Publications by authors named "Anne Adams"

30 Publications

  • Page 1 of 1

Bacteraemia of oral origin in children - A Systematic review and Network meta-analysis.

Oral Dis 2021 Jul 10. Epub 2021 Jul 10.

Center of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Köln, Germany.

Objectives: To systematically review the prevalence of bacteraemia, triggered by dental intervention and home oral hygiene practices, in children. The network meta-analysis (NMA) quantitatively compared the risk of bacteraemia triggered by dental extractions and home and professional cleaning procedures.

Materials And Methods: Clinical trials with the outcome 'bacteraemia in children' were searched. The NMA was performed using the frequentist weighted least-squares approach comparing the odds ratios (OR) of different interventions.

Results: Among 11 of 13 studies, dental treatment was performed under general anaesthesia. In 2,381 patients, bacteraemia occurred in 38.7-56% patients following single-tooth extractions, in 22-46% after manual toothbrushing (MTB), and in 26-78% after power toothbrushing (PTB). When MTB was set as the reference (OR 1), rubber cup polishing showed a slightly higher risk (OR 1.26) of bacteraemia. PTB presented a higher risk (OR 1.79-2.27) than with single-tooth extractions (OR 1.55) but lower than that with multiple extractions (OR 2.55).

Conclusion: Daily use of MTB and routine professional cleaning were associated with the lowest risk of developing bacteraemia in children with gingivitis, almost as much as with a single-tooth extractions. Improved plaque control with PTB increased the risk of bacteraemia. There is limited evidence on gingivitis-free and systemically-diseased children.
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http://dx.doi.org/10.1111/odi.13957DOI Listing
July 2021

Endurance-oriented training program with children and adolescents on maintenance hemodialysis to enhance dialysis efficacy-DiaSport.

Pediatr Nephrol 2021 Jun 12. Epub 2021 Jun 12.

Children's Hospital, University of Bonn, Bonn, Germany.

Objective: Pediatric patients spend significant time on maintenance hemodialysis (HD) and traveling. They are often not capable of participating in sports activities. To assess the effects of exercise training during HD on dialysis efficacy in children and adolescents, we set up a multi-center randomized controlled trial (RCT).

Methods: Patients on HD, age 6 to 18 years, were randomized either to 3× weekly bicycle ergometer training or to no training during HD for 12 weeks. Change in single-pool Kt/V (spKt/V) was the primary outcome parameter.

Results: We randomized 54 patients of whom 45 qualified (23 in the intervention and 22 in the waiting control group, 14.5 ± 3.01 years, 32 male and 13 female) for the intention-to-treat (ITT) population. Only 26 patients finished study per-protocol (PP). Training was performed for an average of 11.96 weeks (0.14-13.14) at 2.08 ± 0.76 times per week and for a weekly mean of 55.52 ± 27.26 min. Single-pool Kt/V was similar in the intervention compared to the control group (1.70 [0.33] vs. 1.79 [0.55]) at V0 and (1.70 [0.36] vs. 1.71 [0.51]) at V1; secondary endpoints also showed no difference in both ITT and PP analysis. No significant adverse events were reported. No bleeding or needle dislocation occurred in 1670 training sessions.

Conclusions: Intradialytic bicycle training is safe, but does not improve dialysis efficacy and physical fitness. However, the study can be considered underpowered, particularly because of high dropout rates. Future studies need better strategies to increase motivation and compliance and other more effective/intensive exercise measures should be evaluated.

Trial Registration: The trial was registered in ClinicalTrials.Gov ( Clinicaltrials.gov identifier: NCT01561118) on March 22, 2012.
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http://dx.doi.org/10.1007/s00467-021-05114-8DOI Listing
June 2021

Prognostic Factors and Models for Changes in Cognitive Performance After Multi-Domain Cognitive Training in Healthy Older Adults: A Systematic Review.

Front Hum Neurosci 2021 27;15:636355. Epub 2021 Apr 27.

Department of Medical Psychology | Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

Cognitive Training (CT) may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated. The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT. The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on cognitive outcomes (global cognition, memory, attention, executive functions, language, visuo-spatial abilities) after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool. 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results. Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined. https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531.
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http://dx.doi.org/10.3389/fnhum.2021.636355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110835PMC
April 2021

Bisphosphonates or RANK-ligand-inhibitors for men with prostate cancer and bone metastases: a network meta-analysis.

Cochrane Database Syst Rev 2020 12 3;12:CD013020. Epub 2020 Dec 3.

Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Background: Different bone-modifying agents like bisphosphonates and receptor activator of nuclear factor-kappa B ligand (RANKL)-inhibitors are used as supportive treatment in men with prostate cancer and bone metastases to prevent skeletal-related events (SREs). SREs such as pathologic fractures, spinal cord compression, surgery and radiotherapy to the bone, and hypercalcemia lead to morbidity, a poor performance status, and impaired quality of life. Efficacy and acceptability of the bone-targeted therapy is therefore of high relevance. Until now recommendations in guidelines on which bone-modifying agents should be used are rare and inconsistent.

Objectives: To assess the effects of bisphosphonates and RANKL-inhibitors as supportive treatment for prostate cancer patients with bone metastases and to generate a clinically meaningful treatment ranking according to their safety and efficacy using network meta-analysis.

Search Methods: We identified studies by electronically searching the bibliographic databases Cochrane Controlled Register of Trials (CENTRAL), MEDLINE, and Embase until 23 March 2020. We searched the Cochrane Library and various trial registries and screened abstracts of conference proceedings and reference lists of identified trials.

Selection Criteria: We included randomized controlled trials comparing different bisphosphonates and RANKL-inihibitors with each other or against no further treatment or placebo for men with prostate cancer and bone metastases. We included men with castration-restrictive and castration-sensitive prostate cancer and conducted subgroup analyses according to this criteria.

