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Background Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. Objective This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. Methods The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). Results The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. Conclusions This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. Trial Registration International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 International Registered Report Identifier (IRRID) PRR1-10.2196/22145

BackgroundMild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments.ObjectiveThe aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research.MethodsStudies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military & Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized.ResultsOf the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized.ConclusionsWhen considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs.

Information on strategies and practices in the search of missing persons with dementia is inconsistent which creates challenges for first responders, such as police, when they choose appropriate search and rescue approaches. The purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. They identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario.

PURPOSE This review aims to examine the instruments, approaches, scales, or assessment tools used to evaluate technology acceptance, technology adoption, and usability of information and communication technologies (ICTs) for people living with dementia and their care partners. METHODS A systematic literature review was conducted. Studies that explored the use of instruments, approaches, scales, or assessment tools to evaluate the technology acceptance and usability of ICTs for people living with dementia and their care partners were identified through five databases: Medline, EMBASE, CINAHL, Web of Science, and Scopus. RESULTS We included 74 out of 2182 papers. The most common scales used included the System Usability Scale (SUS) (11%), the ISONORM 9241/10 Questionnaire (4%), and the Post-Study System Usability Questionnaire (PSSUQ) (4%). Most (59%) of the included approaches, however, were bespoke (i.e., created by the authors for a particular study) and were not named. The approaches or tools used to assess technology acceptance, technology adoption, and usability of ICTs that applied to people living with dementia had an average of 15 items and used an average of 5.23 scale points. CONCLUSION There is no clear, standardised approach for assessing the technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners. The findings of this review may be used by academics to design and implement improved and more consistent assessment tools to assess technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners.IMPLICATIONS FOR REHABILITATIONThe number of ICTs for people with dementia and their care partners that can be used for rehabilitation is increasingThe most commonly recognized assessment tools used in this study were the SUS, ISONORM 9241/10, and PSSUQ questionnaires.For the custom assessment tools, the average number of items included in this study was 15 with five-point bidirectional labelling.There is no clear, standardized approach for assessing the technology acceptance, technology adoption, or usability of ICTs for people with dementia and their care partners.

BACKGROUND Mild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments. OBJECTIVE The aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research. METHODS Studies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military & Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized. RESULTS Of the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized. CONCLUSIONS When considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs.

BACKGROUND Canadian Armed Forces service members (CAF-SMs) and veterans exhibit higher rates of injuries and illnesses, such as posttraumatic stress disorder (PTSD) and traumatic brain injury, which can cause and exacerbate cognitive dysfunction. Computerized neurocognitive assessment tools have demonstrated increased reliability and efficiency compared with traditional cognitive assessment tools. Without assessing the degree of technology acceptance and perceptions of usability to end users, it is difficult to determine whether a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in five domains. OBJECTIVE This study aims to determine the technology acceptance and usability of a neurocognitive assessment tool, which was titled BrainFx SCREEN, among CAF-SMs and veterans with PTSD by using the Unified Theory of Acceptance and Use of Technology model. METHODS This mixed methods embedded pilot study included CAF-SMs and veterans (N=21) aged 18-60 years with a diagnosis of PTSD who completed pre- and postquestionnaires on the same day the BrainFx SCREEN was used. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data were assessed using thematic analysis. RESULTS Facilitating conditions, which were the most notable predictors of behavioral intention, increased after using the BrainFx SCREEN, whereas effort expectancy decreased. Performance expectancy, effort expectancy, and social interaction were not factors that could predict behavioral intention. Participants who reported a previous mild traumatic brain injury were significantly more likely to report current symptoms of cognitive impairment. The BrainFx SCREEN is a feasible, usable, and accepted assessment tool for CAF-SMs and veterans who experience PTSD. CONCLUSIONS As military health care systems integrate technological innovations to improve the services and care provided, research must continue to address the acceptability and use of these novel assessments and interventions.

BACKGROUND Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5% of people aged ≥65 years perceive their mental health as fair or poor, and 6.3% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40%-50% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. OBJECTIVE This study aims to explore the trial design and effects of 3Scape videos on older adults’ symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. METHODS The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ≥65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ≥18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study’s primary outcome variables are related to clients’ depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. RESULTS Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. CONCLUSIONS This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/25017

Background Military members are at elevated risk of operational stress injuries, including posttraumatic stress disorder (PTSD) and moral injury. Although psychotherapy can reduce symptoms, some military members may experience treatment-resistant PTSD. Multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has been introduced as a virtual reality (VR) intervention for military members with PTSD related to military service. The 3MDR intervention incorporates exposure therapy, psychotherapy, eye movement desensitization and reconsolidation, VR, supportive counselling, and treadmill walking. Objective The objective of this study is to investigate whether 3MDR reduces PTSD symptoms among military members with combat-related treatment-resistant PTSD (TR-PTSD); examine the technology acceptance and usability of the Computer Assisted Rehabilitation ENvironment (CAREN) and 3MDR interventions by Canadian Armed Forces service members (CAF-SMs), veterans, 3MDR clinicians, and operators; and evaluate the impact on clinicians and operators of delivering 3MDR. Methods This is a mixed-methods waitlist controlled crossover design randomized controlled trial. Participants include both CAF-SMs and veterans (N=40) aged 18-60 years with combat-related TR-PTSD (unsuccessful experience of at least 2 evidence-based trauma treatments). Participants will also include clinicians and operators (N=12) who have been trained in 3MDR and subsequently utilized this intervention with patients. CAF-SMs and veterans will receive 6 weekly 90-minute 3MDR sessions. Quantitative and qualitative data will be collected at baseline and at 1, 3, and 6 months postintervention. Quantitative data collection will include multiomic biomarkers (ie, blood and salivary proteomic and genomic profiles of neuroendocrine, immune-inflammatory mediators, and microRNA), eye tracking, electroencephalography, and physiological data. Data from outcome measures will capture self-reported symptoms of PTSD, moral injury, resilience, and technology acceptance and usability. Qualitative data will be collected from audiovisual recordings of 3MDR sessions and semistructured interviews. Data analysis will include univariate and multivariate approaches, and thematic analysis of treatment sessions and interviews. Machine learning analysis will be included to develop models for the prediction of diagnosis, symptom severity, and treatment outcomes. Results This study commenced in April 2019 and is planned to conclude in April 2021. Study results will guide the further evolution and utilization of 3MDR for military members with TR-PTSD and will have utility in treating other trauma-affected populations. Conclusions The goal of this study is to utilize qualitative and quantitative primary and secondary outcomes to provide evidence for the effectiveness and feasibility of 3MDR for treating CAF-SMs and veterans with combat-related TR-PTSD. The results will inform a full-scale clinical trial and stimulate development and adaptation of the protocol to mobile VR apps in supervised clinical settings. This study will add to knowledge of the clinical effectiveness of 3MDR, and provide the first comprehensive analysis of biomarkers, technology acceptance and usability, moral injury, resilience, and the experience of clinicians and operators delivering 3MDR. Trial Registration ISRCTN Registry 11264368; http://www.isrctn.com/ISRCTN11264368. International Registered Report Identifier (IRRID) DERR1-10.2196/20620

Background A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.

