Incomplete Instructions Research Articles

Assessing usability of electronic patient-reported outcome measures in older people with and without a rare dermatologic disorder

BackgroundRobust and well-defined data collection is important when using electronic patient-reported outcome measures (ePROMs) in clinical studies. Questions have been raised as to whether older age may be a barrier to data collection due to patients’ unfamiliarity with electronic devices. Older adults may also have underlying health conditions that affect their ability to fill out patient-reported outcome measures (PROMs) on electronic devices. The aim of this observational, qualitative research study was to evaluate the usability of electronic PROMs (ePROMs) on a tablet and smartphone in older participants with and without bullous pemphigoid (BP).MethodsOlder people with and without BP were recruited in the US and France. They participated in 60-min in-person interviews, with moderators observing their completion of various tasks, including ePROMs, using a tablet and smartphone. Participants were scored on ease of task completion using a scale from 1 to 5.ResultsA total of 12 participants were recruited (≥65 years old; six each with and without BP [all participants without BP were ≥75 years old]). Most participants (83%) could easily and confidently perform most assigned tasks on both the tablet and smartphone. Although select tasks required assistance, all participants were eventually able to complete all tasks. Overall, ePROM usability did not correlate with age, sex, country, or disease state. Feedback on the general usability of both electronic devices was largely positive, and most participants (n = 11; 92%) were willing to use them. Participants were generally pleased with the training modules offered on both devices, describing the training as sufficient, straightforward, and helpful. In total, 25 usability issues were identified, which fell into three categories: incomplete instructions, unclear language, and insufficient technical/visual design. Participants provided feedback on how to enhance device usability.ConclusionsThe results suggest that older people can confidently use a tablet or smartphone for ePROM completion, particularly with appropriate training. ePROMs should be designed with the needs of the target patient population in mind. These results can be leveraged to improve clinical data recording, optimize device usability, and enhance the user experience for older people and those with functional or physical limitations.Graphical abstract

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies.

This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.

Improve the Completion Rate of Nursing Guidance for Patients with Newly Diagnosed Esophageal Cancer

<p>背景：初診斷食道癌病人，因生理上遭受進食功能與營養缺失，其角色及情緒功能受影響易出現憂鬱或焦慮，而導致整體生活品質下降。在診斷初期，病人有高度照護資訊的需求，但對於短時間的大量信息常造成吸收負荷。連貫完整的護理指導可促進病人對護理指導之理解程度，進而提升自我照顧能力與生活品質。本單位初診斷食道癌病人陸續有檢查或手術延遲、食物哽塞或進食管路阻塞情形， 於2020年3月2日至3月20日，統計單位對其護理指導完整率僅62.5%，影響照護品質，故引發專案動機</p> <p>目的：提升護理人員對初診斷食道癌病人護理指導完整率達97.5%。</p> <p>解決方案：分析原因為護理人員之疾病認知不足、衛教解說耗時、無追蹤機制致重複指導。病人部份包括訊息眾多龐雜影響衛教效率、家屬輪替致指導中斷與不完整。此外尚包括教育資源未符合指導需求、來源與資訊未統合、缺乏追蹤機制等。透過舉辦在職教育、製作衛教卡通圖及工作車桌曆、錄製衛教影片並製作QR Code連結觀看、發放照護手冊及簡易化放療照護包、設計衛教進度檢核表與查核表等策略提升完整率。</p> <p>結果：透過多元護理指導工具及衛教資源整合可提升連貫完整的護理指導。除了增進病人疾病認知及自我照護能力外，亦使醫療滿意度提升，並促進照護品質。</p> <p> </p><p>Background:Patients with newly diagnosed esophageal cancer often suffer from depression and anxiety due to lim­ited oral intake and malnutrition, which affects their physical and emotional function, resulting in a decline in their quality of life. Patients have a high demand for self-care information in the early stages of diagnosis. However, getting large amounts of information in a short time often creates tremendous pressure for the patients. Coherent and compre­hensive nursing guidance can increase the understanding of nursing guidance which further improvs patients’ self-care ability. Delayed examination or surgery, choking, or obstruction of the feeding route occur frequently on patients with esophageal cancer initially diagnosed in our unit. A team was established to improve the low nursing guidance com­pletion rate (62.5%).</p> <p>Purpose: To improve the completion rate of nursing guidance for newly diagnosed esophageal cancer patients from 62.5% to 97.5%.</p> <p>Strategic procedure: Inadequate nursing knowledge, insufficient continuity of health education, and a lack of after­ward follow-ups in delivering information are identified as main obstacles for medical providers. As for patients, main obstacles include massive information and interrupted or incomplete instruction due to family rotation. In addition, the inconsistent resources and content of the supplementary teaching materials needed to be carefully complied to meet the needs and a health education tracking system needed to be set up as well. As a result, specific strategies were developed to successfully decrease the rate of feeding route obstruction. The strategic procedures included consolidat­ing in-service education, remodeling teaching materials, creating a useful pictorial calendar and work cards, making instructor videos, creating QR code links for teaching materials, and designing standardized education protocols and checklists.</p> <p>Outcomes Evaluation: The completion rate of nursing guidance increased to 98.2%.</p> <p>Conclusions: Coherent and comprehensive nursing guidance was created by integrating multiple nursing guidance tools and health education materials. In addition to improving patients’ disease awareness and self-care ability, the im­plementation of the guideline also improves medical satisfaction and the quality of care.</p> <p> </p>

