Public involvement in research within care homes: benefits and challenges in the APPROACH study.

BACKGROUND: Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health-care services achieve integrated working to promote older people's health, PIR was integrated throughout the research processes. OBJECTIVES: This paper aims to present one way in which PIR has been integrated into the design and delivery of a multisite research study based in care homes. DESIGN: A prospective case study design, with an embedded qualitative evaluation of PIR activity. SETTING AND PARTICIPANTS: Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. DATA COLLECTION: Qualitative data collection involved discussion groups, and site-specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. RESULTS: PIR members supported recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimized distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. DISCUSSION AND CONCLUSIONS: Clearly defined roles with identified training and support facilitated involvement in different aspects of the data collection process. This can also ensure that vulnerable older people who participate in research have a positive experience that reinforces the value of their views.

How has child maltreatment surveillance data been used in Canada?

BACKGROUND: Recently, a survey was performed as part of a larger study at the Public Health Agency of Canada (PHAC) to develop and pilot a series of tools to measure the uptake and use of PHAC-produced or -supported knowledge products by its key partners and stakeholders. This article aims to i) examine the uptake and use of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008 (CIS-2008) and to ii) assess the utility of a knowledge uptake survey for collecting performance measurement data. METHODS: Using the knowledge utilization ladder as a theoretical framework, a short survey was developed around the themes of reception, cognition, conversation, reference, effort, influence, and implementation. The survey was administered electronically to potential end-users of the CIS-2008. The final sample comprised 85 respondents. RESULTS: The results demonstrated that the majority of the respondents were aware of CIS-2008 and had read and used it. A wide array of disciplines and sectors were identified as end-users. Types of use included discussion of CIS data with social workers, child welfare and health advocates, students, medical and legal professionals, and senior government decision makers. Further, CIS was referenced in reports, articles, policy research, community programs, and funding proposals and was used to influence or support the development of policies, programs, and projects. Valuable information on the use of surveillance reports, such as CIS-2008, can be gathered from a brief survey that was easy to administer, cost effective, and that respondents needed minimal time to complete. CONCLUSIONS: Piloting of the survey demonstrated that the tool, while not perfect, is quite useful for capturing performance measurement information; CIS-2008 is appreciated and used. There is an increased recognition of the importance of the CIS as a unique source of Canadian child maltreatment surveillance data that can influence and lead to the implementation of new programs and policies. Although suggestions for improvement of the CIS-2008 were provided, the present findings offer support for ongoing national child maltreatment surveillance.

Preventing falls among older people with mental health problems: a systematic review.

BACKGROUND: Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fall prevention interventions for older people with mental health problems being cared for across all settings. METHODS: A systematic review of fall prevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively. RESULTS: Seventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings. CONCLUSIONS: There is a dearth of falls research in mental health settings or which focus on patients with mental health problems despite the high number of falls experienced by this population group. This review highlights the lack of robust evidence to support practitioners to implement practices that prevent people with mental health problems from falling.

A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People.

Health communication has been highlighted as a cost-effective preventive intervention in Africa, where the prevalence of tobacco use is still relatively low compared to other World Health Organization (WHO) regions. This scoping review aimed to examine tobacco control health communication interventions in Africa. The review was guided by the PRISMA-ScR checklist. Data was extracted from 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention on Tobacco Control reports on Article 12. Data extraction informed by the Joanna Briggs Institute (JBI) data-extraction questions was used for peer-reviewed studies while a pre-determined template was used for the other sources. Narrative data synthesis informed by the JBI manual for evidence synthesis was employed. A lack of research that comprehensively addresses all areas of health communication and inconsistent use of health communication campaigns were identified. Only an average of 6 countries had ever implemented high-quality national mass-media campaigns in a decade, while an average of 33 countries consistently failed to conduct campaigns that lasted more than 3 weeks. Although the involvement of key populations was clearly vital to ensure content relevance and message clarity, a lack of health communication informed by young people was observed, as they rarely participated in key decision-making despite reportedly being the targets of interventions. Clear health communication for tobacco-use prevention informed by young people is lacking in African countries. Active participation of young people in developing targeted campaigns is needed to facilitate content relevance and comprehension to ultimately contribute to tobacco-use prevention.