BACKGROUND Military members are at elevated risk of operational stress injuries, including posttraumatic stress disorder (PTSD) and moral injury. Although psychotherapy can reduce symptoms, some military members may experience treatment-resistant PTSD. Multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has been introduced as a virtual reality (VR) intervention for military members with PTSD related to military service. The 3MDR intervention incorporates exposure therapy, psychotherapy, eye movement desensitization and reconsolidation, VR, supportive counselling, and treadmill walking. OBJECTIVE The objective of this study is to investigate whether 3MDR reduces PTSD symptoms among military members with combat-related treatment-resistant PTSD (TR-PTSD); examine the technology acceptance and usability of the Computer Assisted Rehabilitation ENvironment (CAREN) and 3MDR interventions by Canadian Armed Forces service members (CAF-SMs), veterans, 3MDR clinicians, and operators; and evaluate the impact on clinicians and operators of delivering 3MDR. METHODS This is a mixed-methods waitlist controlled crossover design randomized controlled trial. Participants include both CAF-SMs and veterans (N=40) aged 18-60 years with combat-related TR-PTSD (unsuccessful experience of at least 2 evidence-based trauma treatments). Participants will also include clinicians and operators (N=12) who have been trained in 3MDR and subsequently utilized this intervention with patients. CAF-SMs and veterans will receive 6 weekly 90-minute 3MDR sessions. Quantitative and qualitative data will be collected at baseline and at 1, 3, and 6 months postintervention. Quantitative data collection will include multiomic biomarkers (ie, blood and salivary proteomic and genomic profiles of neuroendocrine, immune-inflammatory mediators, and microRNA), eye tracking, electroencephalography, and physiological data. Data from outcome measures will capture self-reported symptoms of PTSD, moral injury, resilience, and technology acceptance and usability. Qualitative data will be collected from audiovisual recordings of 3MDR sessions and semistructured interviews. Data analysis will include univariate and multivariate approaches, and thematic analysis of treatment sessions and interviews. Machine learning analysis will be included to develop models for the prediction of diagnosis, symptom severity, and treatment outcomes. RESULTS This study commenced in April 2019 and is planned to conclude in April 2021. Study results will guide the further evolution and utilization of 3MDR for military members with TR-PTSD and will have utility in treating other trauma-affected populations. CONCLUSIONS The goal of this study is to utilize qualitative and quantitative primary and secondary outcomes to provide evidence for the effectiveness and feasibility of 3MDR for treating CAF-SMs and veterans with combat-related TR-PTSD. The results will inform a full-scale clinical trial and stimulate development and adaptation of the protocol to mobile VR apps in supervised clinical settings. This study will add to knowledge of the clinical effectiveness of 3MDR, and provide the first comprehensive analysis of biomarkers, technology acceptance and usability, moral injury, resilience, and the experience of clinicians and operators delivering 3MDR. CLINICALTRIAL ISRCTN Registry 11264368; http://www.isrctn.com/ISRCTN11264368. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20620

BACKGROUND Impairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted. OBJECTIVE This study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device. METHODS The trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10). RESULTS The FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020. CONCLUSIONS This study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim. CLINICALTRIAL International Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/22145

BACKGROUND A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.

Background.Occupational therapists use technologies to manage wandering-related risks to promote safety and independence among individuals with dementia living in the community.Purpose.The purpose of this review was to examine types of technologies used to manage wandering behaviour.Method.Using a modification of Arksey and O’Malley’s methodology, we systematically searched peer-reviewed and grey literature on technologies used in home or supportive care environments for persons with dementia at risk for wandering. Data from the studies were analyzed descriptively.Findings.The literature described 83 technologies. Nineteen devices were clinically tested. Interventions ranged from alarm products to mobile locator devices. Benefits included reductions in risk and caregiver burden.Implications.Occupational therapy strategies include technologies to enhance function in persons with dementia. Technologies can also reduce risks of wandering and should be affordable. Ethical issues of the use of technology must be addressed. More research is needed to increase levels of evidence.

Globally, populations are aging with increasing life spans. The normal aging process and the resulting disabilities increase fall risks. Falls are an important cause of injury, loss of independence and institutionalization. Technologies have been developed to detect falls and reduce their consequences but their use and impact on quality of life remain debatable. Reviews on fall detection technologies exist but are not extensive. A comprehensive literature review on the state of knowledge of fall detection technologies can inform research, practice, and user adoption., En todo el mundo, la población envejece con una duración de vida cada vez mayor. El proceso normal de envejecimiento y las discapacidades resultantes aumentan el riesgo de caídas. Las caídas son una causa importante de lesiones, pérdida de independencia e institucionalización. Se han desarrollado tecnologías para detectar las caídas y reducir sus consecuencias, pero su uso e impacto en la calidad de vida siguen siendo discutibles. Existen revisiones sobre las tecnologías de detección de caídas, pero no son extensas. Una revisión bibliográfica exhaustiva sobre el estado de los conocimientos de las tecnologías de detección de caídas puede servir de base para la investigación, la práctica y la adopción por parte de los usuarios.

