Digital skills training for older people: The importance of the 'lifeworld'.

When everyday life becomes ever more permeated by digital technologies, many older people join ICT trainings to improve their digital skills. Given that digital skills include more than the command of technology (for instance, changing social practices) teaching ICT to people who grew up long before internet and social media can be challenging. The purpose of this article is to propose a theoretical account of a key element for how teaching digital skills to older people can be made successful. Drawing on qualitative interview data with 26 ICT instructors as well as concepts from sociological theory (lifeworld, role-taking) and cognitive science (dual process model), we argue that ICT training needs to take into account the lifeworlds of older participants. In order to be successful, ICT trainings have to appeal to the current lifeworlds of older people while at the same time overcome mismatching lifeworlds. By connecting content and pedagogics to the older adults' needs, values, and desires, instructors can successfully help integrate new skills into the lifeworld of the older participants.

Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial.

Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.

Machine learning-based reclassification of germline variants of unknown significance: The RENOVO algorithm.

The increasing scope of genetic testing allowed by next-generation sequencing (NGS) dramatically increased the number of genetic variants to be interpreted as pathogenic or benign for adequate patient management. Still, the interpretation process often fails to deliver a clear classification, resulting in either variants of unknown significance (VUSs) or variants with conflicting interpretation of pathogenicity (CIP); these represent a major clinical problem because they do not provide useful information for decision-making, causing a large fraction of genetically determined disease to remain undertreated. We developed a machine learning (random forest)-based tool, RENOVO, that classifies variants as pathogenic or benign on the basis of publicly available information and provides a pathogenicity likelihood score (PLS). Using the same feature classes recommended by guidelines, we trained RENOVO on established pathogenic/benign variants in ClinVar (training set accuracy = 99%) and tested its performance on variants whose interpretation has changed over time (test set accuracy = 95%). We further validated the algorithm on additional datasets including unreported variants validated either through expert consensus (ENIGMA) or laboratory-based functional techniques (on BRCA1/2 and SCN5A). On all datasets, RENOVO outperformed existing automated interpretation tools. On the basis of the above validation metrics, we assigned a defined PLS to all existing ClinVar VUSs, proposing a reclassification for 67% with >90% estimated precision. RENOVO provides a validated tool to reduce the fraction of uninterpreted or misinterpreted variants, tackling an area of unmet need in modern clinical genetics.

The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout.

OBJECTIVE: To conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care. MATERIALS AND METHODS: Literature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings. RESULTS: The search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows. DISCUSSION: The contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows. CONCLUSION: Physician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.

A systematic review of contributing factors of and solutions to electronic health record-related impacts on physician well-being.

OBJECTIVE: Physicians often describe the electronic health record (EHR) as a cumbersome impediment to meaningful work, which has important implications for physician well-being. This systematic review (1) assesses organizational, physician, and information technology factors associated with EHR-related impacts on physician well-being; and (2) highlights potential improvements to EHR form and function, as recommended by frontline physicians. MATERIALS AND METHODS: The MEDLINE, Embase, CINAHL, PsycINFO, ProQuest, and Web of Science databases were searched for literature describing EHR use by physicians and markers of well-being. RESULTS: After reviewing 7388 article, 35 ultimately met the inclusion criteria. Multiple factors across all levels were associated with EHR-related well-being among physicians. Notable predictors amenable to interventions include (1) total EHR time, (2) after-hours EHR time, (3) on-site EHR support, (4) perceived EHR usability, (5) in-basket burden, and (6) documentation burden. Physician recommendations also echoed these themes. CONCLUSIONS: There are multiple complex factors involved in EHR-related well-being among physicians. Our review shows physicians have recommendations that span from federal regulations to organizational policies to EHR modifications. Future research should assess multipronged interventions that address these factors. As primary stakeholders, physicians should be included in the planning and implementation of such modifications to ensure compatibility with physician needs and clinical workflows.

Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program.