Computer Multimedia-Oriented Chinese Language and Literature Distance Teaching System

The traditional Chinese language and literature distance teaching system has the problem of incomplete instruction recognition function, which leads to the slow connection speed of the system. This paper designs a computer multimedia Chinese language and literature distance teaching system. For the hardware part, strain gauge and sensor are combined, connected to VCC through 10 K ohm pull-up resistance, and connected to other components. The software part obtains the expression form of Chinese language and literature; formulates the training target, according to the antimonotone characteristics of the support degree; adopts the association rule algorithm to build the remote teaching system database, combined with the client to parse the signaling message; and designs the software instruction recognition function by using the computer multimedia technology. Experimental Results. The average connection speeds of the Chinese language and literature distance teaching system in this paper and the other two kinds of Chinese language and literature distance teaching system are 8.737 s, 13.140 s, and 13.156 s, respectively, which proves that the performance of the Chinese language and literature distance teaching system combined with computer multimedia technology is more perfect.

Use of Stakeholder Feedback to Develop an App for Vestibular Rehabilitation-Input From Clinicians and Healthy Older Adults.

Close to half people over 60 years of age experience vestibular dysfunction. Although vestibular rehabilitation has been proven effective in reducing dizziness and falls in older adults, adherence to exercise programs is a major issue and reported to be below 50%. Therefore, this research aimed to develop an app with gaming elements to improve adherence to exercises that are part of vestibular rehabilitation, and to provide feedback to increase the accuracy during exercise performance. A clinician-informed design was used where five physical therapists were asked identical questions about the exercises they would like to see in the app, including their duration and frequency. Games were developed to train the vestibulo-ocular (VOR) reflex using VOR and gaze shifting exercises; and to train the vestibulo-spinal system using weight shifting and balance exercises. The games were designed to progress from simple to more complex visuals. The games were controlled by an Inertial Measurement Unit placed on the head or anterior waist. The app was tested on ten healthy females (69.1 ± 5.1 years) with no prior history of vestibular dysfunction or complaints of dizziness. Participants completed gaze stabilization and balance exercises using the app and provided feedback on the user interface, ease of use, usefulness and enjoyment using standardized questionnaires and changes they would like to see in the form of open-ended questions. In general, participants reported that they found the app easy to use, the user interface was friendly, and they enjoyed playing the games due to the graphics and colors. They reported that the feedback provided during the exercise session helped them recognize their mistakes and motivated them to do better. However, some elements of the app were frustrating due to incomplete instructions and inability to distinguish game objects due to insufficient contrast. Feedback received will be implemented in a revised version which will be trialed in older adults with dizziness due to vestibular hypofunction. We have demonstrated that the “Vestibular AppTM” created for rehabilitation with gaming elements was found to be enjoyable, useful, and easy to use by healthy older adults. In the long term, the app may increase adherence to vestibular rehabilitation.

Sleep Quality Among Healthcare Workers During the COVID-19 Pandemic and Its Impact on Medical Errors: Kuwait Experience.

