Technology Acceptance and Authenticity in Interactive Simulation: Experimental Study

BACKGROUND

Remote and virtual simulations have gained prevalence during the COVID-19 pandemic as institutions maintain social distancing measures. Because of the challenges of cost, flexibility, and feasibility in traditional mannequin simulation, many health care educators have used videos as a remote simulation modality; however, videos provide minimal interactivity.

OBJECTIVE

In this study, we aimed to evaluate the role of interactivity in students' simulation experiences. We analyzed students' perceptions of technology acceptance and authenticity in interactive and noninteractive simulations.

METHODS

Undergraduate nursing students participated in interactive and noninteractive simulations. The interactive simulation was conducted using interactive video simulation software that we developed, and the noninteractive simulation consisted of passively playing a video of the simulation. After each simulation, the students completed a 10-item technology acceptance questionnaire and 6-item authenticity questionnaire. The data were analyzed using the Wilcoxon signed-rank test. In addition, we performed an exploratory analysis to compare technology acceptance and authenticity in interactive local and remote simulations using the Mann-Whitney U test.

RESULTS

Data from 29 students were included in this study. Statistically significant differences were found between interactive and noninteractive simulations for overall technology acceptance (P<.001) and authenticity (P<.001). Analysis of the individual questionnaire items showed statistical significance for 3 out of the 10 technology acceptance items (P=.002, P=.002, and P=.004) and 5 out of the 6 authenticity items (P<.001, P<.001, P=.001, P=.003, and P=.005). The interactive simulation scored higher than the noninteractive simulation in all the statistically significant comparisons. Our exploratory analysis revealed that local simulation may promote greater perceptions of technology acceptance (P=.007) and authenticity (P=.027) than remote simulation.

CONCLUSIONS

Students' perceptions of technology acceptance and authenticity were greater in interactive simulation than in noninteractive simulation. These results support the importance of interactivity in students' simulation experiences, especially in remote or virtual simulations in which students' involvement may be less active.

Interactive Video Simulation for Remote Healthcare Learning

Simulation is an essential component of healthcare education as it enables educators to replicate clinical scenarios in a controlled learning environment. Simulation has traditionally been conducted in-person through the use of manikins, however, the COVID-19 pandemic has challenged the practice of manikin simulation. Social distance constraints were enforced during the pandemic to reduce the potential spread of the virus and as a result, many educators and students were denied physical access to their universities' simulation facilities. Healthcare educators sought remote alternatives to manikin simulation and many resorted to instructional videos to educate their learners. While the use of videos increases safety, passively watching videos lacks interactivity which is an important component of simulation learning. In response to these challenges, we developed an interactive video simulation software that uses educators' existing video content to conduct a simulation remotely, thereby promoting safety during the pandemic while also meeting the interactivity standards of best practice for healthcare simulation. In this paper, we compare the interactive video simulation to the current practice of watching non-interactive video of a simulation using the same content. We found that interactivity promotes higher order learning, increases teamwork and enhances the perception of authenticity. Additionally, the majority of participants demonstrated positive reception of the interactive simulation. The simulation software provides the safety desired of a remote simulation during the pandemic while also engaging students in interactive learning experiences.

Comparison of emergency caesarean section to misoprostol induction for the delivery of antepartum eclamptic patients: a pilot study

BACKGROUND

Eclampsia has now emerged as one of the commonest cause of maternal mortality in Nigeria. There is need for research on best modality for delivery of eclamptics.

METHODOLOGY

The pilot study was conducted on 50 eclamptic patients at the Federal Medical Centre, Azare. The patients were randomized for delivery either by caesarean section (CS) or induction of labour. The fetomaternal outcome of the two groups was compared.

RESULTS

25 of the patients had CS and 25 had induction of labour with misoprostol. The mean decision delivery interval was 4.1 hours and 13.08 hours for the CS and misoprostol groups respectively. Misoprostol failure was recorded in 4 (16%) patients and they were subsequently delivered by CS. The duration of admission was longer in the CS group (mean of 10.1 days) compared to the misoprostol group (mean of 6.08 days). There were more maternal complications and admissions of babies into the SCBU in the CS group. Maternal mortality in the two groups was similar (2% each).

CONCLUSION

Misoprostol is cheap, available and safe for delivery of antepartum eclamptics. In the event of delay at caesarean section for antepartum eclamptics patients, misoprostol induction should be started. A multicenter study is called for.

