bluuebunny/crossref_metadata_2025 huggingface dataset:
FGFR inhibitors in cholangiocarcinoma: what’s now and what’s next?
Authors: Saborowski Anna , Lehmann Ulrich , Vogel Arndt
Published: September 2020

Patients with intrahepatic cholangiocarcinoma (iCCA) face a highly dismal prognosis, due to late stage diagnosis, the relative chemoresistance of the disease, and an overall limited portfolio of established therapeutic concepts. In recent years, a number of next generation sequencing studies have provided detailed information on the molecular landscape of biliary malignancies, and have laid the groundwork for the evaluation of novel, targeted therapeutic opportunities. Although nearly 40% of patients harbor genetic alterations for which targeted options exist, rapid translation into clinical trials is hampered by the overall low patient numbers. One of the most frequent genetic events in patients with iCCAs are fusions that involve the fibroblast growth factor receptor 2 ( FGFR2). Impressive results from pivotal phase II studies in pre-treated patients have confirmed that FGFR-inhibitors are a promising therapeutic option for this genetic subgroup, and the rapid pace with which these inhibitors are being clinically developed is clearly justified by the imminent benefit for the patients. However, the success of these agents should not blind us to key challenges that need to be addressed to optimize FGFR-directed therapies in the future. A better understanding of mechanisms that convey primary and secondary resistance will be crucial to improve up-front patient stratification, to prolong the duration of response, and to implement reasonable co-treatment approaches. In this review, we provide background information on the pathobiology of oncogenic FGFR fusions and selected genetic testing strategies, summarize the latest clinical data, and discuss future directions of FGFR-directed therapies in patients with iCCA.
Nimotuzumab plus platinum-based chemotherapy versus platinum-based chemotherapy alone in patients with recurrent or metastatic nasopharyngeal carcinoma
Authors: Zhu Yunshu , Yang Sheng , Zhou Shengyu , Yang Jianliang , Qin Yan , Gui Lin , Shi Yuankai , He Xiaohui
Published: September 2020

Background:

Palliative chemotherapy has been the mainstay treatment for patients with recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC). However, little is known about the efficacy and toxicity of nimotuzumab (NTZ) – a monoclonal antibody drug targeting epidermal growth factor receptor – plus chemotherapy (CT) versus CT alone for these patients.

Methods:

The database at Cancer Hospital of Chinese Academy of Medical Sciences was queried for patients diagnosed with NPC who received CT with or without NTZ between 2004 and 2018. Treatment compliance, survival outcomes, and adverse effects were compared among these groups.

Results:

Records of 70 patients with R/M-NPC were reviewed: 21 (30%) received NTZ plus CT (NTZ+CT) and 49 (70%) received CT. CT regimens included gemcitabine plus platinum, taxane plus platinum (TP), and fluorouracil plus platinum. Comparing the CT group with NTZ+CT group, the median follow up was 62 months (range = 3–133) versus 59 months (range = 9–117); median progression free survival was 7.5 [95% confidence interval (CI) 6.552–8.381] months versus 8.5 (95% CI 6.091–10.976) months, p = 0.424; median overall survival (OS) was 25.6 (95% CI 18.888–32.379) months versus 48.6 (95% CI 35.619–61.581) months, p = 0.017, respectively. Multivariable analysis established treatment group (CT versus NTZ+CT) as an independent prognostic factor for OS (hazard ratio, 0.5; 95% CI 0.255–0.979; p = 0.043). No significant difference with regard to toxicities was observed between the two groups. Among them, a subgroup analysis was performed in 53 (75.7%) patients who received TP with or without NTZ, which showed similar results.

Conclusion:

Our findings suggested that NTZ+CT provides a novel treatment option and prolongs survival significantly for R/M-NPC.
Automated Insulin Delivery in Real Life (AID-IRL): Real-World User Perspectives on Commercial AID
Authors: Lewis Dana
Published: September 2020

Commercial automated insulin delivery (AID) systems are usually assessed based on clinical outcomes, ignoring uptake. A qualitative study evaluated user experiences when switching to currently available commercial AID. Interview feedback was coded on key themes including the adoption experience with regards to quality of life, clinical outcomes, and users’ expectations. Most felt their learning curve was easy. Most saw reduced hypoglycemia and increased time in range, although there were outliers. Many mentioned post-meal hyperglycemia as an improvement area for commercial AID. Users with one particular continuous glucose monitor (CGM) type reported sleep disruption. Companies should consider real-world user feedback with regards to improving training materials for new users with less CGM experience and by improving target flexibility and postprandial algorithm performance, plus reducing manual interventions required by users.
Pharmacological Activities of Coumarin Compounds in Licorice: A Review
Authors: Zang Yimei
Published: September 2020