Data Collection And Analysis: Two review authors independently extracted data and assessed the quality of trials. We defined proportion of participants with pain response and the adverse events renal impairment and osteonecrosis of the jaw (ONJ) as the primary outcomes. Secondary outcomes were SREs in total and each separately (see above), mortality, quality of life, and further adverse events such as grade 3 to 4 adverse events, hypocalcemia, fatigue, diarrhea, and nausea. We conducted network meta-analysis and generated treatment rankings for all outcomes, except quality of life due to insufficient reporting on this outcome. We compiled ranking plots to compare single outcomes of efficacy against outcomes of acceptability of the bone-modifying agents. We assessed the certainty of the evidence for the main outcomes using the GRADE approach.

Main Results: Twenty-five trials fulfilled our inclusion criteria. Twenty-one trials could be considered in the quantitative analysis, of which six bisphosphonates (zoledronic acid, risedronate, pamidronate, alendronate, etidronate, or clodronate) were compared with each other, the RANKL-inhibitor denosumab, or no treatment/placebo. By conducting network meta-analysis we were able to compare all of these reported agents directly and/or indirectly within the network for each outcome. In the abstract only the comparisons of zoledronic acid and denosumab against the main comparator (no treatment/placebo) are described for outcomes that were predefined as most relevant and that also appear in the 'Summary of findings' table. Other results, as well as results of subgroup analyses regarding castration status of participants, are displayed in the Results section of the full text. Treatment with zoledronic acid probably neither reduces nor increases the proportion of participants with pain response when compared to no treatment/placebo (risk ratio (RR) 1.46, 95% confidence interval (CI) 0.93 to 2.32; per 1000 participants 121 more (19 less to 349 more); moderate-certainty evidence; network based on 4 trials including 1013 participants). For this outcome none of the trials reported results for the comparison with denosumab. The adverse event renal impairment probably occurs more often when treated with zoledronic acid compared to treatment/placebo (RR 1.63, 95% CI 1.08 to 2.45; per 1000 participants 78 more (10 more to 180 more); moderate-certainty evidence; network based on 6 trials including 1769 participants). Results for denosumab could not be included for this outcome, since zero events cannot be considered in the network meta-analysis, therefore it does not appear in the ranking. Treatment with denosumab results in increased occurrence of the adverse event ONJ (RR 3.45, 95% CI 1.06 to 11.24; per 1000 participants 30 more (1 more to 125 more); high-certainty evidence; 4 trials, 3006 participants) compared to no treatment/placebo. When comparing zoledronic acid to no treatment/placebo, the confidence intervals include the possibility of benefit or harm, therefore treatment with zoledronic acid probably neither reduces nor increases ONJ (RR 1.88, 95% CI 0.73 to 4.87; per 1000 participants 11 more (3 less to 47 more); moderate-certainty evidence; network based on 4 trials including 3006 participants). Compared to no treatment/placebo, treatment with zoledronic acid (RR 0.84, 95% CI 0.72 to 0.97) and denosumab (RR 0.72, 95% CI 0.54 to 0.96) may result in a reduction of the total number of SREs (per 1000 participants 75 fewer (131 fewer to 14 fewer) and 131 fewer (215 fewer to 19 fewer); both low-certainty evidence; 12 trials, 5240 participants). Treatment with zoledronic acid and denosumab likely neither reduces nor increases mortality when compared to no treatment/placebo (zoledronic acid RR 0.90, 95% CI 0.80 to 1.01; per 1000 participants 48 fewer (97 fewer to 5 more); denosumab RR 0.93, 95% CI 0.77 to 1.11; per 1000 participants 34 fewer (111 fewer to 54 more); both moderate-certainty evidence; 13 trials, 5494 participants). Due to insufficient reporting, no network meta-analysis was possible for the outcome quality of life. One study with 1904 participants comparing zoledronic acid and denosumab showed that more zoledronic acid-treated participants than denosumab-treated participants experienced a greater than or equal to five-point decrease in Functional Assessment of Cancer Therapy-General total scores over a range of 18 months (average relative difference = 6.8%, range -9.4% to 14.6%) or worsening of cancer-related quality of life.

Authors' Conclusions: When considering bone-modifying agents as supportive treatment, one has to balance between efficacy and acceptability. Results suggest that Zoledronic acid likely increases both the proportion of participants with pain response, and the proportion of participants experiencing adverse events However, more trials with head-to-head comparisons including all potential agents are needed to draw the whole picture and proof the results of this analysis.
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http://dx.doi.org/10.1002/14651858.CD013020.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095056PMC
December 2020

Cell-Free HPV-DNA as a Biomarker for Oropharyngeal Squamous Cell Carcinoma-A Step Towards Personalized Medicine?

Cancers (Basel) 2020 Oct 15;12(10). Epub 2020 Oct 15.

Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany.

Global incidences of oropharyngeal squamous cell carcinoma (OPSCC) are rising due to an association with high-risk human papillomavirus (HPV). Although there is an improved overall survival of HPV-related OPSCC; up to 25% of the patients develop recurrent or distant metastatic disease with a fatal outcomes. Biomarkers to monitor this disease are not established. This meta-analysis reviews the role of cell-free HPV DNA in liquid biopsy (LB) as a biomarker for HPV-related OPSCC. Pubmed, Livivo, and Cochrane Library databases were searched from inception to August, 2020. All studies were analyzed by Meta-DiSc 1.4 and Stata 16.0 statistical software. In total, 16 studies were considered for systematic review, whereas 11 studies met inclusion criteria for meta-analysis, respectively. Pooled sensitivity of cfHPV-DNA at first diagnosis and during follow-up was 0.81 (95% CI; 0.78-0.84) and 0.73 (95% CI; 0.57-0.86), while pooled specificity was 0.98 (95% CI; 0.96-0.99) and 1 (95% CI; 0.99-1). The diagnostic odds ratio (DOR) at first diagnosis was 200.60 (95% CI; 93.31-431.22) and 300.31 (95% CI; 60.94-1479.88) during follow-up. The area under the curve (AUC) of summary receiver operating characteristic (SROC) was 0.99 at first diagnosis and 1.00 during follow-up, respectively. In conclusion, cfHPV-DNA presents a potential biomarker with high specificity in patients with HPV-related OPSCC.
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http://dx.doi.org/10.3390/cancers12102997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602702PMC
October 2020

Addition of Radiotherapy to Immunotherapy: Effects on Outcome of Different Subgroups Using a Propensity Score Matching.

