Assessment of the Efficacy of EEG-Based MI-BCI With Visual Feedback and EEG Correlates of Mental Fatigue for Upper-Limb Stroke Rehabilitation.

OBJECTIVE: This single-arm multisite trial investigates the efficacy of the neurostyle brain exercise therapy towards enhanced recovery (nBETTER) system, an electroencephalogram (EEG)-based motor imagery brain-computer interface (MI-BCI) employing visual feedback for upper-limb stroke rehabilitation, and the presence of EEG correlates of mental fatigue during BCI usage. METHODS: A total of 13 recruited stroke patients underwent thrice-weekly nBETTER therapy coupled with standard arm therapy over six weeks. Upper-extremity Fugl-Meyer motor assessment (FMA) scores were measured at baseline (week 0), post-intervention (week 6), and follow-ups (weeks 12 and 24). In total, 11/13 patients (mean age 55.2 years old, mean post-stroke duration 333.7 days, mean baseline FMA 35.5) completed the study. RESULTS: Significant FMA gains relative to baseline were observed at weeks 6 and 24. Retrospectively comparing to the standard arm therapy (SAT) control group and BCI with haptic knob (BCI-HK) intervention group from a previous similar study, the SAT group had no significant gains, whereas the BCI-HK group had significant gains at weeks 6, 12, and 24. EEG analysis revealed significant positive correlations between relative beta power and BCI performance in the frontal and central brain regions, suggesting that mental fatigue may contribute to poorer BCI performance. CONCLUSION: nBETTER, an EEG-based MI-BCI employing only visual feedback, helps stroke survivors sustain short-term FMA improvement. Analysis of EEG relative beta power indicates that mental fatigue may be present. SIGNIFICANCE: This study adds nBETTER to the growing literature of safe and effective stroke rehabilitation MI-BCI, and suggests an additional fatigue-monitoring role in future such BCI.

Role of high-sensitivity C-reactive protein measurements in HIV patients.

As we herald into the 21st century, the quality of life and the repertoire of highly active antiretroviral therapy (HAART) have considerably improved. However, considerable work is still needed to educate the population about primary and secondary prevention modalities. Moreover, regular monitoring of immune response with patients on HAART with conventional biomarkers is still a problem in low resource settings which needs to be addressed. We aim to review high-sensitivity C-reactive protein as a potential biomarker in this regard.

Problematic Online Pornography Use: A Media Attendance Perspective.

Since the rise of the popularity of the Internet, the accessibility of pornography has been a growing concern. One particular concern is the potential risk for addictive behaviors to occur as a result of the ease of viewing online pornographic material. The research presented herein explored online pornography addiction using a media attendance perspective, which allows media critics to examine the needs that people seek to fulfill from engaging with various media. Past studies that have used a media attendance perspective to explore media addiction, rephrased here as problematic media use, have done so using social cognitive theory and the concept of deficient self-regulation. Deficient self-regulation may be experienced by all media consumers and can range from normally impulsive media choices to pathological media choices which may result in detrimental life consequences. Borrowing from this, the current study reevaluated online pornography addiction using deficient self-regulation within a sociocognitive framework of media attendance. Results of our model show deficient self-regulation influences habitual online pornography consumption. Moreover, online pornography use motivated by social needs is perpetuated by deficient self-regulation and may lead to negative life consequences in some individuals. These findings contribute a new perspective and framework for understanding problematic online pornography use.

Negative public perceptions of juvenile diabetics: applying attribution theory to understand the public's stigmatizing views.

Despite a rise in the incidence of juvenile diabetes globally, little research has focused on public perceptions regarding its patients. The need to evaluate whether the public holds stigmatizing views is pressing when one considers the relatively young age of the patients of the disease. The current study extends the attribution theoretic framework to evaluate public stigma regarding juvenile diabetes. The findings suggest that a large percentage of individuals misattribute the causes of the disease and believe it is relatively rare and that its patients are personally responsible for contracting it. Individuals often utilize pejorative terms describing juvenile diabetes as a disease afflicting children who are lazy, unhealthy, fat, obese, lacking exercise, and having eating disorders.

