Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

Background—Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose—Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods—In a lab-based experiment, 28 providers used prototypes of the new and older “legacy” outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results—There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions—Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old “legacy” layout. A thoughtful design of the exam room with respect to the computing may positively impact providers’ workload, situation awareness, time spent in screen sharing activities, and workflow integration

Using video-based observation research methods in primary care health encounters to evaluate complex interactions

Objective The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient–clinician interaction in primary care settings.Methods We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings.Results This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared “unmanned” video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies.Conclusion With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches

Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

OCCUPATIONAL APPLICATIONS When comparing a typical exam room layout to the Department of Veterans Affairs (VA's) new exam room design, with respect to the exam room computing, primary care providers experienced significantly less mental workload and greater situation awareness when using the new exam room design. Further, providers rated the new exam room layout significantly higher in terms of being integrated with their clinical workflow and spent significantly more time in screen sharing activities with the patient. A more thoughtful design of the exam room layout with respect to the placement and physical design of the computing set-up may reduce provider cognitive effort and enhance aspects of patient centeredness by viewing the computer and electronic health record (EHR) it displays as an important mediator between provider and patient. This was achieved by using an all-in-one computer attached to a wall mount that moves the monitor along three axes, allowing for optimal screen positioning and adjustable depending upon the scenario. TECHNICAL ABSTRACT Background: Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose: Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods: In a lab-based experiment, 28 providers used prototypes of the new and older "legacy" outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results: There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions: Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old "legacy" layout. A thoughtful design of the exam room with respect to the computing may positively impact providers' workload, situation awareness, time spent in screen sharing activities, and workflow integration.Agency for Health care Research and Quality (AHRQ), U.S. Department of Health and Human Services [1R03HS024488-01A1]12 month embargo; published online: 8 June 2018This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Sequential Analysis of Livestock Herding Dog and Sheep Interactions

Livestock herding dogs are crucial contributors to Australian agriculture. However, there is a dearth of empirical studies of the behavioural interactions between dog and livestock during herding. A statistical approach that may reveal cause and effect in such interactions is lag sequential analysis. Using 48 video recordings of livestock herding dogs and sheep in a yard trial competition, event-based (time between behaviours is irrelevant) and time-based (time between behaviours is defined) lag sequential analyses identified several significant behavioural interactions (adjusted residuals greater than 2.58; the maximum likelihood-ratio chi-squared statistic for all eight contingency tables identified all sequences as highly significant (p \u3c 0.001)). These sequences were: The dog ceasing all movement followed by the sheep also ceasing movement; the dog chasing the sheep and a group of sheep escaping the main flock; a single sheep escaping the flock and the dog chasing; sheep initiating movement followed by the dog following; foot-stamping followed by the dog ceasing all movement; and, foot-stamping by the sheep and the dog lip-licking in response. Log linear regression identified significant relationships among undesirable behaviours in sheep and both observed trial duration (p = 0.001) and trial score (p = 0.009). No differences in the herding styles of dogs were identified between sex of dog and frequency of sheep escape behaviours (p = 0.355) nor the sex of dog and competition level (p = 0.116). The identification of trial score as a predictor of efficient performance confirms the benefits of incorporating extant objective measures to assess livestock herding dogs

