How well do critical care audit and feedback interventions adhere to best practice? Development and application of the REFLECT-52 evaluation tool

Background Healthcare Audit and Feedback (A&F) interventions have been shown to be an effective means of changing healthcare professional behavior, but work is required to optimize them, as evidence suggests that A&F interventions are not improving over time. Recent published guidance has suggested an initial set of best practices that may help to increase intervention effectiveness, which focus on the “Nature of the desired action,” “Nature of the data available for feedback,” “Feedback display,” and “Delivering the feedback intervention.” We aimed to develop a generalizable evaluation tool that can be used to assess whether A&F interventions conform to these suggestions for best practice and conducted initial testing of the tool through application to a sample of critical care A&F interventions. Methods We used a consensus-based approach to develop an evaluation tool from published guidance and subsequently applied the tool to conduct a secondary analysis of A&F interventions. To start, the 15 suggestions for improved feedback interventions published by Brehaut et al. were deconstructed into rateable items. Items were developed through iterative consensus meetings among researchers. These items were then piloted on 12 A&F studies (two reviewers met for consensus each time after independently applying the tool to four A&F intervention studies). After each consensus meeting, items were modified to improve clarity and specificity, and to help increase the reliability between coders. We then assessed the conformity to best practices of 17 critical care A&F interventions, sourced from a systematic review of A&F interventions on provider ordering of laboratory tests and transfusions in the critical care setting. Data for each criteria item was extracted by one coder and confirmed by a second; results were then aggregated and presented graphically or in a table and described narratively. Results In total, 52 criteria items were developed (38 ratable items and 14 descriptive items). Eight studies targeted lab test ordering behaviors, and 10 studies targeted blood transfusion ordering. Items focused on specifying the “Nature of the Desired Action” were adhered to most commonly—feedback was often presented in the context of an external priority (13/17), showed or described a discrepancy in performance (14/17), and in all cases it was reasonable for the recipients to be responsible for the change in behavior (17/17). Items focused on the “Nature of the Data Available for Feedback” were adhered to less often—only some interventions provided individual (5/17) or patient-level data (5/17), and few included aspirational comparators (2/17), or justifications for specificity of feedback (4/17), choice of comparator (0/9) or the interval between reports (3/13). Items focused on the “Nature of the Feedback Display” were reported poorly—just under half of interventions reported providing feedback in more than one way (8/17) and interventions rarely included pilot-testing of the feedback (1/17 unclear) or presentation of a visual display and summary message in close proximity of each other (1/13). Items focused on “Delivering the Feedback Intervention” were also poorly reported—feedback rarely reported use of barrier/enabler assessments (0/17), involved target members in the development of the feedback (0/17), or involved explicit design to be received and discussed in a social context (3/17); however, most interventions clearly indicated who was providing the feedback (11/17), involved a facilitator (8/12) or involved engaging in self-assessment around the target behavior prior to receipt of feedback (12/17). Conclusions Many of the theory-informed best practice items were not consistently applied in critical care and can suggest clear ways to improve interventions. Standardized reporting of detailed intervention descriptions and feedback templates may also help to further advance research in this field. The 52-item tool can serve as a basis for reliably assessing concordance with best practice guidance in existing A&F interventions trialed in other healthcare settings, and could be used to inform future A&F intervention development. Trial registration Not applicable.

The Effect of Mechanical Coupling on the Perception of Haptic Feedback

A wearable sensory transfer armband was developed to display haptic feedback on the forearm. This device provides focalized mechanotactile feedback in the form of pressure with balloon-like pneumatic actuators. The balloons inflate to exert pressure against the skin just below them. In order to understand and control how the feedback device interacts with the user, its performance was characterized by measuring the pneumatics’ internal pressure, the force applied against the arm surface by the balloon, and the air volume injected into the balloon. The mechanical coupling, or fit, of the feedback display against the arm was also characterized and varied as the previous parameters were observed, any changes and how these pertain to the perception of haptic feedback were analyzed. The study revealed that mechanical coupling significantly affects the forces felt against the forearm. The study also showed that the perception of haptic feedback can vary depending on the anatomical location on the forearm where feedback is applied.

The PRISMA: A Visual Feedback Display for Learning Scenarios

Ambient displays can play an important role in the teaching process guiding students to perform learning activities in public spaces. In the last years, automated feedback is becoming popular due to the proliferation of sensors, actuators, mobile devices, and networks. The contribution of this paper is twofold: (1) first, we present the implementation of an ambient display designed to provide feedback in learning scenarios using different actuators; (2) second, we present the results of a survey to investigate how adequate might be Bluetooth technology to sense and attract students to perform a learning activity.

Development of a high-performance tactile feedback display for three-dimensional shape rendering

This article presents a virtual tactile display using a shape-displaying method with flexible tendon-driven transmission to enhance performance. Sixteen tactors move perpendicularly in a 4 × 4 module to render the local shape of the virtual object to the skin of the user’s fingertip. We detail the display structure design and the transmission system, and we combine the compact design of the drive unit and tactor module with a flexible tendon-driven transmission to address the ergonomic constraints on previous devices and make them more suitable for tactile feedback. In this work, we integrate the display with leap motion controller and a ray detection rendering method to generate tactile feedback. To evaluate the performance, we perform a virtual touch experiment that assesses how much the display can render the surface of three-dimensional objects to aid the participant to match the tactile sensation with visual stimuli in the virtual scene. Results show that the display improves the user experience and has good feasibility and effectiveness. In addition, the portable structure allows the user’s hand to move more freely without redundant restrictions, and the larger tactor amplitude provides more shape patterns than previous models.

The Effects of Feedback Format, and Egocentric & Allocentric Relative Phase on Coordination Stability

The stability of coordinated rhythmic movement is primarily affected by the required mean relative phase. In general, symmetrical coordination is more stable than asymmetrical coordination; however, there are two ways to define relative phase and the associated symmetries. The first is in an egocentric frame of reference, with symmetry defined relative to the sagittal plane down the midline of the body. The second is in an allocentric frame of reference, with symmetry defined in terms of the relative direction of motion. Experiments designed to separate these constraints have shown that both egocentric and allocentric constraints contribute to overall coordination stability, with the former typically showing larger effects. However, separating these constraints has meant comparing movements made either in different planes of motion, or by limbs in different postures. In addition, allocentric information about the coordination is either in the form of the actual limb motion, or a transformed, Lissajous feedback display. These factors limit both the comparisons that can be made and the interpretations of these comparisons. The current study examined the effects of egocentric relative phase, allocentric relative phase, and allocentric feedback format on coordination stability in a single task. We found that while all three independently contributed to stability, the egocentric constraint dominated. This supports previous work. We examine the evidence underpinning theoretical explanations for the egocentric constraint, and describe how it may reflect the haptic perception of relative phase.