The meaning of healthy and not healthy: older African Americans and whites with chronic illness

Qualitative in-person interviews with 114 older African Americans and whites with chronic illness were conducted to assess whether they thought of themselves as healthy or not healthy and the meanings associated with that assessment. The first and most frequently assigned attribute of healthy was the presence of functional capacities; for not healthy it was the presence of medical conditions or physical symptoms. While both African Americans and whites responded similarly regarding the assessment of whether they were healthy or not healthy, African Americans described the attributes associated with healthy or not healthy somewhat differently than whites. Also, both groups reported more varied meanings to the concept of 'healthy' than to 'not healthy', suggesting that 'healthy' may be a multidimensional construct more connected to ones' total life experiences than is 'not healthy'. This study concludes that social and cultural factors such as race, ethnicity or health experiences may influence how individuals perceive and describe their health status and the processes used in making these assessments.

Self care for chronic illness: older African Americans and whites

In-person interviews with two hundred and twenty-one older African Americans and whites in Allegheny County, Pennsylvania on their use of self care activities in the care of one of four chronic illnesses (chronic obstructive pulmonary disease (COPD), heart disease, diabetes mellitus, and arthritis, addressed which types of self care they used for each of these illnesses) the similarities and differences between African Americans and whites in their use of self care and how self care is initiated, modified and integrated into a context that includes help from others. The most common response in each of the illnesses was the use of medications or medical treatments by both African Americans and whites. However, there were some differences in the self care practices used by these two groups by illness type. Whites reported monitoring their illness significantly more than African Americans for diabetes and using assistive devices in the management of COPD significantly more than African Americans. While both African Americans and whites practice self care similarly in the management of heart disease, African Americans reported greater use of exercise in their management of arthritis. The amount of assistance provided by others in support of self care varied by illness and by African American and white. The differences in self care usage may be attributed to many factors, among them, differences in cultural experiences with the illness, health beliefs regarding its efficacy and the amount of assistance received from informal supports.

Medicare HMOs: the experience of older African Americans and whites

This exploratory study of 205 older adults with chronic illness, of whom 55 enrolled in Medicare HMOs, examined the characteristics of those who enrolled, their experiences with managed care, and the differences between African Americans and whites in these domains. HMO enrollees were more likely to report their finances as inadequate; to have a high school education or less; and to have higher levels of social support. No significant differences by race were found in enrollment or in factors related to enrollment. Enrollees joined because of low premiums, enhanced HMO benefits, and pressure from employers providing retiree health benefits. The majority of enrollees reported positive experiences, however, more whites than African Americans reported negative experiences.

Public attitudes regarding willingness to participate in medical research studies

The recruitment of adequate numbers of people to participate in medical research studies is an ongoing problem for biomedical researchers. Although the general public has come to expect and demand that the biomedical community develop new, safe and effective approaches to the prevention and treatment of diseases, that same public is not aware of the important role that public participation plays in the development of medical advances. Much is known about willingness to participate in research studies from the perspectives of patients, survivors, and those at-risk for getting a particular disease. However, little is known about the attitudes and willingness of the general public to participate in medical research. Yet, it is this population that comprises the potential pool of participants for future treatment and prevention studies. In order to examine public attitudes toward and support for medical research, a random digit dial telephone survey was conducted with 489 persons in southwestern Pennsylvania. The survey measured the respondent's stated willingness to take part in a medical research study and the factors associated with willingness to participate. These included the respondent's health status, demographic characteristics, attitudes and beliefs about participation and their knowledge about the conduct of medical research. The results of the study indicate that 46% of those surveyed said that they would be willing to take part in a medical research study focusing on a new treatment for a specific disease that was of concern to them, 25% stated that they would not be willing and 29% stated that they were undecided regarding participation. However, under certain circumstances, such as having cancer, over half of those who were undecided said they would be willing to participate. The characteristics of those willing to participate in a medical research study differ from those not willing. Determinants of willingness include: having a relative or friend who has an illness, being middle aged (between 35-64 years old), prior experience with participation in a medical research study, having a favorable attitude toward the use of human subjects in medical research and beliefs that diverse types of persons participate in clinical trials. Those respondents who were undecided about joining a clinical trial, also have different characteristics than those who are not willing. The determinants of being undecided in contrast to not willing include: having at least a college degree, having a favorable or neutral attitude toward the use of humans in medical research and, believing that the well-being of participants is the primary concern of researchers. The findings of this study have both public policy and practice implications. From a policy perspective, medical research designed to develop new treatments for disease requires an evidenced-based approach for decision making. Such an approach can only succeed if adequate numbers of individuals are willing to participate in these studies. From a practice perspective, the current study suggests that opportunities exist to increase participation by targeting recruitment efforts not only toward the willing but also toward those who are undecided about participation in medical research studies. This would involve tailoring the content of communications to meet the specific characteristics and concerns of each of these two groups of individuals.

