Differences In Ease Of Use Research Articles

Implementation and facilitation of post-resuscitation debriefing: a comparative crossover study of two post-resuscitation debriefing frameworks

BackgroundPost-resuscitation debriefing (PRD) is the process of facilitated, reflective discussion, enabling team-based interpersonal feedback and identification of systems-level barriers to patient care. The importance and benefits of PRD are well recognized; however, numerous barriers exist, preventing its practical implementation. Use of a debriefing tool can aid with facilitating debriefing, creating realistic objectives, and providing feedback.ObjectivesTo assess utility of two PRD tools, Debriefing In Situ Conversation after Emergent Resuscitation Now (DISCERN) and Post-Code Pause (PCP), through user preference. Secondary aims included evaluating differences in quality, subject matter, and types of feedback between tools and implications on quality improvement and patient safety.MethodsProspective, crossover study over a 12-month period from February 2019 to January 2020. Two PDR tools were implemented in 8 week-long blocks in acute care settings at a tertiary care children’s hospital. Debriefings were triggered for any intubation, resuscitation, serious/unanticipated patient outcome, or by request for distressing situations. Post-debriefing, team members completed survey evaluations of the PDR tool used. Descriptive statistics were used to analyze survey responses. A thematic analysis was conducted to identify themes that emerged from qualitative responses.ResultsA total of 114 debriefings took place, representing 655 total survey responses, 327 (49.9%) using PCP and 328 (50.1%) using DISCERN. 65.2% of participants found that PCP provided emotional support while only 50% of respondents reported emotional support from DISCERN. PCP was found to more strongly support clinical education (61.2% vs 56.7%). There were no significant differences in ease of use, support of the debrief process, number of newly identified improvement opportunities, or comfort in making comments or raising questions during debriefs between tools. Thematic analysis revealed six key themes: communication, quality of care, team function & dynamics, resource allocation, preparation and response, and support.ConclusionBoth tools provide teams with an opportunity to reflect on critical events. PCP provided a more organized approach to debriefing, guided the conversation to key areas, and discussed team member wellbeing. When implementing a PRD tool, environmental constraints, desired level of emotional support, and the extent to which open ended data is deemed valuable should be considered.

A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions.

ABSTRACTIntroductionService members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference.Materials and MethodsBarriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress.ResultsVeterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators.ConclusionsResults of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.

One step further: randomised single-centre trial comparing the direct and afterload techniques of embryo transfer.

What are the differences in ease of use between two different embryo transfer (ET) techniques: the preload direct approach and the afterload approach. The afterload technique seems to reduce the rate of difficult ETs. Numerous published trials now document that the ET procedure has an impact on pregnancy and delivery rates after IVF. Difficult transfers should be avoided, as they reduce implantation and pregnancy rates. Preload direct ETs with soft catheters under ultrasound guidance is currently considered the best procedure. However, when using soft catheters, it is not known which technique is preferable or which one should be implemented to reduce the operator factor. This prospective randomised unblinded controlled clinical trial, included 352 ultrasound-guided ETs assigned to either direct ET or afterload ET, between September 2017 and March 2019. The sample size was calculated based on the historical rate of difficult ETs encountered between 2014 and 2015 with a direct ET procedure. The inclusion criteria were women 18-38 years old, with BMI between 18 and 28, receiving a single-thawed blastocyst transfer. The exclusion criteria were use of testicular sperm and preimplantation genetic testing (PGT) cycles. The primary outcome was the rate of difficult or suboptimal transfers defined as: advancement of the outer sheath (specific for the direct transfer), multiple attempts, use of force, required manipulation, use of a stylet or tenaculum, dilatation, or use of a different catheter. The secondary outcome was clinical pregnancy rate. A total of 352 frozen ETs were randomised, with 176 patients in each group. The two arms were homogeneous for female and male age, female BMI, duration of infertility, secondary infertility, previous deliveries or miscarriages, myomas, previous surgery to the uterine cavity, cycle day at ovulation trigger, freeze all cycles, first transfers, indication for treatment, endometrial preparation protocol and duration, endometrial thickness, and blastocyst grade at vitrification. Across the entire population, 85 (24.1%) ETs were defined as difficult. The rate of difficult transfers was significantly higher in the direct ET group than in the afterload group: 68 (38.6%) versus 17 (9.7%), respectively (OR 0.17, 95% CI 0.09-0.30, P < 0.001). The mean percentage in the rate of difficult transfers per operator was 22.5% (SD ± 14.5%), of which 36.1% (SD ± 23.4%) were in the direct group compared with 8.6% (± 8.2%) in the afterload group (P < 0.001). The difficult transfer rate among operators varied from 0 to 43.8% (0-77.8% in the direct group and 0 to 25.0% in the afterload group). The clinical pregnancy rates (42.0% vs 48.3%, P = 0.239 in the direct and afterload groups, respectively) were not significantly different between the groups. There were 18 experienced operators who participated in the trial. Conclusions about the pregnancy rate should not be generalised, since the sample analysis was not performed on this outcome and, although clinically relevant, the difference was not significantly different. The rate of difficult transfers was significantly higher in the direct ET group compared with the afterload ET group, although a wide variation was observed among operators. Further studies regarding the association between transfer technique and ART outcomes are required. No specific funding was sought and there are no competing interests. NCT03161119. 5 April 2017. 26 September 2017.

