-
Frontiers in Neuroscience 2023Experience is known to facilitate our ability to interpret sequences of events and make predictions about the future by extracting temporal regularities in our...
Experience is known to facilitate our ability to interpret sequences of events and make predictions about the future by extracting temporal regularities in our environments. Here, we ask whether uncertainty in dynamic environments affects our ability to learn predictive structures. We exposed participants to sequences of symbols determined by first-order Markov models and asked them to indicate which symbol they expected to follow each sequence. We introduced uncertainty in this prediction task by manipulating the: (a) probability of symbol co-occurrence, (b) stimulus presentation rate. Further, we manipulated feedback, as it is known to play a key role in resolving uncertainty. Our results demonstrate that increasing the similarity in the probabilities of symbol co-occurrence impaired performance on the prediction task. In contrast, increasing uncertainty in stimulus presentation rate by introducing temporal jitter resulted in participants adopting a strategy closer to probability maximization than matching and improving in the prediction tasks. Next, we show that feedback plays a key role in learning predictive statistics. Trial-by-trial feedback yielded stronger improvement than block feedback or no feedback; that is, participants adopted a strategy closer to probability maximization and showed stronger improvement when trained with trial-by-trial feedback. Further, correlating individual strategy with learning performance showed better performance in structure learning for observers who adopted a strategy closer to maximization. Our results indicate that executive cognitive functions (i.e., selective attention) may account for this individual variability in strategy and structure learning ability. Taken together, our results provide evidence for flexible structure learning; individuals adapt their decision strategy closer to probability maximization, reducing uncertainty in temporal sequences and improving their ability to learn predictive statistics in variable environments.
PubMed: 37599995
DOI: 10.3389/fnins.2023.1195388 -
Scientific Reports Jul 2023This study aims to examine the mediating effect of the intention to use wearable payment devices (WPD) between perceived ease of use (PE), perceived usefulness (PU),...
This study aims to examine the mediating effect of the intention to use wearable payment devices (WPD) between perceived ease of use (PE), perceived usefulness (PU), social influence (SI), perceived trust (TR), and lifestyle compatibility (CM) on the adoption of WPD. Examination was made on the moderating effect of age and gender to improve the understanding of the adoption of WPD as a new payment system. Empirical data was collected through an online survey from 1094 respondents in Malaysia. Furthermore, this study employed dual-stage data analysis through partial least squares structural equation modelling (PLS-SEM) to test the causal and moderating effects, including artificial neural network (ANN) to examine the predictive power of the selected model. As a result, it was found that PE, PU, TR, and CM had a significant positive influence on the intention to use WPD. Furthermore, facilitating conditions and the intention to use WPD exhibited strong positive impacts on the adoption of WPD among Malaysian youth. The intention to use WPD positively and significantly mediated all predictors of adoption of WPD. Following that, ANN analysis confirmed high prediction accuracy of the data fitness. Overall, the findings for ANN highlighted the importance of PE, CM, and TR on the intention to adopt WPD and the impact of facilitating conditions on the adoption of WPD among Malaysian youth. Theoretically, the study extended UTAUT with two additional determinants (e.g., perceived trust and lifestyle compatibility), which were found to have significant influences on the intention to use WPD. The study results would be able to help payment service providers and the smart wearable device industry offer an innovative spectrum of products and present effective marketing tactics to encourage the prospective consumers of Wearable Payment Devices in Malaysia.
Topics: Adolescent; Humans; Intention; Prospective Studies; Asian People; Neural Networks, Computer; Wearable Electronic Devices
PubMed: 37433838
DOI: 10.1038/s41598-023-38333-0 -
Cureus Feb 2024In the digital era, the seamless integration of electronic medical records (EMR) stands as a pivotal milestone in transforming healthcare delivery, with Saudi Arabia at... (Review)
Review
In the digital era, the seamless integration of electronic medical records (EMR) stands as a pivotal milestone in transforming healthcare delivery, with Saudi Arabia at the forefront of this revolution in the Middle East. This literature review comprehensively explores the challenges and opportunities associated with adopting EMR in the Kingdom of Saudi Arabia (KSA) in alignment with the nation's Vision 2030 healthcare objectives. The review synthesizes research from various scholarly sources, utilizing databases such as PubMed, Scopus, Google Scholar, and regional databases, and focuses on literature published between 2010 and 2023. Our methodology included a strategic combination of keywords and a stringent selection criterion to ensure a focus on relevant EMR adoption studies within KSA. The review addresses key aspects of EMR adoption, including technical challenges, financial constraints, human factors, cultural and organizational barriers, privacy and security concerns, and policy and regulatory challenges. It also explores the integration of EMR with other digital health initiatives like telehealth, personal health records, and community pharmacy services. The findings reveal a complex interplay of factors influencing EMR adoption, highlighting the need for comprehensive strategies that address technical, financial, cultural, and policy-related barriers. The review concludes that while significant challenges exist, strategic approaches and solutions tailored to the specific context of Saudi Arabia can effectively facilitate EMR integration, thereby enhancing healthcare quality and efficiency in line with the nation's Vision 2030 goals.