OBJECTIVE: To give providers a better understanding of how to use the electronic health record (EHR), improve efficiency, and reduce burnout. MATERIALS AND METHODS: All ambulatory providers were offered at least 1 one-on-one session with an "optimizer" focusing on filling gaps in EHR knowledge and lack of customization. Success was measured using pre- and post-surveys that consisted of validated tools and homegrown questions. Only participants who returned both surveys were included in our calculations. RESULTS: Out of 1155 eligible providers, 1010 participated in optimization sessions. Pre-survey return rate was 90% (1034/1155) and post-survey was 54% (541/1010). 451 participants completed both surveys. After completing their optimization sessions, respondents reported a 26% improvement in mean knowledge of EHR functionality (P < .01), a 19% increase in the mean efficiency in the EHR (P < .01), and a 17% decrease in mean after-hours EHR usage (P < .01). Of the 401 providers asked to rate their burnout, 32% reported feelings of burnout in the pre-survey compared to 23% in the post-survey (P < .01). Providers were also likely to recommend colleagues participate in the program, with a Net Promoter Score of 41. DISCUSSION: It is possible to improve provider efficiency and feelings of burnout with a personalized optimization program. We ascribe these improvements to the one-on-one nature of our program which provides both training as well as addressing the feeling of isolation many providers feel after implementation. CONCLUSION: It is possible to reduce burnout in ambulatory providers with personalized retraining designed to improve efficiency and knowledge of the EHR.

Computerized attention training for visually impaired older adults with dementia: a case study / Treino de atenção computadorizado para idosos com comprometimento visual e demência: um estudo de caso

ABSTRACT. Dementia causes disorders in multiple higher cortical functions. Visual impairment could further impact cognition in those with dementia. This study reports the results of a computerized attention training program in a patient with dementia and visual impairment. The case involves a 98-year-old woman with bilateral maculopathy and moderate dementia. The program consisted of pre- and post-assessments and training sessions. Assessments included the Cantonese version of the Mini-Mental State Examination, the digit span forward test, the Chinese version of the Verbal Learning Test (CVVLT), and the Test of Attentional Performance (TAP). Training sessions were conducted once to twice a week for a total of 8 45-minute sessions. The participant showed a decrease in the CVVLT score and improvements in TAP parameters. The results indicated that, in visually impaired older adults with dementia, attention and processing speed (measured by a sensitive test such as TAP) could potentially be improved with appropriate computerized training.

RESUMO. A demência causa distúrbios em várias funções corticais superiores. O comprometimento da visão pode impactar ainda mais a cognição em pessoas com demência. Este estudo relata os resultados de um programa de treinamento computadorizado de atenção em um paciente com demência e deficiência visual, uma mulher de 98 anos com maculopatia bilateral e demência moderada. O programa consistia em avaliações e pré- e pós-sessões de treinamento. As avaliações incluíram o Mini-Exame do Estado Mental em Cantonês, o teste de extensão de dígitos, a versão chinesa do Teste de Aprendizagem Verbal (CVVLT) e o Teste de Desempenho de Atenção (TAP). As sessões de treinamento foram realizadas uma a duas vezes por semana, com um total de 8 sessões de 45 minutos. A paciente apresentou diminuição no escore CVVLT e melhora nos parâmetros TAP. Os resultados indicaram que em idosos com deficiência visual com demência, a atenção e a velocidade de processamento (medida por um teste sensível como o TAP) poderiam ser melhoradas com a realização de treinamento computadorizado adequado.

Redesign and validation of a computer programming course using Inductive Teaching Method.

Inductive Teaching Method (ITM) promotes effective learning in technological education (Felder & Silverman, 1988). Students prefer ITM more as it makes the subject easily understandable (Goltermann, 2011). The ITM motivates the students to actively participate in class activities and therefore could be considered a better approach to teach computer programming. There has been little research on implementing ITM in computer science courses despite its potential to improve effective learning. In this research, an existing computer programming lab course is taught using a traditional Deductive Teaching Method (DTM). The course is redesigned and taught by adopting the ITM instead. Furthermore, a comprehensive plan has been devised to deliver the course content in computer labs. The course was evaluated in an experiment consisting of 81 undergraduate students. The students in the Experimental Group (EG) (N = 45) were taught using the redesigned ITM course, whereas the students in the Control Group (CG) (N = 36) were taught using the DTM course. The performance of both groups was compared in terms of the marks obtained by them. A pre-test conducted to compare pre-course mathematical and analytical abilities showed that CG was better in analytical reasoning with no significant differences in mathematical abilities. Three post-tests were used to evaluate the groups theoretical and practical competence in programming and showed EG improved performance with large, medium, and small effect sizes as compared to CG. The results of this research could help computer programming educators to implement inductive strategies that could improve the learning of the computer programming.

Internet Programming to Reduce Loneliness and Social Isolation in Aging.