Creation of a Rudimentary Electronic Pediatric Intensive Care Unit Model to Explore Resident-Attending Communication.

Background: At-home attending intensivists often must return to the hospital to assist residents. Introduction: To determine if using telemedicine communication between in-house pediatric residents and at-home attending intensivists impacts the rate of attending return to the hospital and improves resident education. Methods: In this single-center prospective study at an academic children's hospital's pediatric intensive care unit (PICU), 40 patients younger than 18 years were randomized into video or telephone arms. Residents and intensivists completed anonymous surveys after each encounter. Video-conferencing encounters between residents and at-home, on-call intensivists were compared with standard telephone calls for admissions to PICU. Results: Video and telephone arms had 21 and 19 patients enrolled, respectively. Data comparison was performed using Mann-Whitney U, chi-square, and Kruskal-Wallis analysis. Clinical illness severity rating for intensivists and residents was not significantly different for video communication compared with telephone (p = 0.63 and p = 0.42, respectively). Intensivists reported no significant difference in ease of use (p = 0.87). There was perceived improvement in resident education with the use of telemedicine (52.6% vs. 76.2%; p = 0.11). Discussion: Video communication was easy to use but did not change the rating of illness severity or need for intensivist to return to the hospital. There was perceived improvement in resident education with the use of telemedicine, and it may serve as a useful tool in demonstrating acute clinical changes to out-of-hospital intensivists. Conclusions: Larger-scale studies in teaching hospitals with out-of-hospital pediatric intensivists need to be conducted to further evaluate the role of telemedicine in patient management and resident education.

Improving distress screening completion rates: Does virtual robot animation make a difference?

e21672 Background: Distress screening is an important part of cancer patients’ care. Programs accredited by Commission on Cancer must implement distress screening programs, based on improved doctor-patient relationships and clinical outcomes. We are interested in evaluating the use of an anthropomorphic robotic interface to improve survey completion rates and the patient experience. Methods: A validated distress screening survey was scheduled for 74 patients in 2016 in an IRB-exempt survey study. Patients were randomly assigned to fill out the survey on iPAD (N = 33), or on iPAD with a virtual robot animation (“Betty”) introducing the survey (N = 41). Patients were then asked to fill out a validated 10 question Technology Acceptance Model questionnaire (TAM) asking about ease of iPAD use. A five point Likert scale was used. Finally, two yes/no questions were asked: 1) “Were you more interested in filling out the distress screening survey because of the “Betty” animation?”, and 2) “Did the animation make filling out the distress screening survey more enjoyable?” Results: The survey completion rate was 24/33 = 73% for control and 26/41 = 63% for intervention groups (p = 0.86). Forty five patients completed the TAM questionnaire, with completion rate 92% and 88%, respectively. Average iPAD TAM score was 4.3 in the control group and 4.0 in the intervention group (p = 0.12), and none of the 10 questions showed statistically significant difference in ease of use. The last two questions evaluating “Betty” directly were answered by 17/23 and 15/23 patients, respectively. 8/17 felt they were more interested in filling out the distress screening because of “Betty”, and 7/15 felt “Betty” made the distress screening more enjoyable. Conclusions: The presence of “Betty” as part of the survey process did not negatively impact the completion rates. There was no significant difference between the groups in perceived ease of use of the iPAD on which the survey was administered. Approximately half of the patients taking the distress survey with the “Betty” animation felt they were more interested in filling out the survey and the process was more enjoyable. We are currently evaluating whether a true robot may improve completion rates and patient experience.

