Desenvolvimento e propriedades psicométricas do Teste Informatizado de Avaliação das Funções Executivas / Development and psychometric properties of the Computerized Executive Functions Assessment Test / Desarrollo y propiedades psicométricas del Test Informatizado de Evaluación de las Funciones Ejecutivas

Funções executivas (FE) são habilidades que permitem o autocontrole comportamental e cognitivo e estão relacionadas a diversos desfechos ao longo da vida. O uso de testes informatizados para avaliar as FE pode facilitar a precisão dos registros, a padronização e a análise dos dados. Este estudo objetivou desenvolver um instrumento informatizado para avaliar FE em crianças de 4 a 10 anos e analisar características psicométricas. Foram conduzidas cinco etapas: 1) Definição teórica e metodológica; 2) Construção dos itens; 3) Estudo piloto; 4) Análise de juízes; e 5) Estudos psicométricos de validade e fidedignidade. As tarefas informatizadas mostraram-se adequadas para o público-alvo, conforme avaliação dos juízes. As diferentes tarefas de memória de trabalho, inibição e flexibilidade cognitiva apresentaram correlações significativas entre si e a maioria das medidas no teste-reteste evidenciou estabilidade na mensuração. Portanto, os resultados sugerem viabilidade para uso do instrumento no contexto brasileiro. (AU)

Executive functions (EF) are skills linked to behavioral and cognitive self-control and are related to various outcomes throughout life. The use of computerized tests to evaluate EFs can facilitate the accuracy of records, standardization and data analysis. This study aimed to develop a computerized instrument for the EF assessment of children aged 4 to 10 years, and to seek psychometric evidence. Five steps were carried out: 1) Theoretical and methodological definition; 2) Construction of the items; 3) Pilot study; 4) Analysis of experts; and 5) Psychometric studies of validity and reliability. The computerized tasks proved to be suitable for the target audience according to the expert's evaluation. The results between the different tasks of working memory, inhibition and cognitive flexibility showed significant correlations and most test-retest measures showed stability in the measurement. Therefore, the results indicate the feasibility of using the instrument in the Brazilian context. (AU)

Funciones ejecutivas (FE) son habilidades que permiten el autocontrol conductual y cognitivo y están relacionadas con diversos resultados a lo largo de la vida. El uso de tests informatizados para evaluar las FE puede facilitar la precisión de los registros, la estandarización y el análisis de datos. Este estudio tuvo como objetivo desarrollar un instrumento informatizado para la FE para niños de 4 a 10 años, y analizar evidencias psicométricas. Fueron ejecutados cinco pasos: 1) Definición teórica y metodológica; 2) Construcción de los ítems; 3) Estudio piloto; 4) Análisis de jueces; y 5) Estudios psicométricos de validez y fiabilidad. Las tareas informatizadas demostraron ser adecuadas para el público objetivo según la evaluación de los jueces. Las diferentes tareas de memoria de trabajo, inhibición y flexibilidad cognitiva mostraron correlaciones significativas entre sí y la mayoría de las medidas test-retest presentaron estabilidad en la medición. Por lo tanto, los resultados sugieren la viabilidad del instrumento para el contexto brasileño. AU)

Artificial Intelligence and Clinical Decision Making: The New Nature of Medical Uncertainty.

Estimates in a 1989 study indicated that physicians in the United States were unable to reach a diagnosis that accounted for their patient's symptoms in up to 90% of outpatient patient encounters. Many proponents of artificial intelligence (AI) see the current process of moving from clinical data gathering to medical diagnosis as being limited by human analytic capability and expect AI to be a valuable tool to refine this process. The use of AI fundamentally calls into question the extent to which uncertainty in medical decision making is tolerated. Uncertainty is perceived by some as fundamentally undesirable and thus, for them, optimal decision making should be based on minimizing uncertainty. However, uncertainty cannot be reduced to zero; thus, relative uncertainty can be used as a metric to weigh the likelihood of various diagnoses being correct and the appropriateness of treatments. Here, the authors make the argument, using as examples the experiences of 2 AI systems, IBM Watson on Jeopardy and Watson for Oncology, that medical decision making based on relative uncertainty provides a better lens for understanding the application of AI to medicine than one that minimizes uncertainty. This approach to uncertainty has significant implications for how health care leaders consider the benefits and trade-offs of AI-assisted and AI-driven decision tools and ultimately integrate AI into medical practice.