Loneliness and social isolation in older adults carry mortality risks similar to cigarette smoking. The study aim was to use a Culturally Informed Healthy Aging (CIHA) assessment process in Housing and Urban Development (HUD) communities of older adults (N = 262). Through the CIHA assessment process, older adults identified pertinent health problems and the study team developed a health intervention, an Internet Information Station (IIS). The IIS pilot study included computer lesson participation (n = 261), written feedback (n = 42), and the revised University of California, Los Angeles (R-UCLA) Loneliness Scale (n = 11). Increased confidence with technology and connectedness were reported, and a significant difference in "There is no one I can turn to" was observed (IIS compared to non-IIS). The IIS remains an active site for interaction 1-year post intervention. These pilot results supplement the research on older adult engagement in problem identification, intervention design, and outcomes measurement. TARGET: Older adults living in HUD communities. INTERVENTION DESCRIPTION: Through CIHA assessment, health problems were identified, and the IIS was developed and implemented. MECHANISMS OF ACTION: Lessons were developed (e.g., computer basics, connecting with technology, open forum) and evaluated. Pre and post lesson, the R-UCLA Loneliness Scale measured social isolation and loneliness. OUTCOMES: Older adults were engaged in problem identification, program development, and implementation. Feelings of connectedness improved; however, program evaluation with the R-UCLA scale was difficult to obtain. [Research in Gerontological Nursing, 13(5), 233-242.].

The effectiveness of diverse technology-based instructions in assisting people with Alzheimer's disease with medication management.

Purpose: In patients with mild cognitive impairment and Alzheimer's disease (AD), faculties associated with instrumental activities of daily living (IADL) decline owing to reduced cognitive function. One type of IADL is medication behaviour. Medication management is critical for patients with AD. Previous studies have reported that presentations using speech and images are effective for facilitating IADL autonomy but there are few examinations of effective presentation methods. Therefore, we examined what kind of display methods are effective in helping patients with AD with medication management.Materials and methods: Ten healthy elderly and 9 patients with mild AD were asked to perform the task of taking out medicine bags from a case at a designated time. We gave 3 kinds of instructions and examined the differences in participants' reaction times. Task 1 included verbal instructions alone, Task 2 included verbal instructions and pictorial and written instructions, and Task 3 used a video conference system (presenting pictorial, written, and verbal instructions) at a designated time. Task 3 could be conducted remotely over the internet. The relationship between these results and neuropsychological tests was also explored.Results: Task 3 was an effective method for patients with mild AD. In addition, we found correlations between the methods of Tasks 1-3 and the Japanese version of the Mini-Mental State Examination (MMSE-J).Conclusions: The method of Task 3 may lead to home support for patients with AD. The MMSE-J could be used to identify changes in the adaptive functioning of patients exposed to distinct presentation methods.Implications for rehabilitationAppropriate transmission methods will increase the IADL autonomy of patients with mild AD who have memory impairment. While still images alone are not effective for patients with mild AD, when combined with verbal instructions, they prove effective for this group.The results of this study are useful for providing patients with mild AD with support in their IADLs, especially when methods that use images plus speech are employed. As participants were instructed via the internet, this study shows a way to help patients with mild AD even from a remote location.Until now, no studies have examined the adaptation criteria for instructive methods for patients with mild AD. This study shows that the MMSE could be used to determine the applicability of these instructive methods. The identification of cut-off values in future research could lead to more effective IADL support.

Improving Generalization via Attribute Selection on Out-of-the-Box Data.

Zero-shot learning (ZSL) aims to recognize unseen objects (test classes) given some other seen objects (training classes) by sharing information of attributes between different objects. Attributes are artificially annotated for objects and treated equally in recent ZSL tasks. However, some inferior attributes with poor predictability or poor discriminability may have negative impacts on the ZSL system performance. This letter first derives a generalization error bound for ZSL tasks. Our theoretical analysis verifies that selecting the subset of key attributes can improve the generalization performance of the original ZSL model, which uses all the attributes. Unfortunately, previous attribute selection methods have been conducted based on the seen data, and their selected attributes have poor generalization capability to the unseen data, which is unavailable in the training stage of ZSL tasks. Inspired by learning from pseudo-relevance feedback, this letter introduces out-of-the-box data-pseudo-data generated by an attribute-guided generative model-to mimic the unseen data. We then present an iterative attribute selection (IAS) strategy that iteratively selects key attributes based on the out-of-the-box data. Since the distribution of the generated out-of-the-box data is similar to that of the test data, the key attributes selected by IAS can be effectively generalized to test data. Extensive experiments demonstrate that IAS can significantly improve existing attribute-based ZSL methods and achieve state-of-the-art performance.