Objectives: To assess the incidence, type and location of injuries sustained during the Portuguese rugby union sevens circuit. To investigate the influence of players’ training loads on injury risk. Methods: A prospective cohort study recording time-loss injuries was conducted with all teams competing in the Portuguese national rugby sevens circuit (eight from the top-tier and seven from the second-tier). Main outcome measures included: incidence rate, anatomical location, type, injury incident and severity. Data were also collected regarding players’ training loads. Fisher's exact test was used to estimate the relative risk of suffering an injury during the sevens season and training sevens during the fifteens season. Results: A total of 27 injuries were recorded corresponding to an incidence rate of 133.9 injuries per 1000 player match-hours. The average severity was 22.22 days. Contact events preceded 81.5% of injuries. Most injuries occurred in the lower limb (66.7%) and were joint/ligament or muscle/tendon injuries (85.1%). The association between injuries and lower volume of training during the sevens season was identified for the second-tier (p=0.021). For the same level, an inverse relation between training hours and injury severity was also found (p=0.008). Top-tier players training sevens and fifteens simultaneously during the year presented a significant increase of injury risk (relative risk=3.2; p=0.011). Conclusions: Injury incidence in our study is similar to that reported for international sevens, although severity is lower. An association between training loads and the occurrence of injuries was found for both tiers, although with differential results, thus reinforcing the need to customize players’ preparation. Further studies at non-elite competitions are needed to gather significant data to accurately formulate future injury prevention protocols or recommend modifications to game laws or competition formats, aiming at players’ welfare.

Introduction: Persons living with dementia are at risk of becoming lost. When a person is returned home safely after a missing incident, an interview with the person or care partner may identify ways to prevent repeat incidents. It is not known if these interviews are being conducted for this population. Objectives: The purpose of this review was to understand return home interviews and whether they are being used with persons who have dementia. Methods: Scholarly and grey literature were searched in 20 databases. Articles were included from any language, year, study design if they included terms resembling “return home interview”, “missing,” “lost,” or “runaway”. Results: Eleven articles in scholarly, and 94 in grey literature sources were included, most from the United Kingdom. The majority of academic (55%) and grey (61%) articles were related to missing children, and none were specifically about persons living with dementia. Interviews were typically conducted within 72 hours after a missing person was returned, and by police or charitable organizations. The main reasons were to understand the causes of the incident and confirm the missing person’s safety, identify support needs, and to provide support to reduce repeat missing incidents. Conclusion: Existing reasons for interviews can also apply to persons with dementia. This review informs future research on return home interviews. It also informs community organizations, and police services interested in adopting this practice with persons living with dementia. Evaluations would confirm if these interviews can reduce repeat incidents and help keep people with dementia safe.

This study aimed to compare the effects of two different cargo management systems (one powered system, i.e., the RazerLift®, and one Traditional system) on the biomechanical and perceived exertion experienced by workers when performing routine ladder loading and unloading tasks. Seven experienced workers performed ladder loading and unloading tasks. Compared to when the Traditional system was being used, the cumulative static low-back compression force was reduced by 57.9% (p

Background Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5% of people aged ≥65 years perceive their mental health as fair or poor, and 6.3% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40%-50% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. Objective This study aims to explore the trial design and effects of 3Scape videos on older adults’ symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. Methods The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ≥65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ≥18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study’s primary outcome variables are related to clients’ depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. Results Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. Conclusions This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. International Registered Report Identifier (IRRID) PRR1-10.2196/25017

The purpose of this study is to examine the extent and type of robots used for the rehabilitation and education of children and young people with CP and ASD and the associated outcomes., El propósito de este estudio es examinar la extensión y el tipo de robots utilizados para la rehabilitación y educación de niños y jóvenes con parálisis cerebral y TEA y los resultados asociados.

This chapter provides structure and consistency in how people can address the concepts of acceptance, adoption, and usability. It utilizes the terms technology, system and innovation interchangeably. The chapter addresses the following questions: What do the concepts technology acceptance, technology adoption, and usability of technologies mean? Why are certain technologies, or innovations, better accepted and adopted than others? How should one determine or measure acceptance and adoption, and test usability of technologies? Inconsistent terminologies in the assistive technology field ‘hampers understanding and collaboration, and service transitions’. The performance measurements can be conducted either in a laboratory setting or by observing users in their natural work environment. The performance measurements can be conducted either in a laboratory setting or by observing users in their natural work environment. The study used a single indirect method for measuring technology acceptance, with a strong theoretical-based rational.

Introducción: la estomatitis subprótesis es la inflamación de la mucosa de soporte de la prótesis. Objetivo: describir el comportamiento clínico y epidemiológico de esta enfermedad en una población portadora de prótesis. Método: se realizó un estudio transversal de base poblacional en pacientes de la localidad de Buenaventura, pertenecientes a la Clínica René Guzmán Pérez, municipio de Calixto García, provincia de Holguín, Cuba, entre octubre de 2016 a junio de 2018. El universo fue de 835 pacientes portadores de prótesis removibles. La selección de la muestra de 140 pacientes se realizó por muestreo aleatorio simple, según nivel de significación del 95%, potencia estadística de 80%, prevalencia de 30%, precisión de 5% y efecto de diseño de 1, con el empleo de EPIDAT 4,1. Resultados: la edad media de los pacientes con estomatitis subprótesis fue 69,75 (11,50) años, significativamente superior a 57,11 (12,69) de los pacientes sin estomatitis. El 62,14% de los pacientes eran hombres. La prevalencia de estomatitis fue del 45,71%, con predominio de los grados I (22,14%) y II (18,57%). La prevalencia de diabetes mellitus en pacientes con estomatitis fue del 60,47% y de tabaquismo, del 59,09%. Conclusiones: se encontró una alta prevalencia de estomatitis subprótesis, principalmente grados I y II en adultos mayores con factores de riesgo asociados. Los principales factores de riesgo fueron higiene bucal deficiente, prótesis total y tiempo de confección prolongado. Se recomienda un estudio de cohorte para evaluar el efecto a largo plazo. Palabras clave: estomatitis subprótesis, prevalencia, factores de riesgo, adulto mayor, hábito de fumar.

