities of visual rehabilitation

Diseases of the eyes and visual pathways can lead to different visual field defects, which limit the patients' abilities in everyday life in different ways. Central visual field defects cause mainly reading disorders and peripheral defects cause disorders of orientation and mobility. Rehabilitation measures have to be adapted specifically to the deficit and the individual needs of the patient. In central scotoma, reading ability can mostly be restored by magnifying visual aids. In reading disorders caused by insufficient size of the reading visual field, text magnification is contraindicated. In this case, contrast-enhancing or non-visual aids are applied. Modern electronic media are successfully used particularly by young people with visual impairments. Computer-based training programs are of increasing importance, especially saccadic training for orientation disorders due to concentric and homonymous visual field impairments.

A Brief Computer-Based Sexual Assault Risk Reduction Program: A Feasibility, Acceptability, and Preliminary Efficacy Pilot Study.

Sexual victimization among college women is a common problem, necessitating the development of risk reduction programs that are both effective and acceptable to this population. Computer-based programs may be a cost- and time-effective option. This pilot study sought to examine the feasibility, acceptability, and preliminary efficacy of a computer-based risk reduction program. A total of 136 collegiate women were randomly assigned to receive either a computer-based risk reduction program or an educational program about campus resources (active control condition). Measures included predicted use of resistance techniques, risk detection, and acceptability of the program. No participants dropped out of the study, and acceptability ratings were generally high. Women reported learning new material from the program, preferring the computer-based program to large-group programs, and believing that other undergraduate women would benefit from the program. Furthermore, women reported they did not experience significant emotional disturbance due to the material. In addition, postintervention, the risk reduction program group had significantly better risk detection compared with the control group. The control group evidenced a reduction in predicted use of assertive resistance between pre- and postintervention assessments, while the risk reduction program group did not. Given preliminary support for the feasibility, acceptability, and preliminary efficacy of a brief, computerized risk reduction program, further research on computerized, online risk reduction programs, such as the one in this study, appears warranted.

Cognitive stimulation for healthy older adults through computer-based programs: a review of the literature / Estimulación cognitiva para personas mayores sanas mediante programas computarizados: una revisión de la literatura

Cognitive stimulation programs are widely used as a preventive tool for cognitive decline in older adults, as they can favour positive ageing by maintaining older persons’ autonomy and preserving their cognitive functions. Because of this, and due to its potentially easy application on a large scale and at a low cost, the incorporation of technologies for the cognitive stimulation of older adults has become an area of growing interest. This review outlines the advantages and disadvantages of computer-based cognitive stimulation programs aimed at healthy older adults, focusing on aspects that influence their effectiveness and future direction. Twenty-five articles were considered, including original studies, literature reviews and meta-analyses, published between 2013 and 2017. It was concluded that there is a need to generate more randomized studies with active control groups to assess the effectiveness of cognitive stimulation through computer-based programs, as well as develop designs to establish strategies that increase older adults’ adherence and ensure their motivation to carry out these activities.

Evaluation of a Computer-Based Training Program to Teach Adults at Risk for HIV About Pre-Exposure Prophylaxis.

This study developed a computer-based program to teach HIV prevention behaviors and raise awareness of pre-exposure prophylaxis (PrEP) among individuals at risk for HIV. The program was divided into modules containing educational material and multiple-choice questions. Participants received immediate feedback for responses and incentives for correct responses to multiple-choice questions. Participants trained on each module until they met speed and accuracy criteria. The modules were divided into: Course 1 (HIV), Course 2 (PrEP), and Course 3 (HIV risk behaviors). Tests of content from all three courses were delivered before and after participants completed each course. Test scores on the content delivered in the courses improved only after participants completed training on each course. HIV and PrEP knowledge was initially low and increased following completion of each part of the program. Computer-based training offers a convenient and effective approach to promoting HIV prevention knowledge, including use of PrEP.

Independent Computerized Cognitive Remediation for Psychosis: An Investigation of Patient Experiences.

Cognitive remediation (CR) training improves cognition and functioning in patients with psychosis. To date, however, few studies have investigated CR from a subjective patient perspective. We recently conducted a randomized control trial demonstrating the effectiveness of a new, low therapist support, computer-based training program. This study aims to assess the service user experience of this program. Twenty CR completers with psychosis were interviewed using both rated and open-ended questions. Thematic analysis identified three broad themes: a) benefits of doing CR, b) costs of doing CR, and c) experience of doing CR. Positive experiences of therapy participation included improved cognition, improved positive self-regard, a development of life skills, and a transfer of benefits to everyday life. Negative experiences included therapy being difficult and tiring, leading to frustration and anxiety. These findings demonstrate the feasibility of low therapist support CR and point to variables that might impact therapy adherence.