To treat or not to treat: issues in decisions not to treat older persons with cognitive impairment, depression, and incontinence

OBJECTIVES

To examine decisions not to treat problems identified during outpatient geriatric assessment, particularly problems of cognitive impairment, depression, or urinary incontinence.

DESIGN

A descriptive study using patients' medical charts and survey data and interviews with clinical staff.

SETTING

Four hospital-based, ambulatory, geriatric assessment clinics in Allegheny Country, PA.

PARTICIPANTS

The sample comprised 128 older adults, recruited to a randomized, controlled clinical trial, who had problems associated with cognitive impairment, depression, or urinary incontinence.

RESULTS

Although treatment was recommended for most of the problems relating to cognitive impairment, depression, and/or incontinence experienced by this group, slightly more than one-third of cognitive impairment and depression problems and nearly one-half of incontinence did not receive treatment recommendations. Treatment rates varied considerably by condition and combination of comorbidity. Decisions not to treat are classified into six categories: patient or family refused treatment, the assessment was not completed, an intervention was already in place, concurrent problems or comorbities might have interfered with treatment, there was no documented diagnosis or there was a documented consideration and rule out of the problem, or no documented reason.

CONCLUSION

Outpatient geriatric assessment units are designed to deal with the multiple problems experienced by their geriatric patients, and they identify successfully most problems presented by their frail constituents. However, identification of the patient's problems is only the first step in the assessment process and does not necessarily lead to either a documented diagnosis or to a treatment recommendation. Multiple social, cultural, environmental, and medical factors complicate the assessment process and, hence, the decision clinicians face when they decide whether to make recommendations to treat. These clinicians must weigh all medical and non-medical factors, including the patient's receptivity to treatment, when prioritizing the problems they deem to be treatable and making recommendations to treat.

Recruiting older adults for clinical trials

More than 400 community-dwelling older adults were recruited into a clinical trial which compared the effectiveness of diagnosis and treatment through geriatric assessment with that provided through usual community physician care. Six recruitment methods were utilized: referrals, solicitations, presentations, media, mailings, and fliers. Each method is described and its results reported in terms of numbers recruited, yield, and cost per participant. The most efficient method was referrals; the method producing the largest number was presentations; the least effective method was fliers. Problems and solutions are discussed, and guidelines for recruiting older adults are suggested. These guidelines include: monitoring with accompanying adaptation, targeting the groups most likely to benefit, providing incentives, and reducing uncertainty among potential participants.

Evaluation of outpatient geriatric assessment: a randomized multi-site trial

OBJECTIVE

To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.

DESIGN

Randomized, controlled clinical trial, with 12-month follow-up.

SETTING

Four hospital-based ambulatory geriatric assessment clinics and community physicians' offices.

PARTICIPANTS

442 recruited older adults with a health problem or recent change in health status.

INTERVENTION

Outpatient consultative geriatric assessment or usual physician assessment.

MAIN OUTCOME MEASURES

Identification of health problems, mortality, nursing home admissions, health status, health services utilization, satisfaction with care, and caregiver well-being.

RESULTS

Geriatric assessment, in comparison with usual community care, resulted in the identification of a significantly greater number of patients with cognitive impairment (P < .0001), depression (P = .0004) and incontinence (P < .0001). The group receiving a geriatric assessment had greater improvement in anxiety levels at 1 year (P = .036). Caregivers of participants in the geriatric assessment group had less caregiver stress at 1 year (P = .002). No outcome differences in mortality, nursing home admissions, cognitive health, functional health, or health services utilization were observed. Some evidence of greater patient satisfaction with respect to qualities of the physician was found for the geriatric assessment group.