Background Canadian Armed Forces service members (CAF-SMs) and veterans exhibit higher rates of injuries and illnesses, such as posttraumatic stress disorder (PTSD) and traumatic brain injury, which can cause and exacerbate cognitive dysfunction. Computerized neurocognitive assessment tools have demonstrated increased reliability and efficiency compared with traditional cognitive assessment tools. Without assessing the degree of technology acceptance and perceptions of usability to end users, it is difficult to determine whether a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in five domains. Objective This study aims to determine the technology acceptance and usability of a neurocognitive assessment tool, which was titled BrainFx SCREEN, among CAF-SMs and veterans with PTSD by using the Unified Theory of Acceptance and Use of Technology model. Methods This mixed methods embedded pilot study included CAF-SMs and veterans (N=21) aged 18-60 years with a diagnosis of PTSD who completed pre- and postquestionnaires on the same day the BrainFx SCREEN was used. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data were assessed using thematic analysis. Results Facilitating conditions, which were the most notable predictors of behavioral intention, increased after using the BrainFx SCREEN, whereas effort expectancy decreased. Performance expectancy, effort expectancy, and social interaction were not factors that could predict behavioral intention. Participants who reported a previous mild traumatic brain injury were significantly more likely to report current symptoms of cognitive impairment. The BrainFx SCREEN is a feasible, usable, and accepted assessment tool for CAF-SMs and veterans who experience PTSD. Conclusions As military health care systems integrate technological innovations to improve the services and care provided, research must continue to address the acceptability and use of these novel assessments and interventions.

The purpose of this study was to determine what factors predict the level of engagement of older adults, with and without dementia, while playing computer games. Fourteen older adults with and without dementia (60%/40%) played a computer game over 16 sessions, each for 30 minutes. Variables included participants’ demographics, game-play data and environmental factors. Mixed fixed model for longitudinal data analysis design was used to determine how these variables predicted engagement. Five variables predicted engagement at a statistically significant level: Participant’s performance (B1=+0.16, p

To date, there are no broadly accepted or accurate models to determine appropriate staffing [levels] for clinical engineering departments (CEDs). The purpose of this study is to determine what the determinants of the staffing levels are (total number of full time equivalents (FTEs)) in CEDs in healthcare organisations. In doing so, we used a cross-sectional exploratory approach by using a multivariate regression model over a secondary source of data information from the AAMI Benchmarking Solutions—Healthcare Technology Management database. Two hundred and one healthcare organisations were included in our study. Our study revealed that on average, there are almost 14 biomedical technicians (BMETs) per clinical engineer and one FTE per 1083.72 devices (SD 545.69). The results of this study also revealed that the total number of devices and the total technology management hours devoted to these devices positively affects the number of FTEs in a CED, whereas the hospital complexity, measured by healthcare organisation patient discharges matters inversely. The most important factor that matters in the number of FTEs in CEDs was the total technology management hours devoted to devices. A value of explained variance (i.e. R2) of 85% was obtained, indicating the strong power of the prediction accuracy of our multivariate regression model. © 2016 Informa UK Limited, trading as Taylor and Francis Group.

Introduction: oral cancer is a disease with high morbidity and mortality, associated with risk factors whose complex interplay is subject to scientific debate. Objective: to upgrade to the professionals about the risk factors for oral cancer. Methods: the literature review was conducted in SciELO Regional with the descriptors "risk factors" and "oral cancer", for which 31 full-text references were found. In Clinical Key, with the descriptor "cancer of the lip and oral cavity", we found 1746; English descriptors with "genes" and "oral cancer" retrieved 9822 results. PubMed, with the descriptor "oral cancer", retrieved 1207 items. EBSCO, with the descriptor "oral cancer", offered full texts of 5 recent years (839 articles). 200 articles in English and Spanish were retrieved, mainly from 2010-2015, and 62 papers were used. Data analysis and integration: in the oral carcinogenesis, tumor suppressor genes and oncogenes are affected. The non-genetic risk factors are smoking, alcohol consumption, and nutrient deficiency states, environmental factors such as radiation and heavy metals and different bacterial, fungal and viral infections. These factors are also related to immunosuppression, mechanical friction by maladjusted dentures and poor oral hygiene. Conclusions: the main risk factors for oral cancer are described. Susceptibility genes to cancer interact with risk factors mainly related to lifestyle and environmental factors in a complex network, whose identification and control in primary health care is important in the prevention of oral cancer by dentists. Key words: oral cancer; risk factors; oncogenes; tumor suppressor genes; tobacco; alcohol; prevention.

The aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs., El objetivo de este artículo fue realizar una revisión sistemática de la literatura para determinar: (1) los niveles de preparación tecnológica entre los adultos mayores y, (2) la evidencia de hogares inteligentes y tecnologías de monitoreo de la salud basadas en el hogar que apoyan el envejecimiento en el lugar. para adultos mayores que tienen necesidades complejas.

Rugby union has one of the highest injury incidence rates in team sports, however, most of the available data focus on the epidemiology of injuries in countries where rugby is popular. We aimed to report the incidence rate and relevant epidemiological aspects of injuries occurred in a group of Portuguese male rugby players. A prospective cohort study was conducted with a group of 45 senior and 32 under-18 male players (total of 77 players). Outcome measures included injury incidence, position, type, location and severity of injuries. The match injury incidence for all players was 55.84 per 1000 player match-hours (66.66 for seniors, 42.85 for under-18), while mean time-loss for injury was 20.79 days. No statistical differences were found between groups. Lower limb injuries accounted for 60.5% of all injuries, while joint/ligament injuries were the most prevalent type. Contact events were responsible for 65.1% of injuries. Despite the limitations, the obtained data are consistent with the literature. Time-loss injuries seem highly prevalent in rugby union and the incidence rates found in this Portuguese-based study were lower than the reported for international and senior men’s professional rugby union, but higher than those occurring in community rugby in tier-1 countries. The authors believe these data reinforce the need to develop and implement effective injury surveillance and prevention programs.

The purpose of this study was to implement and validate a Monte Carlo Algorithm (MCA) to determine the best T value (the time between two preventative maintenances) that optimizes the achieved availability of equipment types. In doing so, we (1) collected 796 maintenance works orders from 16 medical devices installed in a 900-bed hospital; (2) we fitted the probability distributions for each of the inputs of the achieved availability mathematical model (the mean preventative and corrective service time (in hours)); (3) we generated a set of random inputs following a Weibull distribution of the achieved availability mathematical model; (4) we calculated the achieved availability for every random input generated; this process was repeated for “m” iterations (an accuracy of 1%, 95% CI, alpha = 0.05); (5) the trends of the mean achieved availability for the different maintenance T intervals versus mean time to failure (MTTF) for all the equipment types were plotted; finally, (6) the best T value with the maximum value of the achieved availability of a medical device type for a specific MTTF was the optimal target. The mean simulation time for all the cases was 12 min. The MCA was able to determine the best T value, optimizing the achieved availability in 81.25% of cases. In conclusion, the results showed that, on average, the T maintenance intervals determined by the MCA were statistically significantly different from the original T values suggested either by the clinical engineering department or third-party maintenance providers (MCATmean = 1.68 times/yr, ActualTmean = 2.56 times/yr, p = 0.008).