Investigating Speech Rate Alignment in Individuals with Traumatic Brain Injury

The alignment of verbal and nonverbal behaviors is important for conversation. Research has shown that interactive behavior alignment is commonly impaired following a traumatic brain injury (TBI), and the ability for an individual with TBI to align their speech rate with their conversational partners can be affected. This non-convergence of speech rates can lead to negative social outcomes, including perceptions of decreased social connectedness and decreased willingness of conversational partners to engage in conversation. Despite these negative outcomes, researchers have yet to discover a therapeutic technique to increase speech rate convergence, and in turn, lead to positive social outcomes during conversation. Additionally, research has specifically focused on speech rate convergence in individuals with moderate-to-severe TBI and not individuals with mild TBI (mTBI). It is currently unclear whether speech rate convergence is also affected in individuals mTBI.Speech entrainment (SE) is a therapeutic tool that involves the real time mimicking of an audiovisual (AV) stimulus. Although this task was originally developed to improve the fluency of speech in individuals with non-fluent aphasia, this study trialed SE with individuals with TBI, as it requires repeated alignment of ones speech rate with anothers.For this study, participants with TBI and mTBI engaged in conversations with a familiar partner before and after engaging in 30 minutes of SE. During the task, participants mimicked AV stimuli presented at various speech rates (unmodified at c. 2 syllables/s and accelerated to c. 3.5/syllables/s and c. 5 syllables/s). After the task, observers rated portions of each conversation on degree of perceived rapport between participants and their conversational partners.Results showed that individuals with mTBI entrained to a greater degree to stimuli compared to the moderate-to-severe TBI group at the slow and medium rates. Additionally, all participants, regardless of TBI severity, demonstrated greater entrainment to the slow rate AV stimuli compared to the medium. The degree of speech rate convergence, however, did not appear to change systematically between pre- and post-treatment conversations. Finally, based on observers ratings, conversations with speech rate convergence were unexpectedly perceived as less natural and less favorable compared to conversations with non-convergence of speech rate

Immersive Visualization in Biomedical Computational Fluid Dynamics and Didactic Teaching and Learning

Virtual reality (VR) can stimulate active learning, critical thinking, decision making and improved performance. It requires a medium to show virtual content, which is called a virtual environment (VE). The MARquette Visualization Lab (MARVL) is an example of a VE. Robust processes and workflows that allow for the creation of content for use within MARVL further increases the userbase for this valuable resource. A workflow was created to display biomedical computational fluid dynamics (CFD) and complementary data in a wide range of VE’s. This allows a researcher to study the simulation in its natural three-dimensional (3D) morphology. In addition, it is an exciting way to extract more information from CFD results by taking advantage of improved depth cues, a larger display canvas, custom interactivity, and an immersive approach that surrounds the researcher. The CFD to VR workflow was designed to be basic enough for a novice user. It is also used as a tool to foster collaboration between engineers and clinicians. The workflow aimed to support results from common CFD software packages and across clinical research areas. ParaView, Blender and Unity were used in the workflow to take standard CFD files and process them for viewing in VR. Designated scripts were written to automate the steps implemented in each software package. The workflow was successfully completed across multiple biomedical vessels, scales and applications including: the aorta with application to congenital cardiovascular disease, the Circle of Willis with respect to cerebral aneurysms, and the airway for surgical treatment planning. The workflow was completed by novice users in approximately an hour. Bringing VR further into didactic teaching within academia allows students to be fully immersed in their respective subject matter, thereby increasing the students’ sense of presence, understanding and enthusiasm. MARVL is a space for collaborative learning that also offers an immersive, virtual experience. A workflow was created to view PowerPoint presentations in 3D using MARVL. A resulting Immersive PowerPoint workflow used PowerPoint, Unity and other open-source software packages to display the PowerPoint presentations in 3D. The Immersive PowerPoint workflow can be completed in under thirty minutes

Recent Developments in Smart Healthcare

Medicine is undergoing a sector-wide transformation thanks to the advances in computing and networking technologies. Healthcare is changing from reactive and hospital-centered to preventive and personalized, from disease focused to well-being centered. In essence, the healthcare systems, as well as fundamental medicine research, are becoming smarter. We anticipate significant improvements in areas ranging from molecular genomics and proteomics to decision support for healthcare professionals through big data analytics, to support behavior changes through technology-enabled self-management, and social and motivational support. Furthermore, with smart technologies, healthcare delivery could also be made more efficient, higher quality, and lower cost. In this special issue, we received a total 45 submissions and accepted 19 outstanding papers that roughly span across several interesting topics on smart healthcare, including public health, health information technology (Health IT), and smart medicine