DSM-5 Level 1 cross-cutting measure in an online sample: evaluating its latent dimensionality and utility detecting nonspecific psychological distress.

Included in the most recent Diagnostic and Statistical Manual of Mental Disorders is the Level 1 Cross-Cutting Symptom Measure (CCSM), a self-report checklist with 23 items assessing 13 major psychiatric symptom clusters. To date, minimal literature has examined the factor structure of the CCSM and its utility identifying significant psychological distress, and existing studies pose notable limitations. Four hundred (400) American adults (M age = 34.13; 50.2% female) participated online via Amazon Mechanical Turk as part of a larger study, which included the CCSM. The sample was randomly split to conduct exploratory and confirmatory factor analyses (EFAs and CFAs). EFAs revealed structures with one (general psychopathology) and two (externalizing/serious mental illness and internalizing/affective) factors accounting for 67.3% and 73.7% of the variance, respectively. CFAs indicated good fit for both models, though statistical comparison of the models via χ2 difference test revealed the two-factor model provided significantly better fit. Areas under the receiver operating curve (AUCs) suggested that all CCSM variables of interest poorly differentiated those currently receiving mental health treatment from those who have never received mental health treatment (AUCs ranged from .57 to .68). Implications of these findings, various limitations, and recommendations for future lines of inquiry were discussed.

[Do artificial intelligence systems reason in the same way as clinicians when making diagnoses?] / Une intelligence artificielle raisonne-t-elle de la même façon que les cliniciens pour poser des diagnostics ?

Clinical reasoning is at the heart of physicians' competence, as it allows them to make diagnoses. However, diagnostic errors are common, due to the existence of reasoning biases. Artificial intelligence is undergoing unprecedented development in this context. It is increasingly seen as a solution to improve the diagnostic performance of physicians, or even to perform this task for them, in a totally autonomous and more efficient way. In order to understand the challenges associated with the development of artificial intelligence, it is important to understand how the machine works to make diagnoses, what are the similarities and differences with the physician's diagnostic reasoning, and what are the consequences for medical training and practice.

How Online Family History Tool Design and Message Content Impact User Perceptions: An Examination of Family HealthLink.

BACKGROUND: Family health history tools have the ability to improve health outcomes and promote patient-provider communication, but some research suggests their effectiveness is limited. Tool design features may heavily influence users' perceptions of the tools. AIMS: This study provides a summative evaluation of the Family HealthLink tool, which assesses cancer and coronary heart disease risk based on personal and family health history, to better understand how tool design and message content impact user perceptions. METHOD: User observations and semi-structured interviews were conducted with breast cancer patients (n = 16) and support persons (n = 18) at an academic comprehensive breast center. RESULTS: The users responded positively to many of Family HealthLink's features, but they noted that it lacked a modern design. The participants felt much of the risk information was too generic and did not account for lifestyle factors. The users also did not consistently interpret the qualitative risk assessments provided by Family HealthLink. CONCLUSION: Our data analysis suggests that certain aspects of the Family HealthLink tool could be executed more effectively to take fuller advantage of opportunities for online personalization.

Test-retest reliability and practice effects for the ANAM General Neuropsychological Screening battery.

OBJECTIVE: As the use of computer-based neurocognitive assessment is rapidly expanding, the need to systematically study and document key psychometric properties of these measures has become increasingly more salient. To meet this aim, this study examined test-retest reliability and practice effects for the Automated Neuropsychological Assessment Metrics General Neuropsychological Screening battery (ANAM GNS) in a sample of 94 community dwelling adults. METHOD: ANAM GNS was administered and then repeated (alternate form) after 30 days. Test-retest reliability, practice effects, and the standard error of measurement were calculated. Using these estimates, reliable change indices were calculated to determine degree of performance change needed to exceed chance and measurement error (with 90% confidence interval). RESULTS: The test-retest reliability for the ANAM composite score was .91. Performance significantly improved upon retest, but the effect size was small consistent with minimal practice effects. The threshold indicating change beyond chance or measurement error with 90% certainty was .9 (z-score). CONCLUSIONS: Findings suggest that the ANAM GNS has excellent test-retest reliability upon retest at 30 days. Small practice effects can be expected. Change greater than .9 standard deviations in the ANAM composite score is likely to represent meaningful clinical change. This paper presents initial psychometric data from the ANAM GNS and supports its use as a reliable measure of cognition.

Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation.

BACKGROUND: Evidence is mixed regarding how physicians' use of the electronic health record (EHR) affects communication in medical encounters. OBJECTIVE: To investigate whether the different ways physicians interact with the computer (mouse clicks, key strokes, and gaze) vary in their effects on patient participation in the consultation, physicians' efforts to facilitate patient involvement, and silence. DESIGN: Cross-sectional, observational study of video and event recordings of primary care and specialty consultations. PARTICIPANTS: Thirty-two physicians and 217 patients. MAIN MEASURES: Predictor variables included measures of physician interaction with the EHR (mouse clicks, key strokes, gaze). Outcome measures included active patient participation (asking questions, stating preferences, expressing concerns), physician facilitation of patient involvement (partnership-building and supportive talk), and silence. KEY RESULTS: Patients were less active participants in consultations in which physicians engaged in more keyboard activity (b = -0.002, SE = 0.001, p = 0.02). More physician gaze at the computer was associated with more silence in the encounter (b = 0.21, SE = 0.09, p = 0.02). Physicians' facilitative communication, which predicted more active patient participation (b = 0.65, SE = 0.14, p < 0.001), was not related to EHR activity measures. CONCLUSIONS: Patients may be more reluctant to actively participate in medical encounters when physicians are more physically engaged with the computer (e.g., keyboard activity) than when their behavior is less demonstrative (e.g., gazing at EHR). Using easy to deploy communication tactics (e.g., asking about a patient's thoughts and concerns, social conversation) while working on the computer can help physicians engage patients as well as maintain conversational flow.

Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents.

Recovery from concussion in childhood is poorly understood, despite its importance in decisions regarding return to normal activity. Resolution of post-concussive symptoms (PCS) is widely employed as a marker of recovery in clinical practice; however, it is unclear whether subtle impairments persist only to re-emerge in the context of increased physical or cognitive demands. This study aimed to examine the effect of strenuous exercise on clinical symptom report and neurocognition in children and adolescents after PCS resolution after concussion. We recruited children and adolescents with concussion (n = 30) on presentation to an Emergency Department (ED). At Day 2 and Day 10 post-self-reported symptom resolution, participants completed a strenuous exercise protocol, and pre- and post-exercise assessment of PCS and neurocognition. Results demonstrated an overall reduction in PCS from Day 2 to Day 10 post-symptom resolution, with no evidence of symptom increase after strenuous exercise at either time point. Neurocognitive performance was linked to task complexity: on less cognitively demanding tasks, processing speed was slower post-exercise and, unexpectedly, slower on Day 10 than Day 2, while for more demanding tasks (new learning), Day 2 exercise resulted in faster responses, but Day 10 processing speed post-exercise was slower. In summary, we found the expected recovery pattern for PCS, regardless of exercise, while for neurocognition, recovery was dependent on the degree of cognitive demand, and there was an unexpected reduction in performance from Day 2 to Day 10. Findings provide some suggestion that premature return to normal activities (e.g., school) may slow neurocognitive recovery.

Investigating Event Memory in Children with Autism Spectrum Disorder: Effects of a Computer-Mediated Interview.

The present study aimed to examine the effects of a novel avatar interviewing aid during memory interviews with children with autism spectrum disorder (ASD). Thirty children were recruited for our study (Age: M = 7.60, SD = 0.68), half with ASD (13 boys; 2 girls) and the other half being neurotypical (13 boys; 2 girls). Children participated in a target event and were subsequently interviewed a week later by either an avatar interviewer or a human. The participants were also asked six misleading questions aimed to examine their suggestibility. Bayesian analysis showed some increase in memory performance for both groups of children interviewed by the avatar interviewer, and this effect exacerbated for children with ASD. These results showed encouraging implications for future applications.