CONCLUSIONS

Consultative outpatient geriatric assessment led to significantly improved diagnosis of the common health problems of cognitive impairment, depression, and incontinence, to psychological and emotional benefits for patients, and to reduced levels of caregiver stress. Even with limited follow-up care and control of treatment, outpatient geriatric assessment has potential for significant positive effects.

The relationship between age and major league baseball performance: implications for development

Lifetime performance data of 388 baseball players active in 1965 were analyzed to determine the age of peak performance for skills required to play baseball, to derive age-performance curves for athletic productivity, and to assess the magnitude of individual differences among elite and less able players. Cross-sectional and longitudinal analyses show that athletic performance on key indicators rises relatively quickly from age 19 to a peak age of 27 and then declines. The primary difference between elite and less able players is that performance of the elite players remains high for a longer period of time and decays more gradually. The performance of the most elite players is superior to that of less able players even at very early ages. These results parallel findings reported for other achievement domains and can be explained in terms of basic developmental processes involving the interaction of experience, physiological capacity, and motivation.

The relationship between age and major league baseball performance: implications for development

Lifetime performance data of 388 baseball players active in 1965 were analyzed to determine the age of peak performance for skills required to play baseball, to derive age-performance curves for athletic productivity, and to assess the magnitude of individual differences among elite and less able players. Cross-sectional and longitudinal analyses show that athletic performance on key indicators rises relatively quickly from age 19 to a peak age of 27 and then declines. The primary difference between elite and less able players is that performance of the elite players remains high for a longer period of time and decays more gradually. The performance of the most elite players is superior to that of less able players even at very early ages. These results parallel findings reported for other achievement domains and can be explained in terms of basic developmental processes involving the interaction of experience, physiological capacity, and motivation.

Identification and intervention for urinary incontinence by community physicians and geriatric assessment teams

OBJECTIVE

To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out-patient Geriatric Assessment Units (GAUs) and private physicians in community-based practices (CMDs).

DESIGN

A multi-site, randomized, controlled study where block randomization was utilized to assign subjects 65 years of age and older to either a GAU or a CMD for assessment.

SETTING

One academic and three hospital-based GAUs and CMDs in private practice in a large metropolitan area.

PARTICIPANTS

Three hundred sixty-four community-dwelling frail men (14%) and women (86%) with a mean age of 75 years.

MEASUREMENTS

The independent variable was the type of out patient care, either CMD or GAU, to which the subjects were randomized. The dependent variables were recognition of UI by the health care providers and intervention or referral for the problem of UI once it was identified. Instruments included a structured in-home interview performed before randomization designed to uncover health problems such as urinary incontinence, as well as a medical record review form used post-assessment to ascertain recognition rates and intervention for UI by CMDS and GAUs. Both of the instruments were developed and piloted by the investigators in a preliminary study.

MAIN RESULTS

Of the 364 subjects, 151 (41.5%) reported UI during the in-home interviews. Recognition rates for UI were significantly better for GAUs (48 of 81, 59.3%) than CMDs (11 of 70, 15.7%) (P < 0.001). This was true for mild (< 3 times/week) 44.2% vs 2.1% (P < 0.000005) as well as severe UI (> 3 times/week) 86.2% vs 43.5% (P = 0.00111) for GAUs and CMDs, respectively. There were no significant differences in the rate of referral/intervention for recognized cases of UI by GAUs or CMDs. GAUs referred/treated five (21.7%) cases of mild UI and 10 (40%) cases of severe UI while CMDs referred/treated three (30%) cases of severe UI but did not offer intervention for the one recognized case of mild UI. GAUs were more likely to refer to Continence Programs (12, 25%) compared with CMDs who were more likely to refer (3, 100%) to a urologist. A majority of the subjects with UI did not receive treatment or referral for their problem (8, 72.7% CMDs and 33, 68.6% of GAUs).

CONCLUSIONS

GAUs out performed CMDs in the identification of subjects with both mild and severe UI. However, the intervention/referral rates were low for both GAUs and CMDs. The outcome of this study points to the need for increased emphasis on UI in curriculum preparing physicians and other health providers as well as the need for continuing education for those already in practice.

Modeling skill utilization among prehospital care personnel

Several models linking skill utilization rates for advanced aids and drugs used in prehospital patient management with indicators of the structural and operational characteristics of emergency providers were derived from empirical data. Because the utilization patterns for each clinical category were taken into account, different models were built for each of these categories.