Licorice is a traditional medicine commonly used in China and many other countries. Over the last 50 years, the structure and pharmacological effects of coumarin compounds in licorice have been investigated. However, a comprehensive review of the literature summarizing current trends is currently lacking. Thus, the aim of the present review is to provide an up-to-date summary of the scientific literature regarding the pharmacological effects of coumarin compounds in licorice, thereby laying the foundation for further research and optimal utilization of licorice. We retrieved 111 articles on the coumarin components of licorice and their potential pharmacological effects, based on titles, keywords, and abstracts from databases (including PubMed and Web of Science). Glycycoumarin, isoglycycoumarin, licoarylcoumarin, licopyranocoumarin, glycyrin, isotrifoliol, glycyrol, and glycyrurol have been investigated for their anticancer, hepatoprotective, antispasmodic, immunosuppressive, anti-inflammatory, and antibacterial properties, and use as therapeutic agents in metabolic syndrome, thereby demonstrating their potential for clinical applications. Future research should further explore the pharmacological mechanisms of action of coumarin compounds, including their antibacterial activities. Investigations into the pharmacological activities of different glycycoumarin isomers might open new research frontiers.
Feelings of Annoyance and Spoken Anger Words in Couples’ Everyday Lives: The Role of Family-of-Origin Aggression
Authors: Han Sohyun C. , Schacter Hannah L. , Timmons Adela C. , Kim Yehsong , Sichko Stassja , Pettit Corey , Margolin Gayla
Published: September 2020

Little is known about the words that romantic couples use during emotionally heightened moments such as when feeling annoyed with their partner. In the present study, young adult couples received mobile phones that audio-recorded 50% of their day and prompted hourly self-reports of partner-related annoyance. Actor–partner models tested within-person (hourly) and between-person (across the day) associations between feelings of annoyance and spoken anger words; furthermore, exposure to retrospectively assessed parent-to-child aggression (PCA) was examined as a moderator of these links. Men reporting more annoyance across the day as well as greater PCA used more overall anger words. For women, hourly anger words fluctuated in relation to men’s annoyance; moreover, greater PCA strengthened the link between women’s own hourly reported annoyance and anger words. Our findings highlight nuances in couples’ communication of everyday relationship distress and point to the role of PCA in next-generation romantic relationships.
G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
Authors: Morrow Olivia , Gibson Lucy , Bhamra Manraj , David Anthony S. , Posporelis Sotirios
Published: September 2020

Treatment of psychosis in Parkinson’s disease (PD) is challenging; pharmacological options are limited, with clozapine considered most effective. The risk of agranulocytosis restricts the use of clozapine, but, where this occurs, cautious re-challenge with granulocyte stimulating factor can be successful. We present a unique case of a patient who developed early-onset PD on a background of antecedent treatment-resistant schizophrenia, who had been treated effectively with clozapine for over 15 years with no adverse events. However, during a hospital admission intended to optimise her Parkinsonian medications, she developed persistent neutropenia necessitating clozapine discontinuation. Numerous attempts to re-challenge with clozapine failed until augmentation with lithium and G-CSF was trialled. Two doses of G-CSF led to a sustained increase in the neutrophil count, allowing the continuation of clozapine therapy in the 1 year of follow up. This illustrates the potential for G-CSF to be used to facilitate clozapine use in a patient population not described previously. Neutrophil augmentation allowed the sustained continuation of this effective therapy, treating her psychotic symptoms without detriment to her movement disorder. We suggest that G-CSF might be considered as a treatment option in other cases where clozapine-associated neutropenia obstructs its use.
Right heart catheterization for pulmonary hypertension during the coronavirus disease 2019 pandemic
Authors: Qaiser Kanza N. , Lane James E , Tonelli Adriano R.
Published: September 2020

Right heart catheterization is an essential diagnostic modality in the evaluation of pulmonary hypertension. The coronavirus disease 2019 pandemic has resulted in deferral of elective procedures including right heart catheterization. The benefits of proceeding with right heart catheterization, such as further characterization of hemodynamic subtype and severity of pulmonary hypertension, initiation of targeted pulmonary arterial hypertension therapy, as well as further hemodynamic testing, need to be carefully balanced with the risk of potentially exposing both patients and health care personnel to coronavirus disease 2019 infection. This review article aims to provide best clinical practices for safely performing right heart catheterization in pulmonary hypertension patients during the coronavirus disease 2019 pandemic.
Bridging the Skill Gap in Robotics: Global and National Environment
Authors: Shmatko Natalia , Volkova Galina
Published: September 2020