Addressing the Black Box of AI-A Model and Research Agenda on the Co-constitution of Aging and Artificial Intelligence.

Algorithmic technologies and (large) data infrastructures, often referred to as Artificial Intelligence (AI), have received increasing attention from gerontological research in the last decade. Although there is much literature that dissects and explores the development, application, and evaluation of AI relevant to gerontology, this study makes a novel contribution by critically engaging with the theorizing in this growing field of research. We observe that gerontology's engagement with AI is shaped by an interventionist logic that situates AI as a black box for gerontological research. We demonstrate how this black box logic has neglected many aspects of AI as a research topic for gerontology and discuss three classical concepts in gerontology to show how they can be used to open various black boxes of aging and AI in the areas: (a) the datafication of aging, (b) the political economy of AI and aging, and (c) everyday engagements and embodiments of AI in later life. In the final chapter, we propose a model of the co-constitution of aging and AI that makes theoretical propositions to study the relational terrain between aging and AI and hence aims to open the black box of AI in gerontology beyond interventionist logic.

The global leadership into malnutrition criteria reveals a high percentage of malnutrition which influences overall survival in patients with gastroenteropancreatic neuroendocrine tumours.

Patients with neuroendocrine tumours located in the gastroenteropancreatic tract (GEP-NETs) and treatment with somatostatin analogues (SSA's) are at risk of malnutrition which has been reported previously evaluating weight loss or body mass index (BMI) only. The global leadership into malnutrition (GLIM) criteria include weight loss, BMI, and sarcopenia, for diagnosing malnutrition. These GLIM criteria have not been assessed in patients with GEP-NETs on SSA. The effect of malnutrition on overall survival has not been explored before. The aim of this study is to describe the presence of malnutrition in patients with GEP-NET on SSA based on the GLIM criteria and associate this with overall survival. Cross-sectional study screening all patients with GEP-NETs on SSA's for malnutrition using the GLIM criteria. Body composition analysis for sarcopenia diagnosis were performed. Bloods including vitamins, minerals, and lipid profile were collected. Overall survival since the date of nutrition screening was calculated. Uni- and multivariate Cox regression analysis were performed to identify malnutrition as risk factor for overall survival. A total of 118 patients, 47% male, with median age 67 years (IQR 56.8-75.0) were included. Overall, malnutrition was present in 88 patients (75%); based on low BMI in 26 (22%) patients, based on weight loss in 35 (30%) patients, and based on sarcopenia in 83 (70%) patients. Vitamin deficiencies were present for vitamin D in 64 patients (54%), and vitamin A in 29 patients (25%). The presence of malnutrition demonstrated a significantly worse overall survival (p-value = .01). In multivariate analysis meeting 2 or 3 GLIM criteria was significantly associated with worse overall survival (HR 2.16 95% CI 1.34-3.48, p-value = .002). Weight loss was the most important risk factor out of the 3 GLIM criteria (HR 3.5 95% CI 1.14-10.85, p-value = .03) for worse overall survival. A high percentage (75%) of patients with GEP-NETs using a SSA meet the GLIM criteria for malnutrition. Meeting more than 1 GLIM criterium, especially if there is weight loss these are risk factors for worse overall survival.

The meaning and importance of dignified care: findings from a survey of health and social care professionals.

