Effects of Text Enhancement, Identical Prescription-Package Names, Visual Cues, and Verbal Provocation on Visual Searches of Look-Alike Drug Names: A Simulation and Eye-Tracking Study.

OBJECTIVE: Simulation and eye tracking were used to examine the effects of text enhancement, identical prescription-package names, visual cues, and verbal provocation on visual searches of look-alike drug names. BACKGROUND: Look-alike drug names can cause confusion and medication errors, which jeopardize patient safety. The effectiveness of many strategies that may prevent these problems requires evaluation. METHOD: We conducted two experiments that were based on a four-way, repeated-measures design. The within-subject factors were text enhancement, identical prescription-package names, visual cues, and verbal provocation. In Experiment 1, 40 nurses searched for and selected a target drug from an array of drug packages on a pharmacy shelf mock-up. In Experiment 2, the eye movements of another 40 nurses were tracked while they performed a computer-based drug search task. RESULTS: Text enhancement had no significant effect on the drug search. Nurses selected the target drugs more quickly and easily when the prescriptions and drug packages shared identical drug name formats. The use of a visual cue to direct nurses' attention facilitated their visual searches and improved their eye gaze behaviors. The nurses reported greater mental effort if they were provoked verbally during the drug search. CONCLUSION: Efficient and practical strategies should be adopted for designs that facilitate accurate drug search. Among these strategies are using identical name appearances on drug prescriptions and packages, using a visual cue to direct nurses' attention, and avoiding rushing nurses while they are concentrating. APPLICATION: The findings aim to inspire recommendations for work system designs that will improve the visual search of look-alike drug names.

Visual differentiation and recognition memory of look-alike drug names: effects of disfluent format, text enhancement and exposure time.

Three computer-based experiments were conducted to examine whether disfluent format, enhanced text, and increased exposure time improve the accuracy of visual differentiation and recognition memory of look-alike drug names. A three-way, repeated-measures look-alike drug name differentiation test assessed the visual differentiation accuracy of 30 nursing students (Experiment 1) and 15 nurses (Experiment 2). A two-way, repeated-measures recognition memory test examined the recognition memory accuracy of 15 nurses for look-alike drug names (Experiment 3). We found that making drug names disfluent did not significantly improve differentiation (Experiment 2) or memory accuracy (Experiment 3), but even impaired differentiation accuracy (Experiment 1). Enhanced text and longer exposure time significantly improved differentiation accuracy (Experiments 1 and 2). However, the enhanced text did not improve recognition memory (Experiment 3). We suggest that making look-alike drug names disfluent is not favourable. Enhanced text and longer exposure times are effective in supporting visual differentiation of look-alike drug names. Practitioner Summary: Confusion arising from look-alike drug names may compromise patient safety. Three experiments examined the effects of disfluent format, text enhancement and increased exposure time on visual and memory performances. Making drug names more difficult to read did not improve performance. Enhancing text design and increasing exposure (i.e. reading) time improved visual differentiation between medications, but did not improve the recognition of medications from memory. Abbreviations: SEEV: Salience-effort-expectancy-value; FDA: Food and Drug Administration; ANOVA: analysis of variance; SD: standard deviation, DF: disfluent format; TE: text enhancement; ET: exposure time.

From Skin Movement to Wearable Robotics: The Case of Robotic Gloves.

Previous research on wearable robotics focused on developing actuation mechanisms while overlooking influences of skin movement. During finger flexion, skins on the opisthenar and finger back are stretched. Impeding such skin movement will obstruct normal finger motions. In this research, a statistical study on skin movement is proposed and conducted to quantify skin movement on human hands. Results of 30 subjects (15 men and 15 women) reveal that skin at the finger back extends by an average of 29.3 ± 7.2% in fist clenching. Based on this study, design guidelines for robotic gloves are proposed, and nominal strain values at different hand regions are tabulated for references in robotic glove design. To explore the influence of skin movement on wearable robotics, an elastomer-constrained flat tube actuator is proposed based on which two prototype robotic gloves are developed: one with an ergonomic strap interface that has small constraint to skin motion, and the other based on the commonly used fabric glove that is supposed to have large constraint to skin motion. With the same power input to the robotic gloves, the strap-based design achieves a finger motion range of 2.5 times and a gripping force of 4.3 times that of the conventional fabric glove.

A systematic review of patient acceptance of consumer health information technology.

A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.

Human factors and ergonomics in home care: Current concerns and future considerations for health information technology.

Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.

A change management framework for macroergonomic field research.

With the proliferation of macroergonomic field research, it is time to carefully examine how such research should be managed and implemented. We argue that the importance of attending to high-quality implementation of field research is equal to that of methodological rigor. One way to systematically manage the implementation process is to adopt a change management framework, wherein the research project is conceptualized as an instance of organization-level change. Consequently, principles for successful organization-level change from the literature on change management can be used to guide successful field research implementation. This paper briefly reviews that literature, deriving 30 principles of successful change management, covering topics such as political awareness, assembling the change team, generating buy-in, and management support. For each principle, corresponding suggestions for macroergonomic field research practice are presented. We urge other researchers to further develop and adopt frameworks that guide the implementation of field research.

Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes? A meta-analysis and narrative review of randomized controlled trials.