PubMed: 38465069
DOI: 10.7759/cureus.53827 -
Heliyon Dec 2023Compliance with feed safety standards and practices on the farm promotes sustainable livestock production and can positively affect the environment and human health....
Compliance with feed safety standards and practices on the farm promotes sustainable livestock production and can positively affect the environment and human health. This study aims to examine farmers' on-farm adoption of feed safety practices and determine the differences in adoption according to the socio-economic characteristics of farmers. An online survey was conducted to collect the study data. The study participants consisted of 442 livestock farmers in Riyadh region, Saudi Arabia. The study findings revealed that farmers highly adopted categories of feed purchasing (77.9 %) and feed mixing and distribution (75.05 %), whereas they were considered as a moderate level adoption regarding feed storing (70.9 %). The cluster analysis results showed two main patterns of adoption- "high adopters" and "moderate adopters"-based on the average level of adoption for 25 feed safety practices examined. The cluster of "high adopters" accounted for 59.9 % of the sample and had higher average adoption in all practices examined. The findings revealed that there are significant differences between the two segments of farmers, corresponding to gender, membership in livestock association, extension contact, raising sheep, and feeding system. This study proposes the regular monitoring of farms to ensure strict adherence to feed safety regulations, with the implementation of awareness and capacity development initiatives pertaining to feed safety concerns.
PubMed: 38125446
DOI: 10.1016/j.heliyon.2023.e22838 -
Implementation Science : IS Jul 2023Successful implementation and utilization of Computerized Clinical Decision Support Systems (CDSS) in hospitals is complex and challenging. Implementation science, and... (Review)
Review
Identifying barriers and facilitators to successful implementation of computerized clinical decision support systems in hospitals: a NASSS framework-informed scoping review.
BACKGROUND
Successful implementation and utilization of Computerized Clinical Decision Support Systems (CDSS) in hospitals is complex and challenging. Implementation science, and in particular the Nonadoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, may offer a systematic approach for identifying and addressing these challenges. This review aimed to identify, categorize, and describe barriers and facilitators to CDSS implementation in hospital settings and map them to the NASSS framework. Exploring the applicability of the NASSS framework to CDSS implementation was a secondary aim.
METHODS
Electronic database searches were conducted (21 July 2020; updated 5 April 2022) in Ovid MEDLINE, Embase, Scopus, PyscInfo, and CINAHL. Original research studies reporting on measured or perceived barriers and/or facilitators to implementation and adoption of CDSS in hospital settings, or attitudes of healthcare professionals towards CDSS were included. Articles with a primary focus on CDSS development were excluded. No language or date restrictions were applied. We used qualitative content analysis to identify determinants and organize them into higher-order themes, which were then reflexively mapped to the NASSS framework.
RESULTS
Forty-four publications were included. These comprised a range of study designs, geographic locations, participants, technology types, CDSS functions, and clinical contexts of implementation. A total of 227 individual barriers and 130 individual facilitators were identified across the included studies. The most commonly reported influences on implementation were fit of CDSS with workflows (19 studies), the usefulness of the CDSS output in practice (17 studies), CDSS technical dependencies and design (16 studies), trust of users in the CDSS input data and evidence base (15 studies), and the contextual fit of the CDSS with the user's role or clinical setting (14 studies). Most determinants could be appropriately categorized into domains of the NASSS framework with barriers and facilitators in the "Technology," "Organization," and "Adopters" domains most frequently reported. No determinants were assigned to the "Embedding and Adaptation Over Time" domain.
CONCLUSIONS
This review identified the most common determinants which could be targeted for modification to either remove barriers or facilitate the adoption and use of CDSS within hospitals. Greater adoption of implementation theory should be encouraged to support CDSS implementation.
Topics: Humans; Decision Support Systems, Clinical; Hospitals; Health Personnel; Technology
PubMed: 37495997
DOI: 10.1186/s13012-023-01287-y -
Journal of Cancer Research and Clinical... Oct 2023The treatment paradigm for locally advanced rectal cancer (LARC) is shifting toward the total neoadjuvant therapy (TNT) concept, which administered systemic chemotherapy...
