Case-mixing effects on children's word recognition: lexical feedback and development

Effects of Text Enhancement on Reduction of Look-Alike Drug Name Confusion: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES

Drug name confusion induced by look-alike drug names represents a serious health care management problem in practice. Text enhancement by changing visual attributes of look-alike drug names has been proposed and widely applied in practice to mitigate drug name confusion. However, the effectiveness of text enhancement on reducing drug name confusion is yet to be determined. This study aimed to explore the effects of text enhancement on reduction of confusion caused by look-alike drug names through systematic review and meta-analysis.

METHODS

We searched 5 databases (from database inception to January 2020) for empirical studies that examined the effects of text enhancement on reduction of look-alike drug name-induced drug name confusion. The pooled outcome data were analyzed using either meta-analysis or a narrative synthesis approach.

RESULTS

From the 351 identified articles, 11 articles representing 20 individual trials were included. Five basic text enhancement methods were revealed, including Tall Man, red, boldface, contrast, and size enhancement, from which 4 Tall Man variants and 6 text enhancement combinations were derived. The meta-analysis results showed significant reduction in omission errors when using Tall Man (standardized mean difference [SMD] = -0.628, 95% confidence interval [CI]: -1.018 to -0.238, P = .002), red (SMD = -0.516, 95% CI: -1.002 to -0.030, P = .038), boldface (SMD = -1.027, 95% CI: -1.240 to -0.814, P < .001), and contrast (SMD = -0.437, 95% CI: -0.869 to -0.004, P = 0.048), as compared with lowercase. This finding was also supported in our subgroup analysis by task type for name differentiation tasks. No other significant effects of text enhancement were found for either commission errors or response time.

CONCLUSIONS

Using Tall Man, red, boldface, or contrast could help reduce omission errors (ie, wrong medication selection) caused by look-alike drug names, particularly in name differentiation tasks. However, no text enhancement could shorten name search and/or differentiation time. Our findings could facilitate the understanding of the effects of text enhancement in the prevention of confusion errors caused by look-alike drug names and promote the application of text enhancement in practice.

Effects of Text Enhancement, Identical Prescription-Package Names, Visual Cues, and Verbal Provocation on Visual Searches of Look-Alike Drug Names: A Simulation and Eye-Tracking Study

OBJECTIVE

Simulation and eye tracking were used to examine the effects of text enhancement, identical prescription-package names, visual cues, and verbal provocation on visual searches of look-alike drug names.

BACKGROUND

Look-alike drug names can cause confusion and medication errors, which jeopardize patient safety. The effectiveness of many strategies that may prevent these problems requires evaluation.

METHOD

We conducted two experiments that were based on a four-way, repeated-measures design. The within-subject factors were text enhancement, identical prescription-package names, visual cues, and verbal provocation. In Experiment 1, 40 nurses searched for and selected a target drug from an array of drug packages on a pharmacy shelf mock-up. In Experiment 2, the eye movements of another 40 nurses were tracked while they performed a computer-based drug search task.

RESULTS

Text enhancement had no significant effect on the drug search. Nurses selected the target drugs more quickly and easily when the prescriptions and drug packages shared identical drug name formats. The use of a visual cue to direct nurses' attention facilitated their visual searches and improved their eye gaze behaviors. The nurses reported greater mental effort if they were provoked verbally during the drug search.

CONCLUSION

Efficient and practical strategies should be adopted for designs that facilitate accurate drug search. Among these strategies are using identical name appearances on drug prescriptions and packages, using a visual cue to direct nurses' attention, and avoiding rushing nurses while they are concentrating.

APPLICATION

The findings aim to inspire recommendations for work system designs that will improve the visual search of look-alike drug names.

The role of letter features on the consonant-bias effect: Evidence from masked priming

Recent research has shown an advantage of consonants at early stages of visual word recognition (C-bias), although the locus of this effect remains elusive. Here we examine whether the C-bias is affected by the consonant letters' features. Skilled readers performed a masked priming lexical decision task in which target words containing only either consonants without any ascending/descending features (flat words, canino[canine]) or consonants with ascending/descending features (non-flat words, palito[toothpick]) were preceded by briefly (50 ms) presented primes that could preserve the same consonants of the targets (cenune-CANINO, pelute-PALITO), the same vowels of the targets (raxizo-CANINO, fajibo-PALITO), or, as controls, unrelated (ruxuze-CANINO, fejube-PALITO) and identity primes (canino-CANINO, palito-PALITO). The case in which prime-target pairs were presented was also manipulated (lower-upper vs. upper-lower). Results showed that in both case conditions flat words were recognized faster than non-flat words. Evidence for the C-bias was observed both for flat and non-flat words in the lower-upper condition, in which a vowel inhibitory priming effect was also observed for non-flat words. In the upper-lower condition, however, the C-bias was restricted to flat words. These findings suggest that letter features play a role in the C-bias and ask for amendments in current models of visual word recognition.