BACKGROUND: There are well established national and local policies championing the need to provide dignity in care for older people. We have evidence as to what older people and their relatives understand by the term 'dignified care' but less insight into the perspectives of staff regarding their understanding of this key policy objective. METHODS: A survey of health and social care professionals across four NHS Trusts in England to investigate how dignified care for older people is understood and delivered. We received 192 questionnaires of the 650 distributed. RESULTS: Health and social care professionals described the meaning of dignified care in terms of their relationships with patients: 'respect' (47%), 'being treated as an individual' (40%), 'being involved in decision making' (26%) and 'privacy' (24%). 'Being treated as an individual' and 'maintaining privacy' were ranked as the most important components of dignified care. Physical caring tasks such as 'helping with washing, dressing and feeding' were rarely described as being part of dignified care and attributed much less importance than the relational components. CONCLUSION: Dignity in care is a concept with multiple meanings. Older people and their relatives focus upon the importance of providing physical care when describing what this means to them. Our participants focussed upon the relational aspects of care delivery rather than care itself. Proactive measures are therefore required to ensure that the physical aspects of care are met for all older people receiving care in NHS trusts.

Ageing, the digital and everyday life during and since the Covid-19 pandemic.

Introduction: During and since the Covid-19 pandemic there has been an intensified integration of digital technologies into the everyday lives of older people. We do, however, know little about the ways in which older people incorporate digital technologies and communications into their daily lives and their own meanings, embodiment and experiences of the digital during and since the Covid-19 pandemic. Method: The aim of our research was to explore the use of digital devices during and since the Covid-19 pandemic and to identify facilitators and barriers to incorporating digital devices into everyday life. The research involved a series of online focus groups with people aged between 63 and 86 years living in the United Kingdom and were conducted in 2022. Each focus group lasted around 90 min and data was audio-recorded and transcribed. The data was analysed thematically. Results: From the analysis, three interconnecting whilst analytically distinct themes around the meaning and experiences of using digital devices in everyday life during and since the pandemic, are thematically presented as: (1) Incorporating the digital into everyday life; (2) Social and digital connectivity; and (3) Challenges and limitations of the digital in everyday life. Discussion: The research has provided insights into the way digital devices were used by older people during and since the Covid-19 pandemic. In particular, we highlight the increasing importance of digital connectivity and the ways in which older people actively engage (and resist) technologies of communication in their daily lives; and the significance of embodied co-presence and the immediacy of shared space and/or time is highlighted.

"A different environment for success:" a mixed-methods exploration of social participation outcomes among adolescents on the autism spectrum in an inclusive, interest-based school club.

Background: Adolescents on the autism spectrum often experience challenges participating socially in inclusive education. The majority of school-based social supports focuses on social skills training, although research shows that students on the spectrum prefer activity-based social groups over social instructions. Thus, activity-based school clubs incorporating student interests may support social participation. Method: This mixed-methods study explored the preliminary social participation outcomes of adolescents on the spectrum in an inclusive Maker Club at three public schools. The quantitative phase examined longitudinal social behavior rates throughout the school club among students (n = 12). The qualitative phase interviewed six teachers in three schools (n = 6) to explore teacher perceptions of student social outcomes compared to general classrooms and program outcomes associated with the programs. Results: Mixed-effects modeling revealed increased social response rates and social reciprocity over time in both students on the spectrum and non-autistic peers without any group differences. Teachers reported that students on the spectrum engaged more socially than in general classrooms and attributed the positive outcomes to activities encouraging shared interests and the flexible social environment. Conclusions: Inclusive school clubs incorporating shared interests and joint activities among students may socially support students on the spectrum in inclusive education.

Key Device Attributes for Injectable Somatostatin Receptor Ligand Therapy in Acromegaly and Neuroendocrine Tumours.