The purpose of this study was to determine whether the maintenance of medical equipment should be outsourced (or not). For this, we used data mining techniques called decision trees. We (1) collected 2364 maintenance works orders from 62 medical devices installed in a 900-bed hospital; (2) then we randomly selected 90% of the maintenance works orders to train 8 different decision tree schemas (J48 (pruned and unpruned), Naive Bayes tree, random tree, alternating decision tree, logistic model tree, decision stump, REP tree); (3) next, the remaining 10% of the works orders were used to test the decision tree schemas. The relative absolute error was used to evaluate what the tested decision tree schemas had learned; finally (4), we chose the decision tree schema with the lowest relative absolute error. Overall, the decision tree schemas performed well. 62.5% (5/8) of the decision tree schemas had less than 20% relative absolute error. 87.5% (7/8) of the decision tree schemas had more than 90% in the correct classification (whether to outsource maintenance tasks or not). The different tested decision tree schemas showed that the most important variables when making the decision whether to outsource maintenance tasks or not were: medical device, risk class (I, IIA, IIB, III), complexity, obsolescence, maintenance frequency, service time and outsourcing. The best decision tree schema was the logistic model tree (LMT) with 14.6628% relative absolute error and 94.7034% in the correct classification.

The current version of the Developmental Test of Visual Perception (DTVP-3) is one of the most commonly used tests to identify the presence and degree of visual-perceptual and visual-integration deficits in children from 4 to 12 years of age. This test consists of five main sub-tests including a eye-hand coordination test (EHCT). Currently, the EHCT is based on observations by a therapist and requires a post-hoc analysis using the DTVP normative data, a time-consumption task that is not free of therapist error. Thus, a medical device is needed to automatically measure, score and report the test scores obtained from the DTVP-3. This device will lead to an overall decrease in the time taken for the post-hoc analysis and an improvement in the accuracy of the EHCT score. We determined that the device must allow a stylus position to be tracked in two dimensions with a resolution of 1 mm and the system must be small in size in order not to interfere with the test. In this study, we proposed a system based on Hall-effect technology sensors, which allows distances from the magnetic field magnitudes to be indirectlyestimated using small sensors. A first prototype consisted of a matrix array of sensors. A radial basis function was used to model the magnitude-distance response of each sensor. The model was estimated by using a multivariate linear regression, and it was found that the proposed model for 1 mm resolution tests, had an average r2 of 99%.

Introduction: Rugby Sevens is one of the fastest growing sports in the world, especially the sevens variant after its inclusion in the Summer Olympics’ programme. The Portuguese University Sevens Championship is an amateur tournament that takes place every year. Objectives: To gather a set of relevant data regarding the profile of the Portuguese university rugby sevens’ players, as well as the epidemiology of injuries at this level of competition. Methodology: Firstly, an observational study was conducted to collect data regarding each player anthropometry, individual experience, training habits and warm-up routines. Secondly, a prospective cohort study including all participating athletes was conducted, to identify and describe all injuries occurring during the competition. A follow-up period until the return to sport from all injured players was conducted. Results: A total of 87 players from 8 teams competed in the tournament. On average, athlete’s heighted 178.6 cm (± 6.65) and weighted 83.34 kg (± 11.22). Total match exposure was 53.67 player match-hours and the injury incidence rate was 186.2 per 1000 player match-hours (94.7-332.4, CI 95%). Average severity was 26.6 days (± 6.23). Most injuries occurred on the second half (n=6), following contact events with the opponent (n=8). Lower limb (n=6) and joint/ligament (n=7) injuries were the most frequent. Discussion: The overall injury incidence rate was higher than any previously reported in the literature. Insufficient training and warm-up routines of the injured players strengthens the idea that these are key elements in injury prevention. The small sample limits the results' statistical significance. Conclusions: Similar but larger studies must be conducted to gain better knowledge of the individual profile of the Portuguese university rugby player and the burden of injuries at this level of competition.

The objective of this study was to examine the extent to which caregivers can be used to provide proxy responses for dementia clients in a study on the acceptance of GPS technology. Methods: Forty-five client–caregiver dyads used one of three GPS devices. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to create two questionnaires, one for dementia clients and one for caregivers, as proxies. Spearman rho bivariate correlations of responses for each UTAUT construct were used to compare the client and caregiver responses post-usage of the GPS devices. Results: The mean age of the clients was 76.02 years (SD = 11.5). Overall, after using the GPS devices, the responses of the clients and caregivers were correlated and statistically significant (rxy Overall summative scale = 0.550). In addition, 4 out of 6 constructs of the UTAUT were correlated and statistically significant (p, El objetivo de este estudio fue examinar hasta qué punto se puede utilizar a los cuidadores para que proporcionen respuestas proxy para los clientes con demencia en un estudio sobre la aceptación de la tecnología GPS. Métodos: Cuarenta y cinco díadas cliente-cuidador utilizaron uno de los tres dispositivos GPS. Se utilizó la Teoría Unificada de Aceptación y Uso de la Tecnología (UTAUT) para crear dos cuestionarios, uno para los clientes con demencia y otro para los cuidadores, como sustitutos. Se utilizaron correlaciones bivariadas de Spearman rho de las respuestas para cada constructo de la UTAUT para comparar las respuestas de los clientes y los cuidadores tras el uso de los dispositivos GPS. Resultados: La edad media de los clientes era de 76,02 años (SD = 11,5). En general, tras el uso de los dispositivos GPS, las respuestas de los clientes y los cuidadores estaban correlacionadas y eran estadísticamente significativas (rxy escala sumativa global = 0,550). Además, 4 de los 6 constructos de la UTAUT estaban correlacionados y eran estadísticamente significativos (p < 0,05) (rxy Expectativa de rendimiento = 0,160; rxy Influencia social = 0,478; rxy Intención de comportamiento de uso = 0,347; y rxy Uso real = 0,570). Conclusiones: El grado de acuerdo entre los cuidadores y los clientes, especialmente para los constructos intención de uso y uso real de la tecnología GPS, sugiere que los cuidadores pueden responder en nombre de los clientes con demencia en los cuestionarios de aceptación de la tecnología.