Millions of people suffer from sleep disturbances. In addition, the coronavirus disease 2019 (COVID-19) pandemic created several new challenges-particularly for frontline healthcare workers (HCWs). This study assessed the sleep quality (SQ) among HCWs. A cross-sectional study was conducted using an English-language online survey. The participants were invited via a web link sent using social network platforms. It included sociodemographic- and profession-related characteristics. COVID-19-associated risks were assessed (e.g., being on the front line, doing swabs, satisfaction about protective equipment, and management protocols). Assessment of SQ was done using the Pittsburgh Sleep Quality Index (PSQI) and various medical errors were recorded. A total of 217 HCWs completed the survey with mean (±standard deviation) age of 35.8 (±7.3) years; 56.2% were male, 18.43% had comorbidities, and 61.75% experienced sleep difficulties before the COVID-19 crisis. This work reports a 78.8% prevalence of poor SQ, with the mean (standard deviation) global PSQI score of 9.36 (±4.4). HCWs with poor sleep experienced more positive comorbid profile (23.64% versus 6.52%, p=0.01). Working on the front lines of COVID-19 was associated with poor sleep (69.59% versus 47.83%, p=0.006). Among the participants, 77.42% performed medical errors, particularly not checking for drug allergies (17.97%), dispensing medication with incomplete instructions (20.74%), providing incorrect doses or overdosing (14.75%), incorrectly explaining the use of medication (9.22%), and prescribing a drug to the wrong patient (10.14%). This nationwide survey reported high prevalence of poor SQ among HCWs during the COVID-19 pandemic. Being an HCW on the front lines of COVID-19 and doing swabs with a positive comorbidity was associated with poor sleep.

Medical errors: Healthcare professionals' perspective at a tertiary hospital in Kuwait.

Medical errors are of economic importance and can contribute to serious adverse events for patients. Medical errors refer to preventable events resulting from healthcare interactions, whether these events harm the patient or not. In Kuwait, there is a paucity literature detailing the causes, forms, and risks of medical errors in their state-funded healthcare facilities. This study aimed to explore medical errors, their causes and preventive strategies in a Kuwait tertiary hospital based on the perceptions and experience of a cross-section of healthcare professionals using a questionnaire with 27 open (n = 10) and closed (n = 17) questions. The recruited healthcare professionals in this study included pharmacists, nurses, physicians, dentists, radiographers, hospital administrators, surgeons, nutritionists, and physiotherapists. The collected data were analysed quantitatively using descriptive statistics. A total of 203 participants filled and completed the survey questionnaire. The frequency of medical errors in Kuwait was found to be high at 60.3% ranging from incidences of prolonged hospital stays (32.9%), adverse events and life-threatening complications (32.3%), and fatalities (20.9%). The common medical errors result from incomplete instructions, incorrect dosage, and incorrect route of administration, diagnosis errors, and labelling errors. The perceived causes of these medical errors include high workload, lack of support systems, stress, medical negligence, inadequate training, miscommunication, poor collaboration, and non-adherence to safety guidelines among the healthcare professionals.

Is it Truly Easy for Second Language Learners to Compose -ing Form Construction?

English rules are occasionally restricted, for instance, -ing form. This form is acquired in the early stage of natural acceptance and whether the earliest will guarantee ESL students to understand and compose it easily. This research is designated to investigate errors, sources of errors, and error tendencies made by students in composing –ing form. This research was carried out at UAD University in the English Department. Writing essay test was utilized to diagnose the tendency of –ing form misconception. Erroneous data were identified and categorized based on surface structure taxonomies and communication effect taxonomies. The findings prove that –ing form construction is not that easy for students to compose. Misformation frequenly appears due to some inappropriate formulation, mainly when students are asked to compose the –ing form as the constituent of phrase or clause, the direct object of certain verbs, and object of preposition with a particle of preposition to. The main factor affecting the deviation is caused by the distinct linguistic system of both English and Indonesian. The lack of knowledge towards the target language or incomplete instruction additionally makes students over-generalize every aspect of English rule which is occasionally restricted.

The challenges of improving peripherally inserted central catheter (PICC) care instructions at hospital discharge.