INTRODUCTION: People living with acromegaly and neuroendocrine tumours (NETs) may be treated with injectable somatostatin receptor ligands (SRLs), administered by either a caregiver or as self-injection via a proprietary or generic device. Injection device attributes that contribute to ease of use and storage, minimise preparation requirements, and reduce injection pain are associated with improved adherence and more favourable therapeutic outcomes. The aim of this study was to assess current opinion surrounding favourable SRL device attributes for people living with acromegaly and NETs as well as that of their caregivers. METHODS: Participants (healthcare professionals [HCPs] and patients/non-HCP caregivers) from 11 countries were invited to answer survey questions related to their demographic, experience, and preferences as they relate to the real-world use of injectable SRL devices. Questions were developed based on review of available literature and meetings with a Scientific Committee. RESULTS: Device attributes preferred by the patient/non-HCP caregiver group (n = 211) included confidence that the correct drug amount is delivered (76%), quick administration with minimal pain/discomfort (68%), and device safety (needle-safety and low risk of contamination; 53%). Device attributes preferred by HCPs (n = 52) were quick administration with minimal pain/discomfort (69%), correct use is easy to learn, confidence in handling the device (63%), and confidence that the correct drug amount is delivered (62%). CONCLUSION: The results identified key features of injection devices for SRL therapy which merit consideration for optimal management and underscore the importance of patient partnership in treatment decisions.

Nature As a "Lifeline": The Power of Photography When Exploring the Experiences of Older Adults Living With Memory Loss and Memory Concerns.

The visual is an underutilized modality through which to investigate experiences of memory loss in older people. We describe a visual ethnography with older adults experiencing subjective or objective memory loss, receiving a cognitive well-being group intervention designed to prevent cognitive decline and dementia (APPLE-Tree program). We aimed to explore lived experiences of people with memory concerns, how participants engaged with this photography and codesign project, and how collaboration with an artist/photographer enhanced this process. Nineteen participants shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. Fourteen participated in qualitative photo-elicitation interviews, and 13 collaborated with a professional artist/photographer to cocreate an exhibition, in individual meetings and workshops, during which a researcher took ethnographic field notes. Eight participants were reinterviewed after the exhibition launch.We contextualize images produced by participants in relation to discourses around the visual and aging and highlight their relationship with themes developed through thematic analysis that interconnects photographic, observational, and interview data. We present themes around the use of photographs to: (1) celebrate connections to nature as a lifeline; (2) anchor lives within the context of relationships with family; and (3) reflect on self and identity, enduring through aging, memory concerns, pandemic, and aging stereotypes. We explore visual research as a powerful tool for eliciting meaningful accounts from older adults experiencing cognitive change and to connect the arts and social sciences within aging studies.

Integrated working between residential care homes and primary care: a survey of care homes in England.

BACKGROUND: Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS) about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. METHODS: A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care) were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621) in England in 2009. Responses were analysed using quantitative and qualitative methods. RESULTS: The survey achieved an overall response rate of 15.8%. Most care homes (78.7%) worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs) had visited the care homes in the last six months (SD 5.11, median 14); a mean of .39 (SD.163) professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60%) managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low levels of respect for the experience and knowledge of care home staff. CONCLUSIONS: Care homes are a hub for a wide range of NHS activity, but this is ad hoc with no recognised way to support working together. Integration between care homes and local health services is only really evident at the level of individual working relationships and reflects patterns of collaborative working rather than integration. More integrated working between care homes and primary health services has the potential to improve quality of care in a cost-effective manner, but strategic decisions to create more formal arrangements are required to bring this about. Commissioners of services for older people need to capitalise on good working relationships and address idiosyncratic patterns of provision to care homes.The low response rate is indicative of the difficulty of undertaking research in care homes.

Do smoking cessation websites meet the needs of smokers with severe mental illnesses?

Many people learn about smoking cessation through information on the Internet. Whether people with severe mental illnesses, who have very high rates of smoking, are able to use currently available websites about smoking cessation is unknown. The study reported here assessed whether four smoking cessation websites met usability guidelines and whether they were usable by smokers with severe mental illnesses. Four websites that appeared first on a Google search and represented an array of sponsors were selected. First, five experts rated the websites on adequacy of content in six areas and usability in 20 areas. Second, 16 smokers with severe mental illnesses performed two search tasks on the websites with researchers observing their searches and interviewing them regarding usability. One of the websites was rated by experts as acceptable for content and usability, but most of the participants were unable to navigate this website. The only website that was navigable received poor content ratings by experts. Four easily accessible websites did not meet the needs of smokers with severe mental illnesses. Although the Internet is a promising strategy to provide education about treatments, website developers must attend to the needs and capacities of multiple user groups.