Validez en test adaptativos informatizados: alternativa para evaluar población con limitaciones visuales / Validade em testes adaptativos computadorizados: alternativa para avaliar população com deficiência visual / Validity in computerized adaptive testing: an alternative to assess visually impaired individuals

Este artículo centra su interés en la importancia de la validez dentro de los procesos de evaluación psicológica cuando se pretende evaluar a personas invidentes o con baja visión, y en el desarrollo de los Test Adaptativos Informatizados (TAI) como una alternativa para la evaluación de esta población. Se presenta una revisión sobre el concepto de validez a partir de las aproximaciones contemporáneas dominantes, y se habla acerca del desarrollo de los TAI, el problema de su validez y los alcances de esta tecnología como una alternativa para evaluar personas con baja visión o invidentes. Finalmente, este trabajo deja abierta la posibilidad para futuros desarrollos e investigaciones en torno a otras alternativas de evaluación con equidad para poblaciones con discapacidad física.

Este artigo centra o seu interesse na importância da validade dentro dos processos de avaliação psicológica de pessoas cegas ou com baixa visão e no desenvolvimento dos Testes Adaptativos Computadorizados (TAC) como uma alternativa para a avaliação dessa população. Apresenta-se uma revisão sobre o conceito de validade a partir das abordagens contemporâneas dominantes e sobre o desenvolvimento dos TAC, o problema da sua validade e os alcances dessa tecnologia como uma alternativa para avaliar pessoas cegas. Finalmente, o trabalho deixa em aberto a possibilidade de futuros desenvolvimentos e pesquisas sobre alternativas de avaliação com equidade para a população com deficiência física.

This article focuses on the importance of validity in the process of psychological evaluation, especially when the evaluation is intended for people with visual impairment, and about the development of the Computerized Adaptive Testing (CAT) as an alternative for the assessment of this population. First, a review of the main controversies about the concept of validity and the development of Computerized Adaptive Test is presented. Then, topics related to validity in CAT and scope, technological limitations, and the challenges of its use as an alternative to evaluate the visual impairment population are discussed. Finally, possibilities for future developments and research on high quality alternative assessment for populations with physical disabilities are set forth.

Validez en test adaptativos informatizados: alternativa para evaluar población con limitaciones visuales / Validade em testes adaptativos computadorizados: alternativa para avaliar população com deficiência visual / Validity in computerized adaptive testing: An alternative to assess visually impaired individuals

Este artículo centra su interés en la importancia de la validez dentro de los procesos de evaluación psicológica cuando se pretende evaluar a personas invidentes o con baja visión, y en el desarrollo de los Test Adaptativos Informatizados (TAI) como una alternativa para la evaluación de esta población. Se presenta una revisión sobre el concepto de validez a partir de las aproximaciones contemporáneas dominantes, y se habla acerca del desarrollo de los TAI, el problema de su validez y los alcances de esta tecnología como una alternativa para evaluar personas con baja visión o invidentes. Finalmente, este trabajo deja abierta la posibilidad para futuros desarrollos e investigaciones en torno a otras alternativas de evaluación con equidad para poblaciones con discapacidad física.(AU)

Este artigo centra o seu interesse na importância da validade dentro dos processos de avaliação psicológica de pessoas cegas ou com baixa visão e no desenvolvimento dos Testes Adaptativos Computadorizados (TAC) como uma alternativa para a avaliação dessa população. Apresenta-se uma revisão sobre o conceito de validade a partir das abordagens contemporâneas dominantes e sobre o desenvolvimento dos TAC, o problema da sua validade e os alcances dessa tecnologia como uma alternativa para avaliar pessoas cegas. Finalmente, o trabalho deixa em aberto a possibilidade de futuros desenvolvimentos e pesquisas sobre alternativas de avaliação com equidade para a população com deficiência física.(AU)

This article focuses on the importance of validity in the process of psychological evaluation, especially when the evaluation is intended for people with visual impairment, and about the development of the Computerized Adaptive Testing (CAT) as an alternative for the assessment of this population. First, a review of the main controversies about the concept of validity and the development of Computerized Adaptive Test is presented. Then, topics related to validity in CAT and scope, technological limitations, and the challenges of its use as an alternative to evaluate the visual impairment population are discussed. Finally, possibilities for future developments and research on high quality alternative assessment for populations with physical disabilities are set forth.(AU)