Three of five persons with dementia will wander, raising concern as to how it can be managed effectively. Wander-management strategies comprise a range of interventions for different environments. Although technological interventions may help in the management of wandering, no review has exhaustively searched what types of high- and low-technological solutions are being used to reduce the risks of wandering. In this article, we perform a review of gray and scholarly literature that examines the range and extent of high- and low-tech strategies used to manage wandering behavior in persons with dementia. We conclude that although effectiveness of 49 interventions and usability of 13 interventions were clinically tested, most were evaluated in institutional or laboratory settings, few addressed ethical issues, and the overall level of scientific evidence from these outcomes was low. Based on this review, we provide guidelines and recommendations for future research in this field., Highlights • Twenty categories of high and low-tech wander-management strategies were identified. • Most strategies were only evaluated in institutional or laboratory settings. • Overall level of scientific evidence from the outcomes of these strategies was low. • Research is required to demonstrate the efficacy of high- and low-tech strategies.

This research was aimed at examining how transaction performance regarding medical equipment maintenance affected overall healthcare service quality, understood as healthcare input and/or process quality. A cross-sectional, retrospective, exploratory study was thus designed for examining 719 maintenance transactions. Such sample size guaranteed 0.8 statistical power, having 0.2 effect size at =0.05. Secondary source data were taken from databases kept at two hospitals in Bogota, Colombia. A multivariate linear regression model was used for analysing the effect of turnaround time (TAT, the independent variable) in terms of hours on healthcare institution service quality (decreased overall quality, the dependent variable), controlling for the type of service provider carrying out the maintenance transaction (i.e. in-house or outsourcing) and the maintenance type concerned (i.e. preventive or corrective) in healthcare service quality. The results provided sufficient statistically significant support (p

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Don Juzwishin,1 Madiha Mueen,2 Antonio Miguel Cruz,3,4 Tracy Ruptash,5 Shannon Barnard,6 Meghan Sebastianski,1 Rosmin Esmail,7 Lili Liu4 1Health Technology Assessment and Innovation, Alberta Health Services, 2Department of Family Medicine, University of Alberta, Edmonton, AB, Canada; 3School of Medicine and Health Sciences, Universidad del Rosario, Bogotá D.C., Colombia; 4Department of Occupational Therapy, Faculty of Rehabilitation Medicine, Edmonton, 5Continuing Care Special Initiatives, Seniors Health, Community, Seniors, Addiction and Mental Health, Alberta Health Services, Grande Prairie, AB, 6Integrated Home Care, Alberta Health Services, 7Health Technology Assessment and Adoption,Alberta Health Services, Calgary, AB, Canada Abstract: Becoming lost or its risk is a problem for dementia clients, their families and caregivers. The purpose of the paper is to describe, analyze and share lessons from a pilot project to use global positioning system devices to manage the risk of becoming lost and, at the same time, maintaining client autonomy. The study informs technology implementation approaches and strategies for innovative health technologies. The project used a prospective mixed-methods approach including a pre and post paper-based questionnaire, focus groups and individual interviews. Technology uptake was examined post knowledge transfer using the After Action Review method, which has shown utility in military and health care settings. Project successes and weaknesses are identified to inform future approaches of innovative health technology pilot projects. Lessons from the pilot emphasize the need for innovators to understand the multifaceted context they are entering, enlist the support of leaders, dedicate a project lead, support autonomous decision making and problem solving, meet regularly to monitor progress and address issues and support peer-to-peer collaboration. Keywords: evaluation, innovation, GPS, technology, adoption&nbsp

This paper aims to implement and validate a Monte Carlo-based algorithm to determine the optimal interval of preventive maintenance of medical devices. The optimization criterion used was that which maximizes the equipment’s achieved availability. The Monte Carlo algorithm was implemented and tested using maintenance data from infusion pumps, electrocardiographs, and ECG monitors from both primary and secondary data source of information. The performance of the algorithm behaved well; it had a 65-sec response time for 10,000 simulations. The accuracy of the calculations did not exceed 1%. In addition to that, the implementation of the Monte Carlo algorithm was able to determine the better availability curve for the interval of preventive maintenance “tuned” with the mean time to failure for each medical devices population type.

The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost., El propósito de este estudio fue examinar la aceptación del Sistema de Posicionamiento Global (GPS) utilizado para ayudar a las personas con demencia que corren el riesgo de deambular por sus comunidades. Utilizamos un enfoque de investigación de métodos mixtos que incluía registros de uso, cuestionarios en papel previos y posteriores y grupos focales. Se incluyeron cuarenta y cinco pares de cliente-cuidador (díadas) para utilizar uno de los dispositivos GPS durante un promedio de 5,8 meses durante un período de 1 año. La aceptación del GPS fue alta; era probable que las díadas siguieran utilizando el GPS. Según los participantes, el GPS brindó tranquilidad a los cuidadores y redujo la ansiedad en las díadas cuando los clientes se perdían.

This paper aims to measure what are the students’ perceived learning outcome achievements after finishing their clinical engineering major courses. This is a pre- post-test with no control group study design. Forty students were involved in this pilot study. A paper-based survey composed of a demographic section and a 5-point Likert (“1” is strongly disagree and “5” is strongly agree) section measured the students’ perceived learning outcome achievements after exposing them to clinical engineering major courses. A Wilcoxon signed-rank and Mann-Whitney U test statistics were conducted to test the two hypotheses of this study. Our analysis showed statistically significant results between the pre-survey mean and SD: 21.10 SD 3.54; and between the postsurvey mean and SD: 22.75 SD 3.68 (Z -2.12, p, Este trabajo tiene como objetivo medir cuáles son los logros de los estudiantes de los estudiantes después de terminar sus cursos de ingeniería clínica. cursos de especialización en ingeniería clínica. Se trata de un estudio pre-post-test sin diseño de estudio con grupo de control. Cuarenta estudiantes participaron en este estudio piloto. Una encuesta en papel compuesta por una sección demográfica demográfica y una sección de Likert de 5 puntos ("1" es totalmente en desacuerdo y "5" es de acuerdo) midió los resultados de aprendizaje percibidos por los estudiantes de los estudiantes después de exponerlos a los cursos de ingeniería clínica. de ingeniería clínica. Para comprobar las dos hipótesis, se realizaron las pruebas de rango con signo de Wilcoxon y U de Mann-Whitney. para comprobar las dos hipótesis de este estudio. Nuestro análisis mostró resultados estadísticamente significativos entre la media y la DE de la encuesta previa: 21,10 DE 3,54; y entre la media y la DE de la encuesta posterior: 22,75 DE 3,68 (Z -2,12, p, School of Medicine and Health Sciences, Universidad del Rosario/Biomedical Engineering Department. Calle 63D # 24-31, 7 de Agosto, Bogotá D.C, Colombia. Email’s corresponding author: antonio.miguel@urosario.edu.co, miguelcr@ualberta.ca

This study uses multivariate regression analysis to examine the effects of asset specificity on the financial performance of both external and internal governance structures for medical device maintenance, and investigates how the financial performance of external governance structures differs depending on whether a hospital is private or public. The hypotheses were tested using information on 764 medical devices and 62 maintenance service providers, resulting in 1403 maintenance transactions. As such, our data sample is significantly larger than those used in previous studies in this area. The results empirically support our core theoretical argument that governance financial performance is influenced by assets specificity. © 2014 Elsevier B.V. All rights reserved.