This article focuses on the demand for skills of highly qualified scientific and technical professionals (engineers and researchers) in robotics, on both a global and national level. Information is collected using the text-mining of open-access vacancies for understanding the global trends and in-depth interviews with experts for a more detailed study of national trends. The study explores the combination of hard and soft skills, as well as interdisciplinary skills. Soft skill requirements play an important role in the demanded skill set of the specialist, but the claims for hard skills (including digital) are not becoming less strict. Programming and the knowledge of specialized software packages are the most important skills, but must be combined with practical skills (assembly, welding, soldering). The broad range of application areas for robotic systems creates demand for new multidisciplinary skills (knowledge of artificial intelligence, new materials, and biology). Rapid technological development underlines the growing importance of soft skills, such as communication skills, self-motivation, and a willingness to learn. Lists of the most demanded skills in different countries principally coincide. Results can be applied for developing policies aimed at eliminating the skill gap in prospective technological areas.
Biomechanical Stability of Primary and Revision Sacroiliac Joint Fusion Devices: A Cadaveric Study
Authors: Carbone Jake , Swink Isaac , Muzzonigro Thomas , Diehl Daniel , Oh Michael , Lindsey Derek P. , Yerby Scott , Cheng Boyle C.
Published: September 2020

Study Design:

An in vitro biomechanics study.

Objective:

To evaluate the efficacy of triangular titanium implants in providing mechanical stabilization to a sacroiliac joint with primary and revision sized implants.

Methods:

Ten lumbopelvic cadaveric specimens were tested in 4 stages: intact, pubic symphysis sectioned, primary, and simulated revision. Primary treatment was performed using 3 laterally placed triangular titanium implants. To simulate revision conditions before and after bone ingrowth and ongrowth on the implants, 7.5-mm and 10.75-mm implants were randomly assigned to one side of each specimen during the simulated revision stage. A 6 degrees of freedom spinal loading frame was used to load specimens in 4 directions: flexion extension, lateral bending, axial torsion, and axial compression. Biomechanical evaluation was based on measures of sacroiliac joint rotational and translational motion.

Results:

Both primary and revision implants showed the ability to reduce translational motion to a level significantly lower than the intact condition when loaded in axial compression. Simulated revision conditions showed no statistically significant differences compared with the primary implant condition, with the exception of flexion-extension range of motion where motions associated with the revised condition were significantly lower. Comparison of rotational and translation motions associated with the 7.5- and 10.75-mm implants showed no significant differences between the treatment conditions.

Conclusions:

These results indicate that implantation of laterally placed triangular titanium implants significantly reduces the motion of a sacroiliac joint using either the primary and revision sized implants. No statistically significant differences were detected when comparing the efficacy of primary, 7.5-mm revision, or 10.75-mm revision implants.
Effects of Caffeine on Intervertebral Disc Cell Viability in a Whole Organ Culture Model
Authors: Raines Benjamin T. , Stannard James T. , Stricklin Olivia E. , Stoker Aaron M. , Choma Theodore J. , Cook James L.
Published: September 2020

Study Design:

Controlled laboratory study.

Objective:

To investigate the impact of exposure to physiologically relevant caffeine concentrations on intervertebral disc (IVD) cell viability and extracellular matrix composition (ECM) in a whole organ culture model as potential contributing mechanisms in development and progression of IVD disorders in humans. Primary outcome measures were IVD viable cell density (VCD) and ECM composition.

Methods:

A total of 190 IVD whole organ explants from tails of 16 skeletally mature rats—consisting of cranial body half, endplate, IVD, endplate, and caudal body half—were harvested. IVD explants were randomly assigned to 1 of 2 groups: uninjured (n = 90) or injured (20G needle disc puncture/aspiration method, n = 100). Explants from each group were randomly assigned to 1 of 3 treatment groups: low caffeine (LCAF: 5 mg/L), moderate caffeine (MCAF: 10 mg/L), and high caffeine (HCAF: 15 mg/L) concentrations.

Results:

Cell viability was significantly higher in the low-caffeine group compared with the high-caffeine group at day 7 ( P = .037) and in the low-caffeine group compared with the medium- and high-caffeine groups at day 21 ( P ≤ .004). Analysis of ECM showed that all uninjured and control groups had significantly higher ( P < .05) glycosaminoglycan concentrations compared with all injured groups. Furthermore, we observed a temporal, downward trend in proteoglycan to collagen ratio for the caffeine groups.

Conclusions:

Caffeine intake may be a risk factor for IVD degeneration, especially in conjunction with disc injury. Mechanisms for caffeine associated disc degeneration may involve cell and ECM, and further studies should elucidate mechanistic pathways and potential benefits for caffeine restriction.
Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?
Authors: Divi Srikanth N. , Makanji Heeren S. , Kepler Christopher K. , Anderson D. Greg , Goyal Dhruv K. C. , Warner Eric D. , Galetta Matthew S. , Hilibrand Alan S. , Kaye I. David , Kurd Mark F. , Radcliff Kristen E. , Rihn Jeffrey A. , Woods Barrett I. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: September 2020

Study Design:

Retrospective cohort study.