Comparison of two ophthalmoscopes for direct ophthalmoscopy

To measure the ease of use and performance of the Optyse lens-free ophthalmoscope compared with the standard Keeler pocket ophthalmoscope, and to assess its suitability as an inexpensive ophthalmoscope for medical students. Randomized cross-over study. Twenty second-year medical students, 10 as ophthalmoscopists ('observers') and 10 as 'patients'. Students used both ophthalmoscopes to examine the optic disc in each eye of 10 'patients'. They were randomized as to the order in which they were used. A Consultant ophthalmologist was used as the gold standard. Main outcome measures were accuracy in estimating vertical cup:disc ratio (VCDR), ease of use (EOU) for each examination, and overall ease of use (OEOU). Of 400 attempted eye examinations, sufficient visualization was achieved in 220 cases to allow a VCDR estimation: 107/200 VCDR estimates with the Optyse and 113/200 with the Keeler. Accuracy of VCDR estimates was better with the Optyse by the equivalent of 0.05 VCDR (P = 0.002). There was no significant difference in EOU or OEOU between the two ophthalmoscopes. EOU for 400 examinations: median (IQR) of 6 (3-8) for Optyse versus 6 (3-8) for Keeler (P = 0.648). OEOU for 20 scores: median (IQR) of 6.5 (2-9) for Optyse versus 5.5 (3-8) for Keeler (P = 0.21). Medical students found the Optyse and Keeler pocket ophthalmoscopes to be of similar ease of use and performed slightly better with the Optyse when estimating VCDR. The lens-free Optyse ophthalmoscope is a reasonable alternative to the standard Keeler pocket ophthalmoscope.

Die perkutane Knochenbiopsie: Experimentelle Studie zum Vergleich von Knochenbiopsiesystemen

The aim of this study was to assess the differences in ease of use and quality of samples of several bone biopsy needles in an animal test. An evaluation of eight bone biopsy needles of different gauges was undertaken. With each needle, 5 biopsies of an animal bone (lumbal vertebral body of calf, pig and lamb) were performed and compared to each other. The subjective assessment of force to obtain a sample, ease of needle use and ease of sample removal were graded on a 5-point scale. Each biopsy specimen was measured before and after fixation and the gross state was evaluated. For evaluation of histopathological quality, width and degree of fragmentation were also evaluated on a scale. The Somatex, Bone Marrow and Safe Cut 8 G and the Cardinal Health, Jamshidi 8 G needles were rated as being the easiest ones to use, while the Bloodline, Easy Trap 8 G and the RADI, Bonopty 15 G biopsy needles were rated as being the most difficult ones. Histological specimen quality was highest for the Somatex 8 G needles, the Cardinal Health, Jamshidi 8 G and the Bloodline, Easy Trap 8 G needles. The Inter.V, SnareLok 8 G and the RADI, Bonopty 15 G needles had the lowest yield. Furthermore, differences in length before and after fixation were recorded. The average decrease of core length after fixation was 18 %. The bone biopsy needles tested here vary significantly in performance and quality of the histopathological specimen. Detailed knowledge of the strengths and weaknesses of different needles could facilitate the decision for the selection of an appropriate instrument.

Assessment of bone biopsy needles for sample size, specimen quality and ease of use

To assess whether there are significant differences in ease of use and quality of samples among several bone biopsy needles currently available. Eight commonly used, commercially available bone biopsy needles of different gauges were evaluated. Each needle was used to obtain five consecutive samples from a lamb lumbar pedicle. Subjective assessment of ease of needle use, ease of sample removal from the needle and sample quality, before and after fixation, was graded on a 5-point scale. The number of attempts necessary to reach a 1 cm depth was recorded. Each biopsy specimen was measured in the gross state and after fixation. The RADI Bonopty 15 g and Kendall Monoject J-type 11 g needles were rated the easiest to use, while the Parallax Core-Assure 11 g and the Bard Ostycut 16 g were rated the most difficult. Parallax Core-Assure and Kendall Monoject needles had the highest quality specimen in the gross state; Cook Elson/Ackerman 14 g and Bard Ostycut 16 g needles yielded the lowest. The MD Tech without Trap-Lok 11 g needle had the highest quality core after fixation, while the Bard Ostycut 16 g had the lowest. There was a significant difference in pre-fixation sample length between needles (P<0.0001), despite acquiring all cores to a standard 1 cm depth. Core length and width decrease in size by an average of 28% and 42% after fixation. Bone biopsy needles vary significantly in performance. Detailed knowledge of the strengths and weaknesses of different needles is important to make an appropriate selection for each individual's practice.