Loneliness and ethnic minority elders in Great Britain: an exploratory study.

Loneliness, which describes the deficit between an individuals' expectation of the quality and/or quantity of social relationships and the actuality, is associated with poor quality of life, negative health outcomes and, in some cases, increased use of statutory services. Within Great Britain few studies have examined the prevalence of loneliness amongst older people from ethnic minorities. In this exploratory study we consider the prevalence of loneliness amongst older people, those aged 65 years and over, from the key minority groups growing old in Britain (Indian, Pakistani, Bangladeshi, African Caribbean, and Chinese) and draw explicit comparisons for these groups with the prevalence of loneliness reported for the general population and with older people in their countries of origin. We use two data sources: the Ethnicity and Loneliness Survey, a study of 300 minority elders aged 65+ living in the community, provides our prevalence estimates and secondary analysis of a study of 169 South Asian elders (aged 65+) undertaken in Birmingham to validate our prevalence rates for the Indian and Bangladeshi populations. We identified very high rates of reported loneliness, ranging from 24% to 50% amongst for those elders originating from China, Africa, the Caribbean, Pakistan and Bangladesh whilst those from India approximated to the norms of 8-10% for Britain. These results suggest that it is feasible to research loneliness amongst minority communities in Britain; that the levels of loneliness are, with the exception of the Indian population, very much higher than for the general population but are broadly comparable with rates of loneliness reported for older people in their countries of origin. There is a rich research agenda to be developed in extending our understanding of loneliness in later life amongst the increasingly culturally and ethnically diverse older population of Great Britain.

Visualizing the datasphere: Representations of old bodies and their data in promotional images of smart sensor technologies for aging at home.

Technologies for people aging at home are increasingly prevalent and include ambient monitoring devices that work together with wearables to remotely track and monitor older adults' biometric data and activities of daily living. There is, however, little research into the promotional and speculative images of technology-in-use. Our paper examines the ways in which the datafication of aging is offered up visually by technology companies to promote their products. Specifically, we ask: how are data visualized in promotional images of smart sensor technologies for aging at home? And in these visualizations, what happens to the aging body and relations of care? We include in our definition of smart sensor technologies both wearable and ambient monitoring devices, so long as they are used for the in-home passive monitoring of the inhabitant by a caregiver, excluding those devices targeted for institutional settings or those used for self-monitoring purposes. Our sample consists of 221 images collected between January and July of 2021 from the websites of 14 English-language companies that offer smart sensor technology for aging at home. Following a visual semiotic analysis, we present 3 themes on the visual representation of old bodies and their data: (1) Captured Data, (2) Spatialized Data, and (3) Networked Data. Each, we argue, contribute to a broader visualization of the "datasphere". We conclude by highlighting the underlying assumptions of old bodies in the co-constitution of aging and technologies in which the fleshy and lived corporeality of bodies is more often lost, reduced to data points and automated care scenarios, and further disentangled from other bodies, contexts and things.

Experiences of Students, Teachers, and Parents Participating in an Inclusive, School-Based Informal Engineering Education Program.

Many youth on the autism spectrum possess interests and strengths for STEM-related postsecondary pathways, yet there are few research-based programs to support those interests and competencies including complex problem solving and social communication. This qualitative study explored the experiences and perceived outcomes of students, teachers, and parents participating in an inclusive, strength-based, extracurricular engineering design program entitled the IDEAS Maker Club. Twenty-six students, 13 parents, and nine teachers in the program completed interviews and program logs while researchers conducted classroom observations over 2 years. Thematic analysis identified five common themes: (1) positive student experience and engagement, (2) skills acquisition, (3) development of interest in STEM and related careers, (4) social relationships and community, and (5) safe spaces that supported self-determination.