Cancers (Basel) 2020 Aug 27;12(9). Epub 2020 Aug 27.

Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.

Immune checkpoint inhibition (ICI) has been established as successful modality in cancer treatment. Combination concepts are used to optimize treatment outcome, but may also induce higher toxicity rates than monotherapy. Several rationales support the combination of radiotherapy (RT) with ICI as radioimmunotherapy (RIT), but it is still unknown in which clinical situation RIT would be most beneficial. Therefore, we have conducted a retrospective matched-pair analysis of 201 patients with advanced-stage cancers and formed two groups treated with programmed cell death protein 1 (PD-1) inhibitors only (PD1i) or in combination with local RT (RIT) at our center between 2013 and 2017. We collected baseline characteristics, programmed death ligand 1 (PD-L1) status, mutational status, PD-1 inhibitor and RT treatment details, and side effects according to the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0. Patients received pembrolizumab ( = 93) or nivolumab ( = 108), 153 with additional RT. For overall survival (OS) and progression-free survival (PFS), there was no significant difference between both groups. After propensity score matching (PSM), we analyzed 96 patients, 67 with additional and 29 without RT. We matched for different covariates that could have a possible influence on the treatment outcome. The RIT group displayed a trend towards a longer OS until the PD1i group reached a survival plateau. PD-L1-positive patients, smokers, patients with a BMI ≤ 25, and patients without malignant melanoma showed a longer OS when treated with RIT. Our data show that some subgroups may benefit more from RIT than others. Suitable biomarkers as well as the optimal timing and dosage must be established in order to achieve the best effect on cancer treatment outcome.
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http://dx.doi.org/10.3390/cancers12092429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563550PMC
August 2020

Letter to the Editors of the Journal of Pediatric Gastroenterology and Nutrition: Surprise Benefits of Telemedicine.

J Pediatr Gastroenterol Nutr 2020 09;71(3):e102

UNC Feeding Team, Divisions of Pediatric Gastroenterology and of Rehabilitation Services, NC Children's Hospital, Chapel Hill, NC.

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http://dx.doi.org/10.1097/MPG.0000000000002835DOI Listing
September 2020

Community-Based Participatory Approach to Increase African Americans' Access to Healthy Foods in Atlanta, GA.

J Community Health 2021 02;46(1):41-50

Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30315, USA.

African Americans in Atlanta, Georgia disproportionately reside in communities with limited access to healthy foods. Collaborations with local corner stores to provide healthy food options have been identified as an evidence-based intervention that could be used to increase food access. This paper describes the community-based participatory approach used to culturally-tailor a Healthy Corner Store Initiative (HCSI) in five Atlanta communities. A mixed method approach (qualitative/quantitative) was utilized. Spatial analysis and an environmental assessment were conducted to locate all corner stores in the partner communities that were listed in a business database. An environmental assessment was conducted at 34 corner stores using a structured log and checklist. Among them, 11 were selected and signed memorandums of understanding to implement the HCSI. A customer intercept survey was administered to 100 African American corner store customers at five of the healthy corner store sites. Descriptive statistics were used to analyze log/checklist and survey data. Corner store customers indicated that they typically purchase snacks, tobacco, and breads, but would purchase certain healthy foods, if offered. They also indicated that freshness of fruits and vegetables and positive relationships with corner store owners would influence healthy food purchases. Findings demonstrate that working collaboratively with community members, researchers and business owners is a critical step in nurturing trust, strengthening credibility, and building partnerships towards increased healthy food access and improved community health.
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http://dx.doi.org/10.1007/s10900-020-00840-wDOI Listing
February 2021

Multiple drug combinations of bortezomib, lenalidomide, and thalidomide for first-line treatment in adults with transplant-ineligible multiple myeloma: a network meta-analysis.

Cochrane Database Syst Rev 2019 11 25;2019(11). Epub 2019 Nov 25.

Faculty of Medicine and University Hospital Cologne, University of Cologne, Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Kerpener Str. 62, Cologne, Germany, 50937.

Background: Multiple myeloma is a bone marrow-based hematological malignancy accounting for approximately two per cent of cancers. First-line treatment for transplant-ineligible individuals consists of multiple drug combinations of bortezomib (V), lenalidomide (R), or thalidomide (T). However, access to these medicines is restricted in many countries worldwide.

Objectives: To assess and compare the effectiveness and safety of multiple drug combinations of V, R, and T for adults with newly diagnosed transplant-ineligible multiple myeloma and to inform an application for the inclusion of these medicines into the World Health Organization's (WHO) list of essential medicines.

Search Methods: We searched CENTRAL and MEDLINE, conference proceedings and study registries on 14 February 2019 for randomised controlled trials (RCTs) comparing multiple drug combinations of V, R and T for adults with newly diagnosed transplant-ineligible multiple myeloma.

Selection Criteria: We included RCTs comparing combination therapies of V, R, and T, plus melphalan and prednisone (MP) or dexamethasone (D) for first-line treatment of adults with transplant-ineligible multiple myeloma. We excluded trials including adults with relapsed or refractory disease, trials comparing drug therapies to other types of therapy and trials including second-generation novel agents.

Data Collection And Analysis: Two review authors independently extracted data and assessed risk of bias of included trials. As effect measures we used hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) and risk ratios (RRs) for adverse events. An HR or RR < 1 indicates an advantage for the intervention compared to the main comparator MP. Where available, we extracted quality of life (QoL) data (scores of standardised questionnaires). Results quoted are from network meta-analysis (NMA) unless stated.