Improving gesture-based interaction between an assistive bathing robot and older adults via user training on the gestural commands.

BACKGROUND: Gesture-based human-robot interaction (HRI) depends on the technical performance of the robot-integrated gesture recognition system (GRS) and on the gestural performance of the robot user, which has been shown to be rather low in older adults. Training of gestural commands (GCs) might improve the quality of older users' input for gesture-based HRI, which in turn may lead to an overall improved HRI. OBJECTIVE: To evaluate the effects of a user training on gesture-based HRI between an assistive bathing robot and potential elderly robot users. METHODS: Twenty-five older adults with bathing disability participated in this quasi-experimental, single-group, pre-/post-test study and underwent a specific user training (10-15 min) on GCs for HRI with the assistive bathing robot. Outcomes measured before and after training included participants' gestural performance assessed by a scoring method of an established test of gesture production (TULIA) and sensor-based gestural performance (SGP) scores derived from the GRS-recorded data, and robot's command recognition rate (CRR). RESULTS: Gestural performance (TULIA = +57.1 ±â€¯56.2 %, SGP scores = +41.1 ±â€¯74.4 %) and CRR (+31.9 ±â€¯51.2 %) significantly improved over training (p < .001). Improvements in gestural performance and CRR were highly associated with each other (r = 0.80-0.81, p < .001). Participants with lower initial gestural performance and higher gerontechnology anxiety benefited most from the training. CONCLUSIONS: Our study highlights that training in gesture-based HRI with an assistive bathing robot is highly beneficial for the quality of older users' GCs, leading to higher CRRs of the robot-integrated GRS, and thus to an overall improved HRI.

Modelo de capacitação para realização do processo de enfermagem em sistema informatizado / Training model for carrying out the nursing process in a computerized system

Resumo: O Processo de Enfermagem na prática assistencial, é um importante método de organização do trabalho de enfermagem, pois permite organizar e planejar as ações de enfermagem a partir da tomada de decisão do enfermeiro. Neste estudo, o Processo de Enfermagem enfatiza o processo de enfermagem informatizado. Desse modo, elaborou-se a seguinte questão norteadora: Como construir um modelo de capacitação para enfermeiros para a realização do processo de enfermagem informatizado? Objetivo geral: Propor um modelo para a capacitação de enfermeiros das unidades assistenciais do Estado do Paraná para realização do processo de enfermagem com auxílio de sistema informatizado. Metodologia: A pesquisa é descritiva e faz parte de um estudo de métodos mistos, descritivo exploratório, desenvolvido junto à Superintendência das Unidades Próprias do Estado do Paraná (SUP), no período de setembro de 2019 a novembro de 2019. Os participantes da pesquisa foram agrupados em dois grupos distintos, nominados de grupo "A" e grupo "B". O "A" foram reunidos 19 enfermeiros e demais membros da equipe Servidores que participaram ativamente do planejamento, desenvolvimento, implementação e capacitação do módulo da SAE do GSUS nos hospitais próprios da SESA, neste grupo os dados foram coletados mediante a realização de Grupo Focal. O grupo "B" foi composto por 47 enfermeiros assistenciais das unidades de Terapia Intensiva, com experiência no uso do Módulo da SAE do Sistema de Gestão da Assistência de Saúde do Sistema Único de Saúde - GSUS. A coleta de dados foi realizada mediante questionário online autodirigido, que abrangeu as experiências positivas e as dificuldades que o GSUS oferece para implementação do Processo de Enfermagem. Resultados: Após análise dos dados do grupo "A" pelo IRAMUTEC, foram identificadas duas classes distintas: os pontos positivos sobre a capacitação e os desafios sobre a capacitação. No grupo "B" ressalta-se as respostas ao questionário que remetem a necessidade da implementação total e capacitação continuada para o entendimento do módulo GSUS. Com base nos dados coletados nos grupos "A" e "B" foi elaborada uma proposta de modelo de capacitação, como produto final deste estudo. Conclusão: Ciente dos desafios que o enfermeiro tem no seu dia a dia na elaboração e compreensão do Processo de Enfermagem, a proposição de um modelo de capacitação informatizado, permeada de sugestões facilitadoras, surge como uma alternativa de ensino-aprendizagem para a utilização plena do módulo GSUS.