Therapeutic Cycles Model (TCM): instrumento de avaliação do processo psicoterapêutico / Therapeutic Cycles Model (TCM): instrument of evalution of psychotherapeutic process / Therapeutic Cycles Model (TCM): instrumento de evaluación del proceso psicoterapéutico

O objetivo deste trabalho foi apresentar a versão brasileira do Therapeutic Cycles Model (TCM) a partir da análise de uma sessão de um processo de psicoterapia psicanalítica. O TCM é um método de análise de textos por computador que identifica os momentos-chave no discurso de paciente, psicoterapeuta, ou de ambos, em interação. As análises são feitas com o auxílio de um software (Cycles Model), que dispõe de listas de palavras de tom emocional e de abstrações, permitindo a classificação do texto em duas categorias: conteúdo emocional e cognitivo das verbalizações na sessão. Buscou-se ilustrar uma possibilidade de utilização do TCM a partir de uma sessão de psicoterapia. A análise exploratória dos conteúdos verbalizados pela dupla, paciente e psicoterapeuta, a partir dos ciclos terapêuticos demonstrou que esse instrumento contribui na identificação de momentos clinicamente significativos do discurso do paciente em sessões individuais. Sendo assim, o TCM pode ser mais uma ferramenta para compreender o processo terapêutico e, com isso, auxiliar o psicoterapeuta em sua prática...

The objective of this study was to present the Brazilian version of Therapeutic Cycles Model (TCM) from the analysis of a psychoanalytic psychotherapeutical process. TCM is a method of computer analysis of texts by identifying key-moments in the speech of the patient, therapist, or both in interaction. The analysis is performed with the software (Cycles Model), which provides word lists of emotional tone and abstractions, allowing classification of text into two categories: emotional and cognitive content of utterances in the session. We have tried to illustrate a possibility of TCM's use from a psychotherapy session. Exploratory analysis of the contents verbalized by the double patient and psychotherapist demonstrated that this instrument helps in identifying clinically significant moments in speech of the patient in individual sessions. Thus, the TCM can be a tool in comprehending psychotherapeutic processes, helping psychotherapist in practice...

El objetivo de este trabajo fue presentar la versión brasileña del Therapeutic Cycles Model (TCM) partiendo del análisis de una sesión de un proceso de psicoterapia psicoanalítica. El TCM es un método computarizado de análisis de textos que identifica los momentos clave en el discurso del paciente, del psicoterapeuta o de la interacción entre ambos. El proceso de análisis se realiza con el auxilio de un software (Cycles Model), que dispone de listas de palabras de tono emocional y de abstracciones, permitiendo la clasificación del texto en dos categorías: contenido emocional y contenido cognitivo de las verbalizaciones durante la sesión. Se buscó la posibilidad de utilización del TCM a partir de una sesión de psicoterapia. El análisis exploratorio de los contenidos verbalizados por la dupla paciente/psicoterapeuta demostró que este instrumento ayuda en la identificación de momentos clínicamente significativos del discurso del paciente en sesiones individuales. De este modo, el TCM puede ser una herramienta más para comprender el proceso terapéutico y por lo tanto auxiliar al psicoterapeuta en su práctica...

Therapeutic Cycles Model (TCM): instrumento de avaliação do processo psicoterapêutico / Therapeutic Cycles Model (TCM): instrument of evalution of psychotherapeutic process / Therapeutic Cycles Model (TCM): instrumento de evaluación del proceso psicoterapéutico

O objetivo deste trabalho foi apresentar a versão brasileira do Therapeutic Cycles Model (TCM) a partir da análise de uma sessão de um processo de psicoterapia psicanalítica. O TCM é um método de análise de textos por computador que identifica os momentos-chave no discurso de paciente, psicoterapeuta, ou de ambos, em interação. As análises são feitas com o auxílio de um software (Cycles Model), que dispõe de listas de palavras de tom emocional e de abstrações, permitindo a classificação do texto em duas categorias: conteúdo emocional e cognitivo das verbalizações na sessão. Buscou-se ilustrar uma possibilidade de utilização do TCM a partir de uma sessão de psicoterapia. A análise exploratória dos conteúdos verbalizados pela dupla, paciente e psicoterapeuta, a partir dos ciclos terapêuticos demonstrou que esse instrumento contribui na identificação de momentos clinicamente significativos do discurso do paciente em sessões individuais. Sendo assim, o TCM pode ser mais uma ferramenta para compreender o processo terapêutico e, com isso, auxiliar o psicoterapeuta em sua prática.(AU)