A contemporary assessment of total neoadjuvant therapy (TNT) protocols for locally advanced rectal cancer: adoption and expert perspectives at German Cancer Society (DKG)-certified colorectal cancer centers.
PURPOSE
The treatment paradigm for locally advanced rectal cancer (LARC) is shifting toward the total neoadjuvant therapy (TNT) concept, which administered systemic chemotherapy in the neoadjuvant setting, either before or after chemoradiotherapy (CRT) or short-course radiotherapy (SCRT). First results have shown higher pathologic complete response (pCR) rates and a favorable impact on disease-free survival (DFS). Our study aimed to evaluate the current clinical practice and expert opinion regarding TNT for locally advanced rectal cancer across DKG (German Cancer Society)-certified colorectal cancer centers.
METHODS
A comprehensive online questionnaire, constituted of 14 TNT-focused queries targeting patients with locally advanced rectal cancer, was conducted among DKG-certified colorectal cancer centers registered within the database of the Addz (Arbeitsgemeinschaft Deutscher Darmzentren) between December 2022 and January 2023.
RESULTS
A significant majority (68%) indicated that they treated between 0 and 10 patients using a TNT protocol. Only a third (36%) of these centers participated in patient enrollment for a TNT study. Despite this, 84% of centers reported treating patients in a manner analogous to a TNT study, with the RAPIDO regimen being the most prevalent approach, employed by 60% of the respondents. The decision to adopt a TNT approach was primarily influenced by factors, such as the lower third of the rectum (93% of centers), cT4 stage (86% of centers), and a positive circumferential resection margin (80% of centers). Regarding concerns, 65% of the survey respondents expressed no reservations about the TNT concept, while 35% had concerns. In particular, there appears to be disagreement and uncertainty in regard to a clinical complete response and the "Watch and Wait" approach. While some centers adopt the watch-and-wait approach (42%), others only utilize it when extirpation is otherwise necessary (39%), and a portion still proceeds with surgery as initially planned (19%). The survey also addressed unmet needs, which were elaborated in the free-text responses. Overall, there was high interest in participating in planned observational studies.
CONCLUSIONS
This study presents an overview of current clinical practice and unmet needs within DKG-certified German colorectal cancer centers. It is noteworthy that total neoadjuvant therapy (TNT) is predominantly performed outside of clinical trials. Moreover, across the centers, there is significant heterogeneity in handling clinical complete response and adopting the "watch and wait" approach. Further research is needed to establish standardization in the care of locally advanced rectal cancer.
Topics: Humans; Rectum; Neoadjuvant Therapy; Rectal Neoplasms; Chemoradiotherapy; Disease-Free Survival; Antineoplastic Combined Chemotherapy Protocols; Neoplasms, Second Primary; Neoplasm Staging
PubMed: 37438538
DOI: 10.1007/s00432-023-05139-6 -
Nature Communications Nov 2023Green technologies, such as solar panels, foster the use of clean energy, yet often involve large-scale investments. Hence, adoption by retail consumers has been a key...
Green technologies, such as solar panels, foster the use of clean energy, yet often involve large-scale investments. Hence, adoption by retail consumers has been a key barrier. Here, we show that message framing can significantly increase customers' serious commitment to adopting solar panels by providing empirical evidence in the field from a large-scale randomized controlled trial with a nationwide online retailer in the Netherlands (N = 26,873 participants). We design four messages aimed at promoting the purchase behavior of solar panel installations. Our messages present outcomes for oneself or for the environment and highlight cost savings versus earnings (for oneself) or reducing emissions versus generating green electricity (for the environment). Across all messages, we observe a higher rate of customers committing to solar panels compared to the baseline. However, the framing in terms of financial savings for oneself was by far the most effective, resulting in a 40% higher level of commitment than the baseline and 30% higher than the average of the other three messages, which were not significantly different in effect from each other. Our results show that message framing is cost-efficient and scalable among retail consumers to promote large-scale investments in green technologies and thus clean energy.
PubMed: 37938568
DOI: 10.1038/s41467-023-42904-0 -
Journal of Managed Care & Specialty... Dec 2023Over the years, the practice of medication management has taken on various terms and definitions. As a result, health plans have developed different approaches to...