The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects.

CONTEXT: The promise of the electronic medical record (EMR) lies in its ability to reduce the costs of health care delivery and improve the overall quality of care--a promise that is realized through major changes in workflows within the health care organization. Yet little systematic information exists about the workflow effects of EMRs. Moreover, some of the research to-date points to reduced satisfaction among physicians after implementation of the EMR and increased time, i.e., negative workflow effects. A better understanding of the impact of the EMR on workflows is, hence, vital to understanding what the technology really does offer that is new and unique. OBJECTIVE: (i) To empirically develop a physician centric conceptual model of the workflow effects of EMRs; (ii) To use the model to understand the antecedents to the physicians' workflow expectation from the new EMR; (iii) To track physicians' satisfaction overtime, 3 months and 20 months after implementation of the EMR; (iv) To explore the impact of technology learning curves on physicians' reported satisfaction levels. DESIGN: The current research uses the mixed-method technique of concept mapping to empirically develop the conceptual model of an EMR's workflow effects. The model is then used within a controlled study to track physician expectations from a new EMR system as well as their assessments of the EMR's performance 3 months and 20 months after implementation. SETTING: The research tracks the actual implementation of a new EMR within the outpatient clinics of a large northeastern research hospital. PARTICIPANTS: The pre-implementation survey netted 20 physician responses; post-implementation Time 1 survey netted 22 responses, and Time 2 survey netted 26 physician responses. INTERVENTION: The implementation of the actual EMR served as the intervention. Since the study was conducted within the same setting and tracked a homogenous group of respondents, the overall study design ensured against extraneous influences on the results. MAIN OUTCOME MEASURES: Outcome measures were derived empirically from the conceptual model. They included 85 items that measured physician perceptions of the EMR's workflow effect on the following eight issues: (1) administration, (2) efficiency in patient processing, (3) basic clinical processes, (4) documentation of patient encounter, (5) economic challenges and reimbursement, (6) technical issues, (7) patient safety and care, and (8) communication and confidentiality. The items were used to track expectations prior to implementation and they served as retrospective measures of satisfaction with the EMR in post-implementation Time 1 and Time 2. RESULTS: The findings suggest that physicians conceptualize EMRs as an incremental extension of older computerized provider order entries (CPOEs) rather than as a new innovation. The EMRs major functional advantages are seen to be very similar to, if not the same as, those of CPOEs. Technology learning curves play a statistically significant though minor role in shaping physician perceptions. CONCLUSIONS: The physicians' expectations from the EMR are based on their prior beliefs rather than on a rational evaluation of the EMR's fit, functionality, or performance. Their decision regarding the usefulness of the EMR is made very early, within the first few months of use of the EMR. These early perceptions then remain stable and become the lens through which subsequent experience with the EMR is interpreted. The findings suggest a need for communication based interventions aimed at explaining the value, fit, and usefulness of EMRs to physicians early in the pre- and immediate post-EMR implementation stages.

Using frames to influence consumer willingness to pay for the patient health record: a randomized experiment.

The American College of Medical Informatics rated the lack of willingness to pay for the patient health record (PHR) as the biggest obstacles to its rapid diffusion. Extending research propositions from the decision sciences and political communication, this study tests the influence of different types of emphasis frames on increasing consumer willingness to pay for the PHR. Using a randomized experiment embedded within a probability survey, the effects of 3 different types of emphasis frames (individual-focused, collective-focused, and joint), along with a no-frames control, are tested on a sample of early and later technology adopters. The results indicate a significant relationship between the type of frame and the type of adopter. Early adopters were more susceptible to individual-focused frames that made causal attributions at the individual level, whereas later adopters were significantly influenced by collective-focused frames that made causal attributions at the societal level. Interestingly, the framing effect continued and significantly influenced both early and later adopters' willingness to pay for the PHR. The findings demonstrate the need to carefully communicate the value of a technology to adopters and suggest the possibility of using frames to spur the diffusion of PHRs.