Abstract: The Nursing Process in care practice is an important method of organizing nursing work, as it allows the organization and planning of nursing actions based on the nurse's decision making. In this study, the Nursing Process emphasizes the computerized nursing process. Thus, the following guiding question was elaborated: How to build a training model for nurses to carry out the computerized nursing process? General objective: To propose a model for the training of nurses of the care units of the State of Paraná to perform the nursing process with the aid of a computerized system. Methodology: The research is descriptive and is part of a study of mixed methods, exploratory descriptive, developed with the Superintendence of the Paraná State Own Units (SUP), from April 2018 to November 2019. The research participants were grouped in two distinct groups, named group "A" and group "B". The "A" consisted of 19 nurses and other Servers team members who actively participated in the planning, development, implementation and training of the GSUS SAE module in SESA's own hospitals. In this group the data were collected through the Focus Group. Group "B" consisted of 47 intensive care unit nurses with experience in using the SAE Module of the Health Care Management System of the Unified Health System - GSUS. Data collection was performed through a self-directed online questionnaire, which covered the positive experiences and difficulties that GSUS offers to implement the Nursing Process. Results: After analysis of the data from group "A" by IRAMUTEC, two distinct classes were identified: the strengths on training and the challenges on training. In group "B", the answers to the questionnaire highlighting the need for full implementation and continued training for understanding the GSUS module. Based on the data collected in groups "A" and "B", a training model proposal was elaborated as the final product of this study. Conclusion: Aware of the challenges that nurses have in their daily life in the elaboration and understanding of the Nursing Process, the proposition of a computerized training model, permeated by facilitating suggestions, emerges as an alternative of teaching and learning for the full use of the Nursing Process. GSUS module.

High Order Profile Expansion to tackle the new user problem on recommender systems.

Collaborative Filtering algorithms provide users with recommendations based on their opinions, that is, on the ratings given by the user for some items. They are the most popular and widely implemented algorithms in Recommender Systems, especially in e-commerce, considering their good results. However, when the information is extremely sparse, independently of the domain nature, they do not present such good results. In particular, it is difficult to offer recommendations which are accurate enough to a user who has just arrived to a system or who has rated few items. This is the well-known new user problem, a type of cold-start. Profile Expansion techniques had been already presented as a method to alleviate this situation. These techniques increase the size of the user profile, by obtaining information about user tastes in distinct ways. Therefore, recommender algorithms have more information at their disposal, and results improve. In this paper, we present the High Order Profile Expansion techniques, which combine in different ways the Profile Expansion methods. The results show 110% improvement in precision over the algorithm without Profile Expansion, and 10% improvement over Profile Expansion techniques.

Reimagining information literacy instruction in an evidence-based practice nursing course for undergraduate students.

This case report describes the redesign process for an undergraduate evidence-based practice (EBP) nursing course in which the librarian serves as both co-instructor and co-instructional designer. As part of the undergraduate outcomes-based core curriculum, this required course teaches the principles of the research process; teaches students to identify the strengths and limitations of research articles in relation to EBP; and builds student confidence in their abilities to execute information literacy, data management, and scholarly communication competencies. The course redesign built on an existing student-centered course design, with the specific goal of transitioning the course from a senior-level course to a sophomore-level course, while achieving the same learning objectives. This goal was accomplished by integrating a combination of distributed practice and interleaved practice learning experiences into the course curriculum.

How Well Do We Use Our Technology? Examining iPad Navigation Skills in Individuals With Aphasia and Older Adults.

Purpose Technology is increasingly being used in rehabilitation, yet exposure and comfort with technology varies across individuals, particularly among older adults. There are limited ways to evaluate comfort with technology or teach people how to use technological devices. The objective of the current study was to develop an iPad task battery and evaluate performance by individuals with aphasia and older adults, further examining whether participants could learn to improve performance with written, verbal, and visual instructions. Method Thirty-two participants completed this study (16 with poststroke aphasia and 16 older adult controls). Participants completed 3 phases of testing: (a) baseline evaluation of performance of an iPad task battery, (b) teaching and practice of unknown tasks, and (c) retention evaluation. Participants were scored on accuracy, speed, and efficiency in each phase. Results were evaluated as a function of demographic and cognitive-linguistic variables. Results Results demonstrate that variability arises in people's abilities to perform tasks on an iPad and that cognitive skills such as executive functions, planning, and visuospatial attention relate to baseline scores of performance. The majority of participants with aphasia showed evidence of retaining information learned in the teaching and practice phase; however, they showed a lower percentage of retained lessons relative to controls. Conclusions Findings support the hypothesis that technology abilities vary among individuals with and without aphasia. Evaluating technology ability and the ability to learn technology is an important component to consider when prescribing tablet-based therapies.