Main Results: We included 25 studies (148 references) comprising 11,403 participants and 21 treatment regimens. Treatments were differentiated between restricted treatment duration (treatment with a pre-specified amount of cycles) and continuous therapy (treatment administered until disease progression, the person becomes intolerant to the drug, or treatment given for a prolonged period). Continuous therapies are indicated with a "c". Risk of bias was generally high across studies due to the open-label study design. Overall survival (OS) Evidence suggests that treatment with RD (HR 0.63 (95% confidence interval (CI) 0.40 to 0.99), median OS 55.2 months (35.2 to 87.0)); TMP (HR 0.75 (95% CI 0.58 to 0.97), median OS: 46.4 months (35.9 to 60.0)); and VRDc (HR 0.49 (95% CI 0.26 to 0.92), median OS 71.0 months (37.8 to 133.8)) probably increases survival compared to median reported OS of 34.8 months with MP (moderate certainty). Treatment with VMP may result in a large increase in OS, compared to MP (HR 0.70 (95% CI 0.45 to 1.07), median OS 49.7 months (32.5 to 77.3)), low certainty). Progression-free survival (PFS) Treatment withRD (HR 0.65 (95% CI0.44 to 0.96), median PFS: 24.9 months (16.9 to 36.8)); TMP (HR 0.63 (95% CI 0.50 to 0.78), median PFS:25.7 months (20.8 to 32.4)); VMP (HR 0.56 (95% CI 0.35 to 0.90), median PFS: 28.9 months (18.0 to 46.3)); and VRDc (HR 0.34 (95% CI 0.20 to 0.58), median PFS: 47.6 months (27.9 to 81.0)) may result in a large increase in PFS (low certainty) compared to MP (median reported PFS: 16.2 months). Adverse events The risk of polyneuropathies may be lower with RD compared to treatment with MP (RR 0.57 (95% CI 0.16 to 1.99), risk for RD: 0.5% (0.1 to 1.8), mean reported risk for MP: 0.9% (10 of 1074 patients affected), low certainty). However, the CIs are also compatible with no difference or an increase in neuropathies. Treatment with TMP (RR 4.44 (95% CI1.77 to 11.11), risk: 4.0% (1.6 to 10.0)) and VMP (RR 88.22 (95% CI 5.36 to 1451.11), risk: 79.4% (4.8 to 1306.0)) probably results in a large increase in polyneuropathies compared to MP (moderate certainty). No study reported the amount of participants with grade ≥ 3 polyneuropathies for treatment with VRDc. VMP probably increases the proportion of participants with serious adverse events (SAEs) compared to MP (RR 1.28 (95% CI 1.06 to 1.54), risk for VMP: 46.2% (38.3 to 55.6), mean risk for MP: 36.1% (177 of 490 patients affected), moderate certainty). RD, TMP, and VRDc were not connected to MP in the network and the risk of SAEs could not be compared. Treatment with RD (RR 4.18 (95% CI 2.13 to 8.20), NMA-risk: 38.5% (19.6 to 75.4)); and TMP (RR 4.10 (95% CI 2.40 to 7.01), risk: 37.7% (22.1 to 64.5)) results in a large increase of withdrawals from the trial due to adverse events (high certainty) compared to MP (mean reported risk: 9.2% (77 of 837 patients withdrew)). The risk is probably slightly increased with VMP (RR 1.06 (95% CI 0.63 to 1.81), risk: 9.75% (5.8 to 16.7), moderate certainty), while it is much increased with VRDc (RR 8.92 (95% CI 3.82 to 20.84), risk: 82.1% (35.1 to 191.7), high certainty) compared to MP. Quality of life QoL was reported in four studies for seven different treatment regimens (MP, MPc, RD, RMP, RMPc, TMP, TMPc) and was measured with four different tools. Assessment and reporting differed between studies and could not be meta-analysed. However, all studies reported an improvement of QoL after initiation of anti-myeloma treatment for all assessed treatment regimens.

Authors' Conclusions: Based on our four pre-selected comparisons of interest, continuous treatment with VRD had the largest survival benefit compared with MP, while RD and TMP also probably considerably increase survival. However, treatment combinations of V, R, and T also substantially increase the incidence of AEs, and lead to a higher risk of treatment discontinuation. Their effectiveness and safety profiles may best be analysed in further randomised head-to-head trials. Further trials should focus on consistent reporting of safety outcomes and should use a standardised instrument to evaluate QoL to ensure comparability of treatment-combinations.
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http://dx.doi.org/10.1002/14651858.CD013487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876545PMC
November 2019

Understanding how nurse managers see their role in supporting ICU nurse well-being-A case study.

J Nurs Manag 2019 Oct 4;27(7):1512-1521. Epub 2019 Sep 4.

College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.

Aim: To explore how nurse managers perceive and experience their role in supporting the well-being of intensive care nurses.

Background: While it is known that nurse manager behaviours affect nurse well-being, literature indicates that intensive care nurses may not receive the support they require. Understanding how nurse managers see their role in supporting nurse well-being is crucial to offer recommendations for improvement.

Methods: Qualitative multiple case study design. Twelve semi-structured, in-depth interviews were conducted with nurse managers from Australian intensive care unit settings. Data were analysed using thematic analysis.

Results: Nurse manages felt unsure about what their supportive role involved, lacked training on how to support nurse well-being and called for organisational backup to carry out their role effectively. The study also provided insight into the strategies that enabled nurse managers to support nurse well-being.

Conclusion: There is currently no consensus on the role of the nurse manager in supporting nurse well-being resulting in inconsistencies and wide practice variations. Furthermore, nurse managers need support and training if they are required to support nurse well-being.

Implications For Nursing Management: A clear definition of the nurse manager supportive role describing the purpose and core functions involved in this role must be developed to support nurse well-being.
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http://dx.doi.org/10.1111/jonm.12837DOI Listing
October 2019

The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review.

Aust Crit Care 2019 07 30;32(4):319-329. Epub 2018 Aug 30.

Flinders University College of Nursing and Health Sciences, SA, Australia.

Introduction: The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role.

Objectives: To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses.

Review Methods: A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings.

Data Sources: The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment.

Results: Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist, a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research, and the Mixed Methods Appraisal Tool for mixed-method studies. The critical review guidelines by Shenton and Polit and Beck were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'.

Conclusion: Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.
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http://dx.doi.org/10.1016/j.aucc.2018.06.003DOI Listing
July 2019

Assessing and Addressing Threats and Risks to Cybersecurity.