Designing More Effective Log-in and Sign-in Pages

Differences in the ways that Web sites require visitors to log in may be subtle, but they can sometimes make a difference in ease of use.

Dr Wilkinson replies

We know for all cholinesterase inhibitors that longer titration increases tolerability and, while 12 weeks is a relatively short study, it is often the time when clinicians, in normal clinical practice, are making decisions about continuation of therapy. Whatever arguments and excuses are put forward, our study showed that while rivastigmine in this study produced side-effects in this clinic population that were actually slightly better than those described in the product labelling, they were still considerably worse than those with donepezil. This has a resonance for all clinicians who have experience of these drugs. Extending the titration phase will improve tolerability, but even a six-week titration still does not reduce the level to that of donepezil. The arguments for different modes of action have yet to be translated into differences in efficacy, and in the absence of any clear or specific indications for one cholinesterase over another, it is hardly surprising that clinicians would rather not choose a drug with a more tortuous titration schedule and greater incidence of side-effects if they didn't have to. This study will not stand the criticisms of a randomised control trial, as it wasn't one; it was simply designed to demonstrate the differences in ease of use and tolerability of the two π 3 compounds, given as the manufacturers had recommended. As such there was no design flaw. It may not have been the study that Novartis wanted, as it was designed by Pfizer, but there was no flaw in the design. Dr Grossberg has taken the opportunity to present the marketing view for Novartis without the opportunity of those claims being peer reviewed. I would not wish to do that in the letters column, and 1 will simply restate the bald findings and modest claims of our study. This study was a well designed multicentre naturalistic comparison of two cholinesterase inhibitors in the treatment of Alzheimer's disease, and clearly demonstrated that in the absence of any difference in efficacy over a 12-week period, patients, carers and physicians demonstrated greater satisfaction with donepezil than with rivastigmine, although the carers and patients of course did not have any experience of the alternative drug, and were therefore making an objective assessment of their satisfaction with each drug. These findings arc in complete accord with other published data and the experience of clinicians in memory clinics. One final point is that donepezil is not tolerated by everyone, and what we do know is that patients can be transferred from one cholinesterase (that they have not tolerated) to another, often with surprisingly good results. While the marketing men argue over tolerability, we as clinicians must be prepared to expect some side-effects, particularly cholinergic ones, with these compounds, but would deny patients the opportunity of an effective trial without at least switching to one of the other compounds before giving up. I await with interest the publication of comparative studies designed and sponsored by manufacturers of the other compounds. Then we may be able to lay these canards to rest.

Esophageal Exfoliative Cytology Samplers

To compare three types of esophageal exfoliative cytology samplers in terms of patient acceptability, ease of use, final destination of the sampler tip in the gastrointestinal tract and cellular yield. A controlled, single-blind, cross-over study was undertaken to compare the balloon, sponge and sponge-mesh samplers in healthy volunteers. After completing the three procedures in random order, participants were asked about their preferred method. Ease of use was defined as the technician's ability to perform the intubation successfully. Final destination of the samplers was assessed fluoroscopically. Cytopathologists determined the cellular yield of each sampler using the Bethesda System. Sixty-two volunteers participated. The two encapsulated samplers were significantly preferred over the balloon (P < .0001). There was no significant difference in ease of use, final destination or cellular yield of the three techniques. All three samplers were successfully intubated on the first attempt and retrieved adequate numbers of squamous and glandular cells in > 78% of cases. All three samplers obtained satisfactory yields of squamous and glandular cells, but the encapsulated samplers were more patient acceptable. The sponge-mesh sampler may be the least complicated sampler for field screening use. Larger-scale studies will be required to test the accuracy of these three samplers for detecting esophageal dysplasia and carcinoma.