Purpose: The aim of this study was to examine what factors affect the acceptance behavior and use of new technologies for rehabilitation by therapists at a large rehabilitation hospital in Canada. Method: A self-administrated paper-based survey was created by adapting scales with high levels of internal consistency in prior research using the Unified Theory of Acceptance and Use of Technology (UTAUT). Items were scored on a 7-point Likert scale, ranging from “strongly disagree (1)” to “strongly agree (7)”. The target population was all occupational therapists (OT) and physical therapists (PT) involved with the provision of therapeutic interventions at the hospital. Our research model was tested using partial least squares (PLS) technique. Results: Performance expectancy was the strongest salient construct for behavioral intention to use new technologies in rehabilitation, whereas neither effort expectancy nor social influence were salient constructs for behavioral intention to use new technologies; (4) facilitating condition and behavioral intention to use new technologies were salient constructs for current use of new technologies in rehabilitation, with facilitating condition the strongest salient for current use of new technologies in rehabilitation. Conclusion: In a large rehabilitation hospital where use of new technologies in rehabilitation is not mandatory, performance expectancy, or how the technology can help in therapists’ work, was the most important factor in determining therapists’ acceptance and use of technologies. However, effort expectancy and social influence constructs were not important, i.e. therapists were not influenced by the degree of difficulty or social pressures to use technologies. Behavioral intention and facilitating condition, or institutional support, are related to current use of new technologies in rehabilitation.Implications for RehabilitationRehabilitation professionals who are faced with using new technologies are less concerned about effort and social pressures, than they are about what the technologies can do for them or their clients.When it comes to new rehabilitation technologies, actual users express intention.Rehabilitation professionals’ acceptance and adoption of technologies rely on conditions that facilitate their use. These conditions include scheduling, support and a conductive environment. Rehabilitation professionals who are faced with using new technologies are less concerned about effort and social pressures, than they are about what the technologies can do for them or their clients. When it comes to new rehabilitation technologies, actual users express intention. Rehabilitation professionals’ acceptance and adoption of technologies rely on conditions that facilitate their use. These conditions include scheduling, support and a conductive environment.

In this research, association discovery and clustering techniques were utilized for improving the efficiency of a hospital's service and of the maintenance tasks in a clinical engineering department. The indicator in this study is service requests. The association discovery techniques revealed problems in users' training (errors in operating procedures), intrinsic failures in medical devices, and badly scheduled maintenance policies. Clustering techniques uncovered the main causes of failures. With the evidence obtained corrective actions were taken. The service request average dropped dramatically from 6.4 to 0.4 during the analyzed period. © 2013 Elsevier Ltd. All rights reserved.

INTRODUÇÃO: No rugby, cada posição apresenta exigências muito específicas e distintas, tanto em nível antropométrico como fisiológico. Os diferentes estudos publicados revelam a existência de diferenças significativas em nível das características antropométricas e fisiológicas dos atletas de rugby das diferentes posições. Apesar de comuns em países onde a modalidade é mais popular, nenhum estudo procurando caracterizar o atleta de rugby português foi, até agora, publicado. OBJETIVOS: Caracterizar antropométrica e fisiologicamente os atletas de rugby portugueses, procurando identificar eventuais diferenças entre atletas de grupos posicionais distintos. Comparar os resultados obtidos com os demais trabalhos já publicados. MÉTODOS: Avaliamos 46 jogadores de rugby de duas equipes a disputarem competições nacionais seniores masculinas. Os atletas foram agrupados, em função das suas posições em campo, em avançados (n = 24) e recuados (n = 22). Todos os atletas foram submetidos a uma avaliação antropométrica com determinação de estatura, massa corporal e nove pregas cutâneas. Quarenta submeteram-se, igualmente, a uma avaliação das suas capacidades físicas que consistiu na determinação da velocidade, aceleração e capacidade aeróbia máxima. A análise estatística foi realizada com recurso ao software IBM® SPSS® Statistics v.19, tendo sido considerado um valor de significância de 5%. RESULTADOS: Os avançados apresentaram um peso corporal médio de 96,02 kg (± 13,44) e 1,80 m (± 0,06) de estatura, contra os 76,84 kg (± 7,28) de peso médio e 1,73 m (± 0,06) de estatura dos recuados. Quanto à avaliação fisiológica, os recuados apresentaram globalmente melhores resultados. No teste dos 10m demoraram apenas 1,97 s (± 0,20) contra os 2,10 s (± 0,27) dos avançados. No teste de velocidade, os recuados demoraram, em média, 4,50 s (± 0,32), menos 0,36s que os avançados. A capacidade aeróbia máxima em função do peso verificada para os recuados (52,33 mlO2/min/kg ± 5,41) foi, igualmente, superior à dos avançados (46,60 mlO2/min/kg ± 5,64). DISCUSSÃO E CONCLUSÕES: Os avançados eram significativamente mais altos, mais pesados e apresentavam uma maior percentagem de gordura corporal que os recuados. Eram, também, mais lentos, e tinham uma menor capacidade aeróbia máxima em função das suas massas corporais. No entanto, apresentavam uma maior capacidade aeróbia máxima em valor absoluto e produziam um maior momento linear. As diferenças entre avançados e recuados foram ao encontro às da literatura e estão relacionadas com os distintos papéis desempenhados pelos atletas durante o jogo. Apesar das limitações inerentes a este estudo, acreditamos que este é pertinente e irá estimular o aprofundamento dos conhecimentos nesta área. Estudos semelhantes mas de maiores dimensões deverão ser realizados, no futuro, de forma a podermos avaliar e caracterizar mais fielmente o atleta de rugby português.