Front Health Serv Manage 2018 ;35(1):23-29

Dane C. Peterson is hospital group president and chief administrative officer at Emory Healthcare in Atlanta, Georgia. Anne Adams, JD, is chief compliance officer and chief privacy officer at Emory Healthcare. Sheila Sanders is chief information officer at Emory Healthcare. Brad Sanford, CISSP, is chief information security officer at Emory Healthcare.

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http://dx.doi.org/10.1097/HAP.0000000000000040DOI Listing
January 2019

Neonatal nurses' response to a hypothetical premature birth situation: What if it was my baby?

Nurs Ethics 2018 Nov 9;25(7):880-896. Epub 2016 Dec 9.

Oxford Brookes University, UK; Oxford University Hospitals NHS Foundation Trust, UK.

Background:: Evolving technology and scientific advancement have increased the chances of survival of the extremely premature baby; however, such survival can be associated with some severe long-term morbidities.

Research Question:: The research investigates the caregiving and ethical dilemmas faced by neonatal nurses when caring for extremely premature babies (defined as ≤24 weeks' gestation). This article explores the issues arising for neonatal nurses when they considered the philosophical question of 'what if it was me and my baby', or what they believed they would do in the hypothetical situation of going into premature labour and delivering an extremely premature baby.

Participants:: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia.

Ethical Considerations:: Relevant ethical approvals have been obtained by the researchers.

Findings:: A qualitative approach was used to analyse the data. The theme 'imagined futures' was generated which comprised three sub-themes: 'choice is important', 'not subjecting their own baby to treatment' and 'nurses and outcome predictions'. The results offer an important and unique understanding into the perceptions of nursing staff who care for extremely premature babies and their family, see them go home and witness their evolving outcomes. The results show that previous clinical and personal experiences led the nurses in the study to choose to have the belief that if in a similar situation, they would choose not to have their own baby resuscitated and subjected to the very treatment that they provide to other babies.

Conclusion:: The theme 'imagined futures' offers an overall understanding of how neonatal nurses imagine what the life of the extremely premature baby and his or her family will be like after discharge from neonatal intensive care. The nurses' past experience has led them to believe that they would not want this life for themselves and their baby, if they were to deliver at 24 weeks' gestation or less.
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http://dx.doi.org/10.1177/0969733016677871DOI Listing
November 2018

Quality versus quantity: The complexities of quality of life determinations for neonatal nurses.

Nurs Ethics 2017 Nov 24;24(7):802-820. Epub 2016 Jan 24.

Oxford Brookes University, UK; Oxford University Hospitals NHS Foundation Trust, UK.

Background: The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years?

Research Question: The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation.

Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical considerations: Ethical processes and procedures have been adhered to by the researchers.

Findings: A qualitative approach was used to analyse the data. The theme 'difficult choices' was generated which comprised three sub-themes: 'damaged through survival', 'the importance of the brain' and 'families are important'. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby's life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family's life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field.

Conclusion: Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice.
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http://dx.doi.org/10.1177/0969733015625367DOI Listing
November 2017

Clinicopathological Characteristics of RET Rearranged Lung Cancer in European Patients.

J Thorac Oncol 2016 Jan;11(1):122-7

Department for Pulmonology and Allergology, Bethanien Hospital Moers, Moers, Germany.

Introduction: Rearrangements of RET are rare oncogenic events in patients with non-small cell lung cancer (NSCLC). While the characterization of Asian patients suggests a predominance of nonsmokers of young age in this genetically defined lung cancer subgroup, little is known about the characteristics of non-Asian patients. We present the results of an analysis of a European cohort of patients with RET rearranged NSCLC.

Methods: Nine hundred ninety-seven patients with KRAS/EGFR/ALK wildtype lung adenocarcinomas were analyzed using fluorescence in situ hybridization for RET fusions. Tumor specimens were molecularly profiled and clinicopathological characteristics of the patients were collected.

Results: Rearrangements of RET were identified in 22 patients, with a prevalence of 2.2% in the KRAS/EGFR/ALK wildtype subgroup. Co-occurring genetic aberrations were detected in 10 patients, and the majority had mutations in TP53. The median age at diagnosis was 62 years (range, 39-80 years; mean ± SD, 61 ± 11.7 years) with a higher proportion of men (59% versus 41%). There was only a slight predominance of nonsmokers (54.5%) compared to current or former smokers (45.5%).

Conclusions: Patients with RET rearranged adenocarcinomas represent a rare and heterogeneous NSCLC subgroup. In some contrast to published data, we see a high prevalence of current and former smokers in our white RET cohort. The significance of co-occurring aberrations, so far, is unclear.
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http://dx.doi.org/10.1016/j.jtho.2015.09.016DOI Listing
January 2016

Desperately seeking parenthood: neonatal nurses reflect on parental anguish.

J Clin Nurs 2015 Jul 4;24(13-14):1885-94. Epub 2015 May 4.

Oxford Brookes University, Oxford, United Kingdom.

Aim And Objective: This paper aims to explore the ways in which neonatal nurses understand the experience of parents who have experienced infertility, conceived a baby via in vitro fertilisation and delivered an extremely premature infant. The chance of a poor long-term outcome for the baby is significant; therefore, parental anguish plays out in the neonatal intensive care.

Background: Current literature suggests that infertility is a significant issue for ageing women and many couples experience multiple cycles of invitro-fertilisation (IVF) treatment to achieve a pregnancy. Babies conceived through IVF are more likely to have genetic disorders, and be born prematurely. When the baby is born through IVF and is also born extremely prematurely, it creates a crisis situation for the parents. This paper will focus on the parental anguish of achieving a pregnancy through IVF to see the baby born extremely prematurely (defined as ≤ 24-week gestation). It will examine parental anguish from caregiver perspective of the neonatal nurse who supports the parents through this very difficult time.

Design: This study used interviews with neonatal nurses, and drew insights from interpretative phenomenology.