Understanding changes and stability in the long-term use of technologies by seniors who are aging in place: a dynamical framework.

BACKGROUND: If technologies are to support aging in place, then it is important to develop fundamental knowledge on what causes stability and changes in the use of technologies by seniors. However, longitudinal studies on the long-term use of technologies that have been accepted into the home (i.e., post-implementation use) are very scarce. Many factors potentially could influence post-implementation use, including life events, age-related decline, changes in personal goal orientation, and various types of social influences. The aforementioned factors are likely to be interrelated, adding to the complexity. The goal of this study is to better understand changes and stability in the use of technologies by independent-living seniors, by using a dynamical systems theory approach. METHODS: A longitudinal qualitative field study was conducted involving home visits to 33 community-dwelling seniors in the Netherlands, on three occasions (2012-2014). Interviews were held on technology usage patterns, including reasons for stable, increased, declined and stopped use. Technologies were included if they required electric power in order to function, were intended to be used in or around the home, and could support activities of daily living, personal health or safety, mobility, communication, and physical activity. Thematic analysis was employed, using constant case comparison to better understand dynamics and interplay between factors. In total, 148 technology use patterns by 33 participants were analyzed. RESULTS: A core of six interrelated factors was closely linked to the frequency of technology use: emotional attachment, need compatibility, cues to use, proficiency to use, input of resources, and support. Additionally, disruptive forces (e.g., social influences, competition with alternative means, changes of personal needs) could induce change by affecting these six factors. Furthermore, long-term technology use was in some cases more resilient to disruption than in other cases. Findings were accumulated in a new framework: Dynamics In Technology Use by Seniors (DITUS). CONCLUSIONS: Similar to aging, the use of technologies by older people is complex, dynamic and personal. Periods of stability and change both occur naturally. The DITUS framework can aid in understanding stability and instability of technology use, and in developing and implementing sustainable technological solutions for aging in place.

Toward the Design of an Engagement Tool for Effective Electronic Health Record Adoption.

As healthcare systems continue to expand their use of electronic health records (EHRs), barriers to robust and successful engagement with such systems by stakeholders remain tenacious. To this effect, this research presents the results of a survey tool utilizing both original and modified constructs from the Consolidated Framework for Implementation Research to assess key points of engagement barriers and potential points of intervention for stakeholders of EHRs in a large-scale healthcare organization (500-bed level II regional trauma center). Based on the extensive assessment, the paper presents recommendations for the utility of engagement process modeling and discusses how intervention opportunities can be used to mitigate engagement barriers.

Multi-stakeholder perspectives on information communication technology training for older adults: implications for teaching and learning.

Objectives: The objective of this research was to identify and conceptualize barriers and strategies for effective implementation of information communication technology (ICT) training for older adults. Methods: A grounded theory approach was used to collect and analyze qualitative data from 61 participants in three stakeholder groups: older-adult ICT trainees, care providers and ICT trainers. Results: Care providers expressed older adults' reluctance, lack of affinity, fears and socio-contextual attributes as barriers to overcome with ICT training. ICT trainers highlighted motivation, trainer-trainee relationship, patience, self-reliance and mutual value as strategic themes. ICT trainees elucidated occupational accomplishment, challenges and a sense of competence as themes from their experience with training. Discussion: While digital literacy and skill building have traditionally been the key focus of ageing-centred ICT training, a deeper approach to address internal (personal) and external (socio-contextual) barriers, as conceptualized in the study finding, is vital in yielding successful outcomes. Implications for rehabilitation Information communication technology (ICT) is a vital resource for older adults to age-in-place and for health professionals in delivery of tele-rehabilitation. Family members and care providers realize the scope of ICT for ageing-in-place but raise doubts on the inherent motivation and abilities of older adults to adopt ICT. On the other hand, older adults who engage in one-on-one ICT training value their new-found sense of accomplishment and competence in using the Internet and social media. Graduate students who provided the training greatly appreciate their own learning experience, and stress the need for mutual trust, patience and simplicity in teaching ICT. A major precursor to imparting digital literacy and skills in older adults who lack ICT exposure is to help them overcome deep-seated attitudinal and socio-contextual barriers through a one-on-one approach.