Background: Prevention and management of chronic conditions is a priority for many healthcare systems. Personal health records have been suggested to facilitate implementation of chronic care programs. However, patients’ attitude towards personal health records (PHRs) can significantly affect the adoption rates and use of PHRs. Objectives: to evaluate the attitude of patients with Type II diabetes towards using a PHR to manage their condition. Methods: We used a cross-sectional exploratory pilot study. Fifty-four (54) patients used a PHR to monitor and record their blood glucose levels, diet, and activities for 30 days, and to communicate with their clinicians. At the end of the study, patients responded to a survey based on three constructs borrowed from different technology acceptance frameworks: relative advantage, job fit, and perceived usefulness. A multivariate predictive model was formed using partial least squaring technique (PLS) and the effect of each construct on the patients’ attitude towards system use was evaluated. Patients also participated in a semi-structured interview. Results: We found a significant positive correlation between job fit and attitude (JF → ATT = +0.318, p, Antecedentes: la prevención y el manejo de las enfermedades crónicas es una prioridad para muchos profesionales de la salud. sistemas Se han sugerido registros personales de salud para facilitar la implementación de la atención crónica. programas Sin embargo, la actitud de los pacientes hacia los registros personales de salud (PHR, por sus siglas en inglés) puede afectar significativamente las tasas de adopción y el uso de los PHR. Objetivos: evaluar la actitud de los pacientes con diabetes tipo II hacia el uso de un PHR para el manejo de su condición. Métodos: Utilizamos un estudio piloto exploratorio transversal. Cincuenta y cuatro (54) pacientes usaron un PHR para monitorear y registrar sus niveles de glucosa en sangre, dieta y actividades durante 30 días, y comunicarse con sus médicos. Al final del estudio, los pacientes respondieron a una encuesta basada en tres constructos tomados de diferentes marcos de aceptación de tecnología: ventaja relativa, adecuación al trabajo y utilidad percibida. Se formó un modelo predictivo multivariado utilizando la técnica de mínimos cuadrados parciales (PLS) y se determinó el efecto de cada constructo en la actitud de los pacientes hacia el uso del sistema. evaluado. Los pacientes también participaron en una entrevista semiestructurada. Resultados: Encontramos una correlación positiva significativa entre el ajuste al trabajo y la actitud (JF → ATT = +0,318, p

El objetivo de este trabajo es hacer una caracterización del estado de la ingeniería clínica desde las publicaciones científicas. En primer lugar, se exponen brevemente los factores más significativos que influyen en el cambio y en la evolución de los sistemas sanitarios. Luego, se define el concepto de ingeniería clínica, sus funciones fundamentales y su evolución dentro del desarrollo de los sistemas sanitarios. Finalmente, se expone el estado de la especialidad, dando una mirada desde las publicaciones científicas. Se puede observar una aparente falta de interés en la comunidad de ingenieros por publicar trabajos de investigación científica. Esto se puede constatar por la franca tendencia al decrecimiento del número de citaciones y el número de publicaciones (en volumen o en cantidad) en las principales revistas del gremio científico. Finalmente, se exponen, a criterio del autor, los retos actuales y los futuros desarrollos que tiene que enfrentar la especialidad para poder posicionarse en el mundo de las publicaciones. The aim of this paper was to characterize clinical engineering from the perspective of scientific publications. First of all, the most significant factors that influence the change in health systems are briefly exposed. Then, clinical engineering is defined and its main functions and evolution within the development of the health system is explained. Finally, the author describes the state of the field from the viewpoint of the scientific publications; an apparent lack of interest in the engineering community to publish scientific research was observed. This behavior can be seen in the clear declining tendency in the number of citations and the number of publications (in volume or quantity) in major scientific journals in the field. Finally, current challenges and future developments must be addressed to accomplish a better positioning of the specialty in the publishing world.

This paper investigates the use of clustering technique to characterize the providers of maintenance services in a health-care institution according to their performance. A characterization of the inventory of equipment from seven pilot areas was carried out first (including 264 medical devices). The characterization study concluded that the inventory on a whole is old [exploitation time (ET)/useful life (UL) average is 0.78] and has high maintenance service costs relative to the original cost of acquisition (service cost /acquisition cost average 8.61%). A monitoring of the performance of maintenance service providers was then conducted. The variables monitored were response time (RT), service time (ST), availability, and turnaround time (TAT). Finally, the study grouped maintenance service providers into clusters according to performance. The study grouped maintenance service providers into the following clusters. Cluster 0: Identified with the best performance, the lowest values of TAT, RT, and ST, with an average TAT value of 1.46 days; Clusters 1 and 2: Identified with the poorest performance, highest values of TAT, RT, and ST, and an average TAT value of 9.79 days; and Cluster 3: Identified by medium-quality performance, intermediate values of TAT, RT, and ST, and an average TAT value of 2.56 days.

With the advancement of medical technology and thus the complexity of the equipment under their care, clinical engineering departments (CEDs) must continue to make use of computerized tools in the management of departmental activities. Authors of this paper designed, installed, and implemented an application service provider (ASP) model at the laboratory level to offer value added management tools in an online format to CEDs. The project, designed to investigate how to help meet demands across multiple healthcare organizations and provide a means of access for organizations that otherwise might not be able to take advantage of the benefits of those tools, has been well received. Ten hospitals have requested the service, and five of those are ready to proceed with the implementation of the ASP. With the proposed centralized system architecture, the model has shown promise in reducing network infrastructure labor and equipment costs, benchmarking of equipment performance indicators, and developing avenues for proper and timely problem reporting. The following is a detailed description of the design process from conception to implementation of the five main software modules and supporting system architecture.

Multiple linear regression and clustering techniques are tools that have been extensively applied in several financial, technical, and biomedical arenas, where vast quantities of data are produced and stored. These techniques show promise in analyzing the performance of departments responsible for and related to hospital equipment maintenance and, thereafter, identifying and improving areas of concern. As a contributory measure, this research is focused on the analysis of quality and effectiveness of corrective (nonscheduled) maintenance tasks in the healthcare environment and the improvement of those processes. The two main objectives of this research are to build a predictor for a TAT indicator to estimate its values and to use a numeric clustering technique to find possible causes of undesirable values of TAT.