Methods: This research used a combination of a questionnaire and a series of interviews in a qualitative study informed by phenomenology. The analysis of the interview data involved the creation of key themes following extensive coding of thematic statements and the analysis of the emerging themes.

Results: This paper outlines the neonatal nurses' understanding of parental anguish and overwhelming sadness in parents whose baby was conceived by IVF, and was also born extremely prematurely. The theme of 'seeking parenthood' was synthesised from two sub-themes - 'longing for a baby' and 'the desperation to become parents'.

Conclusion: This study identified that neonatal nurses bear witness to parental anguish as their hopes of taking home a live baby might not be realised. The time, effort and money required to achieve a pregnancy does not mean that the baby will be spared the outcomes of extreme prematurity and the risk factors associated with IVF. The parents may be left empty handed. Therefore, the word precious becomes a metaphor for the IVF baby as the neonatal team try desperately to give the parents their much longed baby.

Relevance To Clinical Practice: Delayed child bearing has an impact on fertility, with maternal age having the most impact on the ability to conceive. Babies conceived through IVF technologies have a higher risk of genetic abnormalities and being born prematurely, and this will impact on the neonatal intensive care availability. Extreme prematurity and IVF can significantly impact on the baby's outcome. Witnessing parental anguish can be a major source of stress for the neonatal nurses. Neonatal nurses need to develop strategies not only to help the parents but also to prevent the parents' overwhelming sadness from affecting their ability to function in the neonatal intensive care unit.
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http://dx.doi.org/10.1111/jocn.12811DOI Listing
July 2015

Mapping public engagement with research in a UK University.

PLoS One 2015 2;10(4):e0121874. Epub 2015 Apr 2.

Institute of Educational Technology, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom.

Notwithstanding that 'public engagement' is conceptualised differently internationally and in different academic disciplines, higher education institutions largely accept the importance of public engagement with research. However, there is limited evidence on how researchers conceptualise engagement, their views on what constitutes engagement and the communities they would (or would not) like to engage with. This paper presents the results of a survey of researchers in the Open University that sought to gather data to fill these gaps. This research was part of an action research project designed to embed engagement in the routine practices of researchers at all levels. The findings indicate that researchers have a relatively narrow view of public engagement with research and the communities with which they interact. It also identified that very few strategically evaluate their public engagement activities. We conclude by discussing some of the interventions we have introduced with the aim of broadening and deepening future researcher engagement.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121874PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383503PMC
March 2016

The myth of the miracle baby: how neonatal nurses interpret media accounts of babies of extreme prematurity.

Nurs Inq 2015 Sep 30;22(3):273-81. Epub 2015 Mar 30.

Oxford Brookes University, Oxford, United Kingdom.

Improved life sustaining technology in the neonatal intensive care unit (NICU) has resulted in an increased probability of survival in extremely premature babies. Miracle baby stories in the popular press are a regular occurrence and these reports are often the first source from which the general public learn about extremely premature babies. The research from which this paper is drawn sought to explore the care-giving and ethical dilemmas of neonatal nurses when caring for extremely premature babies 24 weeks gestation and less. This current paper aims to outline the views of neonatal nurses on miracle baby stories in the media. Data were collected via a questionnaire to 760 Australian neonatal nurses with 414 returned, representing a response rate of 54.4%. Narrative was collected from semi-structured interviews with 24 experienced neonatal nurses in NSW, Australia. A qualitative approach utilising thematic analysis was utilised to analyse the data. The theme the myth of the miracle baby is seen as generating myths and unrealistic expectations on the part of vulnerable families and the public. Neonatal nurses, as the primary caregivers for tiny babies and their families, viewed popular media publications with suspicion, believing published reports to be incomplete, inaccurate and biased towards the positive.
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http://dx.doi.org/10.1111/nin.12095DOI Listing
September 2015

Balancing hope with reality: how neonatal nurses manage the uncertainty of caring for extremely premature babies.

J Clin Nurs 2015 Sep 4;24(17-18):2410-8. Epub 2015 Mar 4.

Oxford Brookes University, Oxford, United Kingdom.

Aims And Objectives: This article aims to explore the ways in which neonatal nurses manage the uncertainty associated with the treatment and outcomes of extremely premature babies.

Background: Current literature suggests that survival rates of extremely premature babies have increased; however, the incidence of long-term problems has not decreased among survivors. The outcomes can often not be predicted; therefore, there is much uncertainty associated with survival and outcomes. Neonatal nurses care for babies and families during these times of uncertainty. This article will focus on how neonatal nurses manage and survive the challenges associated with uncertainty when caring for extremely premature babies.

Design: Qualitative.

Methods: This article used a series of interviews in a qualitative study informed by phenomenological insights. The analysis of the interview data involved the discovery of thematic statements and the analysis of the emerging themes.

Results: Three themes captured the experience of working with uncertainty from the perspective of the neonatal nurses: 'Everything is fine, then they crash': When the honeymoon is over; '"I don't know which one is going to be fine": it's like a lottery' and 'Balancing hope with reality'.

Conclusion: Uncertainty had both positive and negative aspects, because while ever there was uncertainty, there was room for hope. While initial uncertainty of the baby's prognosis and outcome gave the nurses hope, certainty of diagnosis and poor outcome could take that hope away.

Relevance To Clinical Practice: Increasing survival of extremely premature babies will see neonatal nurses caring for more babies ≤24 weeks gestation. Prematurity has risks associated with life-sustaining treatments. Uncertainty is a reality of life for these babies, their families and the nursing and medical teams who care for them. It is important to recognise the challenges associated with uncertainty.
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http://dx.doi.org/10.1111/jocn.12800DOI Listing
September 2015

Personalized technology to support older adults with and without cognitive impairment living at home.

Am J Alzheimers Dis Other Demen 2015 Feb 22;30(1):85-97. Epub 2015 Jan 22.

School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA.