The Word Composite Effect Depends on Abstract Lexical Representations But Not Surface Features Like Case and Font

Prior studies have shown that words show a composite effect: When readers perform a same-different matching task on a target-part of a word, performance is affected by the irrelevant part, whose influence is severely reduced when the two parts are misaligned. However, the locus of this word composite effect is largely unknown. To enlighten it, in two experiments, Portuguese readers performed the composite task on letter strings: in Experiment 1, in written words varying in surface features (between-participants: courier, notera, alternating-cAsE), and in Experiment 2 in pseudowords. The word composite effect, signaled by a significant interaction between alignment of the two word parts and congruence between parts was found in the three conditions of Experiment 1, being unaffected by NoVeLtY of the configuration or by handwritten form. This effect seems to have a lexical locus, given that in Experiment 2 only the main effect of congruence between parts was significant and was not modulated by alignment. Indeed, the cross-experiment analysis showed that words presented stronger congruence effects than pseudowords only in the aligned condition, because when misaligned the whole lexical item configuration was disrupted. Therefore, the word composite effect strongly depends on abstract lexical representations, as it is unaffected by surface features and is specific to lexical items.

The effect of proximity, Tall Man lettering, and time pressure on accurate visual perception of drug names

OBJECTIVE

The aim of this study is to assess the effect of proximity and time pressure on accurate and effective visual search during medication selection from a computer screen.

BACKGROUND

The presence of multiple similar objects in proximity to a target object increases the difficulty of a visual search. Visual similarity between drug names can also lead to selection error. The proximity of several similarly named drugs within a visual field could, therefore, adversely affect visual search.

METHOD

In Study 1, 60 nonpharmacy participants selected a target drug name from an array of mock drug packets shown on a computer screen, where one or four similarly named nontargets might be present. Of the participants, 30 completed the task with a time constraint, and the remainder did not. In Study 2, the same experiment was repeated with 28 pharmacy staff.

RESULTS

In Study 1, the proximity of multiple similarly named nontargets within the specified visual field reduced selection accuracy and increased reaction times in the nonpharmacists. Time constraint also had an adverse effect. In Study 2, the pharmacy participants showed increased reaction times when multiple nontargets were present, but the time constraint had no effect. There was no effect of Tall Man lettering.

CONCLUSION

The presence of multiple similarly named medications in close proximity to a target medication increases the difficulty of the visual search for the target. Tall Man lettering has no impact on this adverse effect.

APPLICATION

The widespread use of the alphabetical system in medication storage increases the risk of proximity-based errors in drug selection.

It’s what’s on the outside that matters: An advantage for external features in children’s word recognition

The relative importance of internal and external letter features of words in children's developing reading was investigated to clarify further the nature of early featural analysis. In Experiment 1, 72 6-, 8-, and 10-year-olds read aloud words displayed as wholes, external features only (central features missing, thereby preserving word shape information), or internal features only (central features preserved). There was an improvement in the processing of external features compared with internal features as reading experience increased. Experiment 2 examined the processing of the internal and external features of words employing a forward priming paradigm with 60 8-, 10-, and 12-year-olds. Reaction times to internal feature primes were equivalent to a nonprime blank condition, whereas responses to external feature primes were faster than those to the other two prime types. This advantage for the external features of words is discussed in terms of an early and enduring role for processing the external visual features in words during reading development.

The effect of visual word features on the acquisition of orthographic knowledge

Research with adults has shown that the distortion of visual word features, and in particular of the multiletter features within words, hampers word recognition. In this study, "CaSe MiXiNg" was employed to examine the effect of disrupting visual word features on the acquisition of orthographic knowledge in children. During the training, 18 beginning and 27 advanced readers (in Grades 2, 4, and 5) repeatedly read a set of pseudowords in either lowercase or mixed case. During this training, case mixing appeared to impair reading speed in both reader groups. At posttest, 1 day after the training, case format was either the same as or different from that during the training. Lowercase pseudowords were recognized faster after a lowercase training than after a mixed-case training. In a second study, case was found not to affect the rapid naming of single letters. The combined results suggest that case mixing disrupted the multiletter features in pseudowords and that the disruption of these features can affect the acquisition of orthographic knowledge.

Evaluating a split fovea model of visual word recognition: effects of case alternation in the two visual fields and in the left and right halves of words presented at the fovea

Two experiments are reported exploring the effect of cAsE aLtErNaTiOn on lexical decisions to words and nonwords presented laterally or centrally. In line with previous research, Experiment 1 found that case alternation slowed lexical decision responses to words more in the right visual field (RVF) than in the left visual field (LVF). In Experiment 2, the words and nonwords were all presented centrally. There were three conditions, a condition in which the word and nonwords were presented in lower case letters, a condition in which the letters to the left of the central fixation were case alternated (e.g., aMbItion, mOdLants) and a condition in which the letters to the right of fixation were case alternated (e.g., collApSe, pireNtOl). Alternating the case of letters to the right of fixation slowed lexical decision responses more than alternating letter case to the left of fixation. The results provide further support for a split fovea account of visual word recognition according to which those letters of a centrally-fixated word that fall to the left of fixation are processed initially by the right cerebral hemisphere while those letters that fall to the right of fixation are processed initially by the left cerebral hemisphere, with the characteristics of the left and right hemispheres being revealed in the processing of initial and final letters in centrally presented words.