The objective of this study was to present the Brazilian version of Therapeutic Cycles Model (TCM) from the analysis of a psychoanalytic psychotherapeutical process. TCM is a method of computer analysis of texts by identifying key-moments in the speech of the patient, therapist, or both in interaction. The analysis is performed with the software (Cycles Model), which provides word lists of emotional tone and abstractions, allowing classification of text into two categories: emotional and cognitive content of utterances in the session. We have tried to illustrate a possibility of TCM's use from a psychotherapy session. Exploratory analysis of the contents verbalized by the double patient and psychotherapist demonstrated that this instrument helps in identifying clinically significant moments in speech of the patient in individual sessions. Thus, the TCM can be a tool in comprehending psychotherapeutic processes, helping psychotherapist in practice.(AU)

El objetivo de este trabajo fue presentar la versión brasileña del Therapeutic Cycles Model (TCM) partiendo del análisis de una sesión de un proceso de psicoterapia psicoanalítica. El TCM es un método computarizado de análisis de textos que identifica los momentos clave en el discurso del paciente, del psicoterapeuta o de la interacción entre ambos. El proceso de análisis se realiza con el auxilio de un software (Cycles Model), que dispone de listas de palabras de tono emocional y de abstracciones, permitiendo la clasificación del texto en dos categorías: contenido emocional y contenido cognitivo de las verbalizaciones durante la sesión. Se buscó la posibilidad de utilización del TCM a partir de una sesión de psicoterapia. El análisis exploratorio de los contenidos verbalizados por la dupla paciente/psicoterapeuta demostró que este instrumento ayuda en la identificación de momentos clínicamente significativos del discurso del paciente en sesiones individuales. De este modo, el TCM puede ser una herramienta más para comprender el proceso terapéutico y por lo tanto auxiliar al psicoterapeuta en su práctica.(AU)

The loleva oral and written language test: psychometric properties

LolEva, a computerized test for ages 3 to 8 years old, identifies issues in the development of skills that can lead to reading acquisition difficulties. Its structure captures two distinct areas: Phonological Awareness (PA, seven subtests: rhyme, identification-addition-omission of syllable and phoneme at the beginning and end of a word), and Initial Reading Competence (IRC, six subtests: reading uppercase and lowercase letters, simple words, complex words, and pseudowords, and word segmentation). With results collected in a sample of 341 children with the target ages and attending public or private schools, the alpha coefficient was .94 for PA, and .92 for IRC. Factor analysis indicated three factors are present (performance on PA and IRC, and word reading times), together explaining 75% of variance, providing evidence to support the construct validity of the test. On the other hand, analysis of variance showed significant differences for year-in-school variable for PA subscale, F(4, 336) = 191.385, p < .001, η2 p = .695, 1-β = 1.0, as well as for IRC subscale, both in number of correct answers, which increased as schooling progressed: F(4, 336) = 197.897, p < .001, η2 p = .702, 1-β = 1.0, and task completion time, which decreased as education progressed: F(4, 335) = 47.048, p < .001, η2 p = .360, 1-β = 1.0. Also, PA repeated measures analysis revealed that was easier Identification than Addition and Omission , F(2, 672) = 31.639, p < .001, η2 p = .086, 1-β = 1.0, syllable-related tasks than phoneme-related task, F(1, 336) = 229.000, p < .001, η2 p = .405, 1-β = 1.0, and syllable or phoneme at the end of the word than at the beginning, F(1, 336) = 59.201, p < .001, η2 p = .150, 1-β = 1.0. Moreover, all items were examined and indexes of difficulty and discrimination were obtained (AU)

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Implementation intentions and colorectal screening: a randomized trial in safety-net clinics.

CONTEXT: Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND: The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN: Randomized controlled trial. SETTING/PARTICIPANTS: Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION: The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES: The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS: The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS: The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.

How do people understand their neuropathic pain? A Q-study.