Although persons with dementia (PWD) and their family caregivers need in-home support for common neuropsychiatric symptoms (NPS), few if any assistive technologies are available to help manage NPS. This implementation study tested the feasibility and adoption of a touch screen technology, the Companion, which delivers psychosocial, nondrug interventions to PWD in their home to address individual NPS and needs. Interventions were personalized and delivered in home for a minimum of 3 weeks. Postintervention measures indicated the technology was easy to use, significantly facilitated meaningful and positive engagement, and simplified caregivers' daily lives. Although intervention goals were met, caregivers had high expectations of their loved one's ability to regain independence. Care recipients used the system independently but were limited by cognitive and physical impairments. We conclude the Companion can help manage NPS and offer caregiver respite at home. These data provide important guidance for design and deployment of care technology for the home.
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http://dx.doi.org/10.1177/1533317514568338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819239PMC
February 2015

It's agony for us as well: Neonatal nurses reflect on iatrogenic pain.

Nurs Ethics 2016 Mar 8;23(2):176-90. Epub 2014 Dec 8.

University of Technology, Sydney, Australia.

Background: Improved techniques and life sustaining technology in the neonatal intensive care unit have resulted in an increased probability of survival for extremely premature babies. The by-product of the aggressive treatment is iatrogenic pain, and this infliction of pain can be a cause of suffering and distress for both baby and nurse.

Research Question: The research sought to explore the caregiving dilemmas of neonatal nurses when caring for extremely premature babies. This article aims to explore the issues arising for neonatal nurses when they inflict iatrogenic pain on the most vulnerable of human beings - babies ≤24 weeks gestation.

Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia.

Ethical Consideration: Ethical processes and procedures set out by the ethics committee have been adhered to by the researchers.

Findings: A qualitative approach was used to analyse the data. The theme 'inflicting pain' comprised three sub-themes: 'when caring and torture are the same thing', 'why are we doing this!' and 'comfort for baby and nurse'. The results show that the neonatal nurses were passionate about the need for appropriate pain relief for extremely premature babies.

Conclusion: The neonatal nurses experienced a profound sense of distress manifested as existential suffering when they inflicted pain on extremely premature babies. Inflicting pain rather than relieving it can leave the nurses questioning their role as compassionate healthcare professionals.
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http://dx.doi.org/10.1177/0969733014558968DOI Listing
March 2016

A burden of knowledge: A qualitative study of experiences of neonatal intensive care nurses' concerns when keeping information from parents.

J Child Health Care 2015 Dec 12;19(4):485-94. Epub 2014 May 12.

University of Technology, Sydney, Australia.

Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby's needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme 'keeping secrets' was identified and comprised of three sub-themes 'coping with potentially catastrophic news', 'fear of inadvertent disclosure' and 'a burden that could damage trust'. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent's right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies.
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http://dx.doi.org/10.1177/1367493514530957DOI Listing
December 2015

Looking like a proper baby: nurses' experiences of caring for extremely premature infants.

J Clin Nurs 2015 Jan 9;24(1-2):81-9. Epub 2014 May 9.

Faculty of Health, University of Technology, Sydney, NSW, Australia.

Aims And Objectives: To explore the ways in which neonatal nurses draw meaning and deal with the challenges associated with caring for extremely premature babies.

Background: Current literature suggests that nurses face challenges providing care to certain patients because of their appearance. This article will focus on those difficulties in relation to neonatal nurses caring for infants ≤24 weeks of gestation in the neonatal intensive care unit. Extremely premature babies often have more the appearance of a foetus than the appearance of a baby, and this presented challenges for the neonatal nurses.

Design: This paper has used interviews and drew insights from interpretative phenomenology.

Methods: This paper used a series of interviews in a qualitative study informed by phenomenology. The analysis of the interview data involved the discovery of thematic statements and the analysis of the emerging themes.

Results: This paper outlines the difficulties experienced by neonatal nurses when caring for a baby that resembles a foetus more than it does a full-term infant. The theme the challenges of caregiving was captured by three subthemes: A foetus or a viable baby?; protective strategies and attributing personality.

Conclusion: This study identified that neonatal nurses experience a range of difficulties when providing care for an infant who resembled a foetus rather than a full-term baby. They employed strategies that minimised the foetal appearance and maximised the appearance and attributes associated with a newborn baby.

Relevance To Clinical Practice: Increasing survival of extremely premature infants will see nurses caring for more babies ≤24 weeks of gestation. Caring for extremely premature babies has been reported as being stressful. It is important to understand the nature of stress facing this highly specialised neonatal nursing workforce. Supportive work environments could help to ameliorate stress, facilitate better care of tiny babies and decrease staff turnover.
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http://dx.doi.org/10.1111/jocn.12608DOI Listing
January 2015

Skill components of task analysis.

Instr Sci 2013 Nov 20;41(6):1009-1046. Epub 2013 Feb 20.

School of Psychology, Georgia Institute of Technology, Atlanta, GA 30332-0170, USA.

Some task analysis methods break down a task into a hierarchy of subgoals. Although an important tool of many fields of study, learning to create such a hierarchy (redescription) is not trivial. To further the understanding of what makes task analysis a skill, the present research examined novices' problems with learning Hierarchical Task Analysis and captured practitioners' performance. All participants received a task description and analyzed three cooking and three communication tasks by drawing on their knowledge of those tasks. Thirty six younger adults (18-28 years) in Study 1 analyzed one task before training and five afterwards. Training consisted of a general handout that all participants received and an additional handout that differed between three conditions: a list of steps, a flow-diagram, and concept map. In Study 2, eight experienced task analysts received the same task descriptions as in Study 1 and demonstrated their understanding of task analysis while thinking aloud. Novices' initial task analysis scored low on all coding criteria. Performance improved on some criteria but was well below 100 % on others. Practitioners' task analyses were 2-3 levels deep but also scored low on some criteria. A task analyst's purpose of analysis may be the reason for higher specificity of analysis. This research furthers the understanding of Hierarchical Task Analysis and provides insights into the varying nature of task analyses as a function of experience. The derived skill components can inform training objectives.
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http://dx.doi.org/10.1007/s11251-013-9270-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654559PMC
November 2013

Older Adults Talk Technology: Technology Usage and Attitudes.

Comput Human Behav 2010 Nov;26(6):1710-1721

School of Psychology, Georgia Institute of Technology, Atlanta, GA 30332-0170.