175 Background: Teaching patients and caregivers to manage a Peripherally Inserted Central Catheter (PICC) line placed during hospitalization is essential to successful outpatient transitions. The aim was to improve written care instructions at hospital discharge (CIHD) given to solid tumor oncology patients with new PICC lines by creating an electronic template in the electronic health record. Methods: Inpatients with newly placed PICC lines discharged from the physician assistants' (PA) oncology teams at Brigham and Women's Hospital were identified through PICC team consult lists. We identified 9 elements of complete line care, modeled on National Quality Forum discharge metrics, to include in a template for PICC line care instructions at discharge. PAs received instruction on template use at their weekly meeting. A retrospective chart review of CIHD (February 19, 2016 and October 13, 2016) was performed. Results: A total of 47 cases were reviewed, 19 cases Pre-introduction and 28 cases Post. Before introduction of the template, 74% of cases lacked PICC care instructions (including 13 cases with no mention of the PICC line), 26% had incomplete care instructions, and none had full instructions. Following the intervention, 64% still lacked care instructions (16 cases with no mention of the PICC line), 21% had incomplete care instructions, and 4 patients (14%) had full instructions. Only those CIHD that used the template had complete care instructions. A c-chart demonstrated special cause variation following the intervention but the process was chaotic. Conclusions: The introduction of a template for PICC care instructions led to modest improvement in the number of patients discharged with full instructions. This project highlights the limitations of solutions that incorporate technical solutions but only weak adaptive ones. The next phase of our work will introduce human factors interventions (e.g. automation and forcing functions) to improve the success rate of this critically important function. [Table: see text]

A PRELIMINARY ANALYSIS OF INSTRUCTIONAL CONTROL IN THE MAINTENANCE OF APPROPRIATE BEHAVIOR

This bridge study evaluated the effects of contingency-specifying instructions (CSIs) and incomplete instructions (IIs) in terms of establishing instructional control of appropriate behavior. Results suggested that instructional control and maintenance were achieved with CSIs but not with IIs. Results are discussed in terms of the potential use of instructional control in the maintenance of appropriate behavior for children with attention deficit hyperactivity disorder.

Intervention Validity of Cognitive Assessment

The intervention validity of cognitive assessment batteries is considered within an historical context to identify what the evidence supports (knowns), what cannot be known (unknowables), and what is not yet known (unknowns). Two ways cognitive batteries could inform intervention are identified: a disordinal (i.e., aptitude-treatment interaction) model and an ordinal (i.e., g) model. Existing research provides little support for disordinal models and modest to strong support for ordinal models when applied to conditions of incomplete instruction. Limitations to what can be known (e.g., a failure to prove is not proof of failure) are identified to avoid holding intervention validity research to inappropriate evidential standards. Finally, issues that are within the realm of knowledge but for which there is currently insufficient or no evidence are identified as logical next steps toward understanding the intervention validity of cognitive assessment batteries.

2007 Leadership Academy for Educators

2007 Leadership Academy for Educators

Diary keeping in asthma: comparison of written and electronic methods.

To determine the extent to which symptom diaries of asthmatic patients are inaccurate or based on retrospective recall. Comparison of electronic and pencil and paper diaries. Both forms were completed twice daily at home for 14 days. Outpatient clinic. 24 asthmatic outpatients also tested for severity of asthma and for anxiety. More sessions were missed in the evening than in the morning for both types of diaries. Significantly more retrospective entries were made in the evening (26 entries, 14 patients) than in the morning (6 entries, 3 patients). Discrepant entries of peak expiratory flow accounted for 15% of those made on the appropriate day, and three quarters of patients made at least one discrepant entry. Variation in peak expiratory flow was significantly related to number of discrepancies and number of missing days, and anxiety score was significantly related to number of missing days. About a fifth of written entries may have errors. Poor diary completion may result from having unreasonable expectations of patients and giving incomplete instructions. Electronic, time coded diaries could ensure better quality of records.