Over the years, the practice of medication management has taken on various terms and definitions. As a result, health plans have developed different approaches to identifying beneficiaries for medication therapy management (MTM), engaging pharmacists to provide MTM, and adopting standards for documentation and quality assurance. This variation leads to inconsistent delivery of MTM and potential quality concerns. Therefore, an environment needs to be created that allows for health plans to discuss and share approaches, challenges, and best practices. To achieve this, the University of Minnesota College of Pharmacy has served as an organizer and facilitator of an ongoing series of Minnesota Health Plan Summits to drive sustainable and mutually beneficial MTM programs and payment models across the state. In less than 2 years, the University of Minnesota College of Pharmacy has hosted and organized 4 Health Plan Summits with the objective of sharing ideas and identifying mutual goals (short- and long-term) across health plans and pharmacy providers of MTM services to optimize medication outcomes for the citizens of Minnesota and beyond. These meetings have led to several productive discussions and takeaways, including: (1) having a convener is essential for these types of connections and discussions, (2) health plans and pharmacists find value in these summits, (3) there is a range of experience in MTM program development across health plans, and (4) there are important opportunities to enhance understanding between health plans and pharmacist providers. In addition, 3 workgroups have been established in the following areas: (1) improve consistency in the design of MTM benefits across health plans for service and delivery, including provider credentialing, (2) increase transparency and education between plans and providers on the "fixed points" (such as CMS requirements) vs modifiable portions of plan design, and (3) create agreement on a single quality metric to target, collect data, and demonstrate value of MTM. For change to occur, it often must start locally, suggesting that the formal, facilitated convening of local health plan leaders and pharmacist providers to discuss building consistent and high-quality MTM programs is an essential strategy for MTM program adoption and growth. Including both groups of stakeholders should not only focus on payment, but also the mechanisms necessary to support implementation and create a win-win for both groups. In sharing our experience in Minnesota, we aim to inspire others to form regional initiatives that create structured, facilitated conversations that can produce new partnerships. Strategies that have supported our success are described and can be adopted once a regional entity, such as a school of pharmacy or other trusted entity, chooses to convene a group of invested stakeholders.
Topics: Humans; Pharmacists; Medication Therapy Management; Pharmaceutical Services; Minnesota; Health Planning
PubMed: 38058143
DOI: 10.18553/jmcp.2023.29.12.1284 -
The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Quasi-Experimental Study.Journal of Medical Internet Research Jul 2023Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient...
BACKGROUND
Overcrowding in public hospitals, a common issue in many countries, leads to a range of negative outcomes, such as insufficient access to medical services and patient dissatisfaction. Prior literature regarding solutions to reducing hospital overcrowding primarily focuses on organizational-level operational efficiency. However, few studies have investigated the strategies from the individual patient perspective. Specifically, we considered using mobile health and fitness apps to promote users' health behaviors and produce health benefits, thereby reducing hospital visits.
OBJECTIVE
This study estimated the causal effect of health and fitness app adoption on hospital visits by exploiting the staggered timing of adoption. We also investigated how the effect varied with users' socioeconomic status and digital literacy. This study provides causal evidence for the effects of health apps, extends the digital health literature, and sheds light on mobile health policies.
METHODS
This study used a data set containing health and fitness app use and hospital-related geolocation data of 267,651 Chinese mobile phone users from January to December 2019. We used the difference-in-differences and difference-in-difference-in-differences designs to estimate the causal effect. We performed a sensitivity analysis to establish the robustness of the findings. We also conducted heterogeneity analyses based on the interactions of postadoption indicators with users' consumption levels, city tiers, and digital literacy.
RESULTS
The preferred model (difference-in-difference-in-differences) showed a significant decrease in hospital visits after the adoption of health and fitness apps. App adoption led to a 5.8% (P<.001), 13.1% (P<.001), and 18.4% reduction (P<.001) in hospital visits 1, 2, and 3 months after adoption, respectively. In addition, the moderation analysis shows that the effect is greater for users with high consumption levels, in high-tier cities, or with high digital literacy.
CONCLUSIONS
This study estimated the causal effect of health and fitness app adoption on hospital visits. The results and sensitivity analysis showed that app adoption can reduce users' hospital visits. The effect varies with users' consumption levels, city tiers, and digital literacy. These findings provide useful insights for multiple stakeholders in the Chinese health care context.
Topics: Humans; Mobile Applications; Surveys and Questionnaires; Exercise; Telemedicine; Hospitals
PubMed: 37505809
DOI: 10.2196/45681 -
BMC Health Services Research May 2024School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and...
BACKGROUND
School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents.
METHODS
The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes.
RESULTS
The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level.
CONCLUSIONS
The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.
Topics: Humans; Adolescent; Nigeria; Female; Male; Reproductive Health; Focus Groups; Reproductive Health Services; Sexual Health; Capacity Building; Qualitative Research; Interviews as Topic; Stakeholder Participation
PubMed: 38764028
DOI: 10.1186/s12913-024-11103-y