Neuropathic pain (NP) is not easy to understand for those with the diagnosis. Even in specialist medical services, explanation may not be given or may not be integrated with patients' existing beliefs about their conditions. We were curious about how people with NP conceptualised the problem. Web sites relevant to NP were used to recruit 79 people with NP. They were sampled using Q-methodology, which requires sorting according to degree of agreement or disagreement with diverse statements about NP, derived from the widest possible range of sources. The sets of sorted statements are analysed for factors which represent shared constructions. The four factors that we found differed in important ways: (1) identification of nerve damage as cause; (2) the necessity of identifying cause; (3) the acceptability of symptomatic treatment; (4) the existence or not of psychological influences; and (5) the usefulness of psychological treatment. The meaning of these factors was extended by participants' free comments: certain viewpoints showed associations with their medical and treatment histories and with the interference of pain with daily life. Overall, a biopsychosocial model of pain was only weakly represented, and no integrated model of pain emerged across the four different accounts. There was little reference to NP having been explained when the diagnosis was made. This study highlights the need for more accessible explanations of NP within and outside medical services if people with NP are to use their understanding of NP to help them manage their pain and reduce its impact on their lives.

Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status.

BACKGROUND: Routine screening and advice regarding risky lifestyle behaviours is appropriate in the primary care setting, but often not implemented. Routine electronic collection of patients' self-reported data may streamline the collection of such information. AIM: To explore the perceptions of GPs and their attending patients regarding the acceptability of waiting-room touchscreen computers for the collection of health behaviour information. Uptake, ease of operation, and the perceived likelihood of future implementation were studied. DESIGN AND SETTING: Cross-sectional health-risk survey. General practices in metropolitan areas in Australia. METHOD: Practices were randomly selected by postcode. Consecutive patients who were eligible to take part in the study were approached in the waiting room and invited to do so. Participants completed the touchscreen health survey. A subsample of patients and GPs completed additional items regarding acceptability. RESULTS: Twelve general practices participated in the study, with 4058 patients (86%) and 51 of 68 (75%) GPs consenting to complete the health-risk survey, 596 patients and 30 GPs were selected to complete the acceptability survey. A majority of the 30 GPs indicated that the operation of the survey was not disruptive to practice and more than 90% of patients responded positively to all items regarding its operation. More than three-quarters of the patient sample were willing to consider allowing their responses to be kept on file and complete such surveys in the future. CONCLUSION: As waiting-room-based collection of this information appears to be both feasible and acceptable, practitioners should consider collecting and incorporating routine patient-reported health behaviours for inclusion in the medical record.

Automated detection of heuristics and biases among pathologists in a computer-based system.

The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases.

Computerized assessment facilitates disclosure of sensitive HIV risk behaviors among African Americans entering substance abuse treatment.

BACKGROUND: Individuals entering substance abuse treatment are at elevated risk for HIV infection, and clinicians must generally rely on patient self-report to gauge their involvement in risk behaviors. Strategies to improve accurate reporting of personally sensitive or stigmatizing risk behaviors are needed. OBJECTIVE: This study compared computerized and face-to-face interview methods in eliciting self-disclosure of HIV risk behaviors among a high-risk sample of urban African Americans entering substance abuse treatment (N = 146). METHODS: Participants completed a standardized HIV risk behavior screening as a face-to-face interview. Several days later, the same participants completed a computerized self-interview with the same measure, covering the same time frame. RESULTS: Disclosure rates for many sensitive risk behaviors were considerably higher on the computerized interview. Participants had significantly higher odds of disclosure on the computerized interview compared to the face-to-face interview on 2 of 6 drug risk behaviors examined (ORs between 2.75 and 3.15) and 9 of 13 sex risk behaviors examined (ORs between 1.60 and 6.45). The advantage of the computerized interview was most evident for highly stigmatized behaviors, such as unprotected sex with someone other than a spouse or main partner (OR = 3.93; p < .001), unprotected sex during a commercial sex transaction (OR = 5.63; p < .001), unprotected anal sex (OR = 6.45; p < .001), and using unsterilized syringes (OR = 3.15; p < .05). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Findings support the utility of computerized risk behavior assessment with African Americans entering substance abuse treatment. Computerized assessment of HIV risk behaviors may be clinically useful in substance abuse treatment and other healthcare venues serving high-risk populations.