PURPOSE: To assess whether the use of consumer health information technologies (CHITs) improves outcomes in the patient self-management of diabetes. METHOD: The evidence from randomized controlled trials (RCTs) on the effects of CHITs on patient outcomes was analyzed using either meta-analysis or a narrative synthesis approach. A systematic search of seven electronic databases was conducted to identify relevant reports of RCTs for the analysis. In the meta-analyses, standardized mean differences in patient outcomes were calculated and random-effects models were applied in cases where the heterogeneity of the results was moderate or high, otherwise fixed-effects models were used. RESULTS: Sixty-two studies, representing 67 RCTs, met the inclusion criteria. The results of the meta-analyses showed that the use of CHITs was associated with significant reductions in HbA1c, blood pressure, total cholesterol, and triglycerides levels when compared with the usual care. The findings from the narrative synthesis indicated that only a small proportion of the trials reported positive effects of CHITs on patient outcomes. CONCLUSIONS: The use of CHITs in supporting diabetes self-management appears to have potential benefits for patients' self-management of diabetes. However, the effectiveness of the technologies in improving patient outcomes still awaits confirmation in future studies.

A comparison of the effects of different typographical methods on the recognizability of printed drug names.

BACKGROUND: Tall Man lettering is a text enhancement method currently recommended by various organizations for distinguishing look-alike drug names to prevent medication errors. However, the literature has suggested that other typographic styles may be more effective. OBJECTIVE: Our objective was to examine the effects of text enhancements and orthographic similarity on the accuracy of look-alike drug name differentiation. METHODS: We conducted two experiments that were based on a two-way, repeated-measures design with text enhancement (Tall Man, boldface, boldface plus Tall Man, colored text [red] and contrast with lowercase as a 'no text enhancement' control) and orthographic similarity (low, medium, and high) as factors. Engineering students without a pharmacy background in experiment 1 (n = 40) and student pharmacists in experiment 2 (n = 40) participated in a computer-based drug name differentiation task in which they determined whether the two drug names in each of the 336 name pairs were the same or different. Only the data generated from the pairs in which the two names were different were used in the analysis. The differentiation accuracy was measured as the proportion of correct responses. RESULTS: In both experiments, all five text enhancements significantly improved accuracy compared with the lowercase condition; and boldface plus Tall Man and color significantly outperformed Tall Man lettering. A high degree of orthographic similarity yielded the least accuracy, followed by medium and low degrees. CONCLUSIONS: Highlighting the differing portions of confusing drug name pairs using enhanced text clearly renders differentiation easier, although Tall Man lettering may not be the most effective choice for this method.

Effects of text enhancements on the differentiation performance of orthographically similar drug names.

BACKGROUND: Orthographically similar drug names create confusion errors and pose a potential threat to medication safety. Enhancing the differing letters in similar drug names is one possible way to address the problem. OBJECTIVE: This study investigated the effects of text enhancement methods(tall man, bold face, larger lowercase, and red lettering with lowercase as the comparison group) and orthographic similarity (referred to the extent to which the letters that made up the two names in a pair were similar to each other) on the differentiation performance of look-alike drug names. METHODS: Sixty individuals from a university and its affiliated hospital participated in the differentiation test in which they determined whether the two drug names in each of the 120 confusable name pairs were the same or different. Outcome measures were response time and proportion of correct responses. RESULTS: Using larger lowercase and red lettering resulted in significantly shorter response times. Drug names that were more similar to each other led to significantly longer response times. Text enhancement and orthographic similarity did not have impact on proportion of correct responses. CONCLUSIONS: Our study provides additional support for the use of text enhancement to emphasize the differences between medicines with names that look alike.

Factors affecting home care patients' acceptance of a web-based interactive self-management technology.

OBJECTIVE: With the advent of personal health records and other patient-focused health technologies, there is a growing need to better understand factors that contribute to acceptance and use of such innovations. In this study, we employed the Unified Theory of Acceptance and Use of Technology as the basis for determining what predicts patients' acceptance (measured by behavioral intention) and perceived effective use of a web-based, interactive self-management innovation among home care patients. DESIGN: Cross-sectional secondary analysis of data from a randomized field study evaluating a technology-assisted home care nursing practice with adults with chronic cardiac disease. MEASUREMENT AND ANALYSIS: A questionnaire was designed based on validated measurement scales from prior research and was completed by 101 participants for measuring the acceptance constructs as part of the parent study protocol. Latent variable modeling with item parceling guided assessment of patients' acceptance. RESULTS: Perceived usefulness accounted for 53.9% of the variability in behavioral intention, the measure of acceptance. Together, perceived usefulness, health care knowledge, and behavioral intention accounted for 68.5% of the variance in perceived effective use. Perceived ease of use and subjective norm indirectly influenced behavioral intention, through perceived usefulness. Perceived ease of use and subjective norm explained 48% of the total variance in perceived usefulness. CONCLUSION: The study demonstrates that perceived usefulness, perceived ease of use, subjective norm, and healthcare knowledge together predict most of the variance in patients' acceptance and self-reported use of the web-based self-management technology.

Designing a technology enhanced practice for home nursing care of patients with congestive heart failure.

This paper describes the process we used to design the HeartCare website to support Technology Enhanced Practice (TEP) for home care nurses engaged in providing care for patients with Congestive Heart Failure (CHF). Composed of communication, information, and self-monitoring functions, the HeartCare website is aimed at supporting best practice nursing care for these patients. Its unique focus is professional practice, thus the scope of this project is greater and more abstract than those focusing on a task or set of activities. A modified macroergonomic analysis, design work system analysis, and focus groups utilizing participatory design methodology were undertaken to characterize the nursing practice model. Design of the HeartCare website required synthesizing the extant practice model and the agency's evidence-based heart failure protocols, identifying aspects of practice that could be enhanced by supporting technology, and delineation of functional requirements of the Enhanced HeartCare technology. Validation and refinement of the website and planning for user training activities will be accomplished through a two-stage usability testing strategy.