Physician adoption of personal digital assistants (PDA): testing its determinants within a structural equation model.

Research has begun to explore the determinants of personal digital assistant (PDA) adoption in health care. Much of this research has, however, been inconsistent in its treatment of key constructs and its methodological approaches. The current study takes a stricter approach and tracks the pre- and postadoption beliefs of physicians provided with an actual PDA within a single health care facility in the United States. Results show that age, position in hospital, beliefs about health IT, and cluster ownership are significant, direct predictors of the physician's preadoption beliefs about PDAs. Contrary to prior research findings, both ease of use and usefulness perceptions significantly influenced the physician's intent to adopt PDAs. More important, results show that physicians focus on a broader range of PDA factors during preadoption assessment of the technology, while actual use is based solely on the PDA's ease of use. Moreover, the preadoption usefulness perceptions do not influence postadoption usefulness. Hence, the cognitive and affective determinants of intent to use are seemingly different from those used to evaluate PDA use.

Patterns and changes in prescriber attitudes toward PDA prescription-assistive technology.

CONTEXT: Medication error prevention is a priority for the U.S. healthcare system in the 21st century. Use of technology is considered by some as critical to achieve this goal. Knowledge of the attitudinal barriers to such adoption, however, is limited. OBJECTIVE: To determine the attitudes of frontline prescriber clinicians towards technology in general, and PDAs specifically, before and after introduction of a PDA in the clinical setting of medication prescribing. DESIGN: A pre- and post-intervention web-based survey, 12-14 months apart. SETTING: Academic tertiary care children's hospital. PARTICIPANTS: Total of 244 prescriber clinicians. INTERVENTION: Distribution of a PDA with pediatric-specific medication prescribing information after completion of an on-line medication safety certification and other safety focused educational sessions. MAIN OUTCOME MEASURES: Ratings (5-point Likert scale) reflecting perceptions and attitudes towards technology in general and technology in medical settings along with self-reported usage of the PDA for Rx. RESULTS: Early Adopters and Late Adopters were identified statistically, and the group membership reflected their prior exposure to and ownership of other technologies. Early Adopters tended to be younger and less experienced clinically (e.g., residents) and more frequent owners and users of technology. Early Adopters expressed significantly more favorable attitudes toward technology and PDAs on both pre- to post-intervention survey occasions. They also utilized the PDA for Rx more often than LAs. Interestingly, PDA use for Early Adopters was based on its ease of use, while PDA use among later adopters was based on its clinical usefulness. CONCLUSIONS: Provision of point of care information using PDAs and a user-friendly, pediatric-specific medication information software package did not positively affect the attitudes of prescriber clinicians among those already favorable toward technology. However, a significant change was found among those with initially less favorable attitudes. Organizations need to understand the nature of both Early and Late Adopters and plan appropriately for managing the respective needs and expectations when potentially beneficial technologies are introduced. In order to ensure the success of an implementation, the training and supportive interventions need to be carefully designed and specifically catered to the personality-based outcome expectations of the prescriber.

Barriers to the adoption of electronic health records: using concept mapping to develop a comprehensive empirical model.

The study attempts to unify prior research and develop a comprehensive, empirically based conceptual model of the barriers to EHR adoption among community physicians. The model uses concept mapping, which taps the shared expertise of a group and provides reliable estimates with relatively small sample sizes. The methodology includes brainstorming of barrier statements and sorting and rating of issue statements. The model illuminates the larger structure of barriers as well as the finer details of constituent issues. Core issues are standardization and interoperability; also important are technical issues and the cost-benefit of adopting EHRs. However, psychosocial issues, the main focus of diffusion research, seem relatively peripheral. We believe the development of this model is an important first step in creating effective and measurable interventions that enhance the adoption of EHRs in healthcare.