Older adults (n = 113) participated in focus groups discussing their use of and attitudes about technology in the context of their home, work, and healthcare. Participants reported using a wide variety of technology items, particularly in their homes. Positive attitudes (i.e., likes) outnumbered negative attitudes (i.e., dislikes), suggesting that older adults perceive the benefits of technology use to outweigh the costs of such use. Positive attitudes were most frequently related to how the technology supported activities, enhanced convenience, and contained useful features. Negative attitudes were most frequently associated with technology creating inconveniences, unhelpful features, as well as security and reliability concerns. Given that older adults reported more positive than negative attitudes about the technologies they use, these results contradict stereotypes that older adults are afraid or unwilling to use technology. These findings also highlight the importance of perceived benefits of use and ease of use for models of technology acceptance. Emphasizing the benefits of technology in education and training programs may increase future technology adoption.
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http://dx.doi.org/10.1016/j.chb.2010.06.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956433PMC
November 2010

Older Adults' Training Preferences for Learning to Use Technology.

Proc Hum Factors Ergon Soc Annu Meet 2008 09;52(26):2047-2051

Georgia Institute of Technology, Atlanta, Georgia.

Older adults may benefit from using technology in their everyday lives. However, adults over 65 may need more training than their younger counterparts given they have had less experience with technology. In this study, 113 adults between the ages of 65 and 85 participated in focus group interviews discussing their training needs and preferences for technology items used in the home. Participants expressed an interest in receiving additional training, particularly for specific tasks. Participants also discussed preferences for various characteristics of training, such as who should conduct the training and for their preferred method of training. One of the most frequently discussed preferences was for self-training using text materials, such as a manual.
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http://dx.doi.org/10.1177/154193120805202603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192712PMC
September 2008

Patient information needs: pre- and post-consultation.

Health Informatics J 2006 Jun;12(2):165-77

UCLIC Remax House, 31-32 Alfred Place, London, UK.

This paper presents findings from a study of information seeking behaviour by National Health Service patients which explored motivational triggers for infor- mation needs. Previous research has highlighted the importance of contextual elements in users' changing information needs. This paper highlights how those needs may centre on specific events: in particular, a patient's consultation with their doctor. Patients initiate information seeking to assess whether they need clinical intervention, in preparation for the patient-doctor consultation and to verify the diagnosis or treatment stemming from that consultation. The study has revealed that having confidence in health practitioners is one key motiva- tion for information seeking. Another is a desire to use health service resources judiciously, efficiently and effectively.
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http://dx.doi.org/10.1177/1460458206063811DOI Listing
June 2006

HDLalert - a healthcare DL alerting system: from user needs to implementation.

Health Informatics J 2006 Jun;12(2):121-35

Department of Computer Science, University of Waikato PB 3105, Hamilton, New Zealand.

In the health domain, there are many circumstances where clinicians (i.e. doctors, nurses, allied health professionals) and patients wish to track changes in medical knowledge. However, existing 'news' or 'alert' services provide relatively limited means for selecting which information to receive. The result is that clinicians and patients often receive information that is inappropriate, irrelevant or simply too much. In this paper, we detail alert-relevant findings from several international user studies (e.g. UK, Germany and New Zealand) incorporating both clinical staff (across several hospitals) and patients' perceptions. These findings demonstrate the importance of context, in terms of both the user's task and immediate environment. We introduce a novel alerting architecture that can provide a finely tailored stream of alerts to the user, and provides further support to assist the interpretation of received material.
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http://dx.doi.org/10.1177/1460458206063808DOI Listing
June 2006

Implementing digital resources for clinicians' and patients' varying needs.

Med Inform Internet Med 2005 Jun;30(2):107-22

UCL Interaction Centre, London, UK.

This paper presents an overview of several evidence-based medicine and patient information studies conducted across the UK health service over a 4 year period, investigating clinicians', managers', and patients' perceptions of digital resources (primarily digital libraries) in hospitals, Primary Care Trusts, NHS Direct (patient call centre) and patient groups. In-depth interviews and focus groups are analysed using grounded theory methodologies and through content analysis used to produce quantitative finding. The perceived impacts of three different methods employed for delivering health informatics are presented. The findings highlight some generic issues relevant for health informatics in the UK health sector as well as some specific issues for medical digital libraries. This paper reviews in more detail the issues of medical technology implementation (traditional implementation, on the wards, and intermediaries within in communities). A breakdown of the clinicians' and patients' information journey (information initiation, facilitation and interpretation) is also presented with regard to medical digital libraries and online resources. Broad guidelines derived from these findings are provided for health-informatics deployment.
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http://dx.doi.org/10.1080/14639230500298875DOI Listing
June 2005

Exploring the benefits of user education: a review of three case studies.

Health Info Libr J 2005 Sep;22 Suppl 1:45-58

Royal Free and University College Medical School, Centre for Health Informatics and Multi-professional Education, Highgate Hill, London, UK.

This paper builds on Leslie Morton's vision of enabling users through education and training. It describes three different approaches to mediated training for medical students and clinicians provided by peers, juniors (i.e. medical students) and information specialists (i.e. clinical librarians) and considers the benefits to the participants. The training was provided either on a one-to-one basis or within teams in their work environments (e.g. offices, wards, team meetings). The first two projects (peer tutoring and reverse mentoring) suggest that contextualized training, using intermediaries, provides the direct benefit of cost-effective IT skill development and the indirect benefits deriving from the interactions between the trainers and the target groups. The third project, the outreach librarian study, provides evidence of both direct benefits (i.e. time saved, quality of service, skills acquired, financial savings and improved evidence-based medicine implementation) and indirect, long-term benefits relating to more social issues (e.g. perceptions of the library, clinical teams, job satisfaction and patient interactions). The general conclusion to emerge from this review of case studies is that the concept of educational benefits is very broad and that empirical studies need to look at both obvious and less obvious benefits.
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http://dx.doi.org/10.1111/j.1740-3324.2005.00585.xDOI Listing
September 2005
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