Self-repair in dialogues of schizophrenics: Effects of hallucinations and negative symptoms

This paper concerns the discourse features of verbal hallucinations and negative symptoms of schizophrenia. A total of 46 schizophrenics, varying in verbal hallucination and in negative symptoms status, and 22 controls were tested on the Reporter Test. The frequency with which they issued inadequate instructions, attempted to repair the inadequacies, and the success of repairs were compared. We observed that schizophrenics, on the whole, issued more wrong and incomplete instructions. This was in part related to their worse working memory, but it was not affected by verbal hallucinations or negative symptoms. We observed, further, that schizophrenics had no particular problems monitoring messages for inadequacies. We did find, however, that schizophrenics with verbal hallucinations had a specific problem with self-repairing wrong instructions. We interpret these results in the framework of Hoffman's (1986b) plan disruption-based model of verbal hallucinations; the Frith (1987) and Frith and Done (1988) internal monitoring model of positive and negative symptoms; and finally Frith and Frith's (1990) model of negative and positive schizophrenia and we use the results to specify the models.

EFFECTS OF RESPONSE VARIABILITY ON THE SENSITIVITY OF RULE‐GOVERNED BEHAVIOR

Two experiments examined the relation between response variability and sensitivity to changes in reinforcement contingencies. In Experiment 1, two groups of college students were provided complete instructions regarding a button-pressing task; the instructions stated "press the button 40 times for each point" (exchangeable for money). Two additional groups received incomplete instructions that omitted the pattern of responding required for reinforcement under the same schedule. Sensitivity was tested in one completely instructed and one incompletely instructed group after responding had met a stability criterion, and for the remaining two groups after a short exposure to the original schedule. The three groups of subjects whose responding was completely instructed or who had met the stability criterion showed little variability at the moment of change in the reinforcement schedule. The responding of these three groups also was insensitive to the contingency change. Incompletely instructed short-exposure responding was more variable at the moment of schedule change and was sensitive to the new contingency in four of six cases. In Experiment 2, completely and incompletely instructed responding first met a stability criterion. This was followed by a test that showed no sensitivity to a contingency change. A strategic instruction was then presented that stated variable responding would work best. Five of 6 subjects showed increased variability after this instruction, and all 6 showed sensitivity to contingency change. The findings are discussed from a selectionist perspective that describes response acquisition as a process of variation, selection, and maintenance. From this perspective, sensitivity to contingency changes is described as a function of variables that produce response variability.

Realising you don't understand: a further study.

Comprehension monitoring skills of younger (5- to 6-yr-old) and older (8- to 9-yr-old) children were compared. Children examined ambiguous and incomplete pictorial instructions as to how to make two models, and were asked whether there was anything else they would need to know in order to make the models. Questions were answered, and their oral instructions recorded. Both age groups were equally likely to judge the instructions to be incomplete, but the younger children were apparently less able to recognise their lack of understanding. Differences found were taken as evidence of more active and detailed processing of the instructions by the older children.

Interpretation of instructions: A source of individual differences in analogical reasoning

Two studies were conducted to identify individual differences in the effect of instruction on strategies used to solve figural/numerical analogies. In Study 1, students aged 9, 11, 13, and 19 years were given incomplete instructions and then were assessed for (a) consistent use of an appropriate rule for solving analogies and (b) the type and number of stimulus attributes that are incorporated in those analogical rules. Use of an analogical rule increased with age and corresponded to higher scores on a psychometric test of reasoning within each age group. In Study 2, analysis of verbal protocols was used to identify the strategies of some 9- and 11-year-olds who showed a peculiar pattern of responding in Study 1. These children attended to relevant attributes but used systematic nonanalogical rules to solve problems. When provided with more specific instructions, most of these children adopted an analogical rule but failed to incorporate relevant attributes. Results indicate that selection or construction of task-relevant solution strategies from incomplete instructions may partially account for differential performance on tests of analogical reasoning.

History-taking forms and the care of geriatric patients.

Certain historical aspects peculiar to the biology of elderly people may be obscure to the medical observer and need to be fully incorporated in a formulation of a person's state of health. History forms from four acute teaching hospitals and six long-term care facilities were reviewed for the presence of designation of functional assessment, multiple chief complaints, a subjective comment by the patient indicating his degree of health, specifics of home-living arrangement, supporting services received, and dietary history. Ten physical diagnosis course directors were contacted to determine whether their courses emphasize elicitation of multiple chief complaints, the wide spectrum of presentations of acute illnesses in the elderly, specifics of functional assessment, and the need for special techniques of communication and interviewing skills relevant tot he elderly. The study, conducted in the Boston area, indicates that medical students and physicians-in-training are receiving variable and incomplete instruction about the total health care needs of elderly people.