A systematic review of integrated working between care homes and health care services.

BACKGROUND: In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. METHODS: A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. RESULTS: Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration. CONCLUSIONS: Despite evidence about what inhibits and facilitates integrated working there was limited evidence about what the outcomes of different approaches to integrated care between health service and care homes might be. The majority of studies only achieved integrated working at the patient level of care and the focus on health service defined problems and outcome measures did not incorporate the priorities of residents or acknowledge the skills of care home staff. There is a need for more research to understand how integrated working is achieved and to test the effect of different approaches on cost, staff satisfaction and resident outcomes.

Developing a quit smoking website that is usable by people with severe mental illnesses.

OBJECTIVE: Evidence-based treatments may be delivered in computerized, web-based formats. This strategy can deliver the intervention consistently with minimal treatment provider time and cost. However, standard web sites may not be usable by people with severe mental illnesses who may experience cognitive deficits and low computer experience. This manuscript reports on the iterative development and usability testing of a website designed to educate and motivate adults with severe mental illnesses to engage in smoking cessation activities. METHODS: Three phases of semi-structured interviews were performed with participants after they used the program and combined with information from screen-recorded usability data. T-tests compared the differences between uses of the first computer program version and a later version. RESULTS: Iteratively conducted usability tests demonstrated an increased ease of use from the first to the last version of the website through significant improvement in the percentage of unproductive clicking along with fewer questions asked about how to use the program. The improvement in use of the website resulted from changes such as: integrating a mouse tutorial, increasing font sizes, and increasing button sizes. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The website usability recommendations provide some guidelines for interventionists developing web tools for people who experience serious psychiatric disabilities. In general, insights from the study highlight the need for thoughtful design and usability testing when creating a website for people with severe mental illness.

Comparison of 3D Digitally Assisted Visualization System with Current Standard Visualization for the Removal of Vitreous in a Preclinical Model.

PURPOSE: Novel 3D digital display systems, such as NGENUITY 3D digitally assisted visualization system (DAVS), can provide enhanced illumination, depth of field, and digital filtering. This study compared vitreous removal using NGENUITY 3D DAVS with a standard surgical microscope. METHODS: This was an in vivo, 2-arm laboratory study in 15 Yorkshire pig eyes. The LuxOR LX3 microscope with NGENUITY 3D DAVS (arm 1) and the LuxOR LX3 microscope alone (arm 2) were used with 5× optical magnification and Oculus BIOM 200 mm optics. Standard core and peripheral vitrectomy without scleral depression was performed using the CONSTELLATION Vision System. Residual vitreous weight was assessed in enucleated eyes by a masked observer. Axial length and vitreous weight of contralateral eyes were compared from an additional 14 Yorkshire pigs to confirm that eyes from a single animal were essentially identical. RESULTS: After vitrectomy, mean ± SD residual vitreous was significantly smaller with NGENUITY versus standard microscope (0.143 ± 0.146 versus 0.580 ± 0.269 g, respectively; P < 0.0001). Based on a mean initial vitreous weight of 2.5 g, as determined by assessment in contralateral eyes from an additional 14 Yorkshire pigs, the mean percentage vitreous removal was 94% ± 6% versus 77% ± 11%, respectively. Further, vitreous weight and axial length for contralateral eyes from any single animal in these additional 14 animals were essentially identical, as mean differences were 0.046 ± 0.035 g and 0.11 ± 0.08 mm, respectively. CONCLUSION: Vitrectomy with NGENUITY 3D DAVS resulted in significantly less residual vitreous in pig eyes compared with standard microscopy. NGENUITY may improve vitreous removal during vitreoretinal surgery by enhancing visualization.