Objective:

The goal of this study was to determine whether the absolute size (mm2), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention.

Methods:

MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics—including size of disc herniation (mm2), size of spinal canal (mm2), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)—were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses.

Results:

The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, P = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], P = .002) or disc extrusion (OR 11.5 [1.63, 81.2], P = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], P = .017, and OR = 5.46 [1.77, 16.8], P = .003, respectively).

Conclusions:

Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.
Physical Examination Is Predictive of Cauda Equina Syndrome: MRI to Rule Out Diagnosis Is Unnecessary
Authors: Zusman Natalie L. , Radoslovich Stephanie S. , Smith Spencer J. , Tanski Mary , Gundle Kenneth R. , Yoo Jung Uck
Published: September 2020

Study Design:

Cross-sectional cohort study.

Objectives:

Cauda equina syndrome (CES) is a neurologic emergency, and delay in diagnosis can result in irreversible impairment. Our purpose was to determine the value of physical examination in diagnosis of CES in patients complaining of bladder and/or bowel complications in the emergency department.

Methods:

Adult patients at one tertiary academic medical center that endorsed bowel/bladder dysfunction, underwent a lumbar magnetic resonance imaging (MRI), and received an orthopedic spine surgery consultation from 2008 to 2017 were included. Patients consulted for trauma or tumor were excluded. A chart and imaging review was performed to collect demographic, physical examination, and treatment data. Sensitivity, specificity, and negative and positive predictive values were calculated, and fast-and-frugal decision trees (FFTs) were generated using R.

Results:

Of 142 eligible patients, 10 were diagnosed with CES. The sensitivity and specificity of the exam findings were highest for bulbocavernosus reflex (BCR) (100% and 100%), followed by rectal tone (80% and 86%), postvoid residual bladder (80% and 59%), and perianal sensation (60% and 68%). The positive predictive value was high for BCR (100%), but low for other findings (13% to 31%). However, negative predictive values were consistently high for all examinations (96% to 100%). Two FFTs utilizing combinations of voluntary rectal tone, perianal sensation, and BCR resulted in no false negatives.

Conclusions:

A combination of physical examination findings of lower sacral function is an effective means of ruling out CES and, with further study, may eliminate the need for MRI in many patients reporting back pain and bowel or bladder dysfunction.
Intravascular Large B-Cell Lymphoma Presenting as Acute Axonal Polyneuropathy: A Case Report and Literature Review
Authors: Minish Jordan M. , Kelkar Amar H. , Mehta Amol R. , Gaffar Maira , Dang Nam H.
Published: September 2020

Intravascular large B-cell lymphoma (ILBL) is a rare and difficult to diagnose subtype of large B-cell lymphoma. The most common locations of presentation are in the central nervous system and the skin, but there are reports of other organ involvement. Due to the indolence, nonspecific symptoms, and rarity of the disease, this form of lymphoma is most often diagnosed postmortem. In this article, we describe a case of ILBL that presented as a rapidly progressive acute axonal polyneuropathy. Acute axonal polyneuropathy is a common disease process with a wide differential diagnosis, but there is limited literature on its prevalence as the presenting symptom of ILBL. This patient was treated with R-EPOCH and intrathecal methotrexate with significant improvement in his polyneuropathy after 1 cycle, and complete remission after 6 cycles. Data on chemotherapy regimens and their success rates for this disease are lacking.
The Changing Landscape in Home Care: Human Factors Opportunities
Authors: Bass Ellen J.
Published: September 2020

Payment models and associated episode period changes have placed pressures on home care agencies with respect to data collection and documentation burden. Related topics of interest to the human factors community therefore are worthy of investigation in the home care space. In addition to more traditional human factors studies, multidisciplinary collaborative research on the impact of payments models is necessary to ensure that issues related to documentation burden are eliminated and that home care agencies can continue to provide care to the millions of homebound patients needing their help.
Human factors: bridging artificial intelligence and patient safety
Authors: Choudhury Avishek , Asan Onur
Published: September 2020

The recent launch of complex artificial intelligence (AI) in the domain of healthcare has embedded perplexities within patients, clinicians, and policymakers. The opaque and complex nature of artificial intelligence makes it challenging for clinicians to interpret its outcome. Incorrect interpretation and poor utilization of AI might hamper patient safety. The principles of human factors and ergonomics (HFE) can assist in simplifying AI design and consecutively optimize human performance ensuring better understanding of AI outcome, their interaction with the clinical workflow. In this paper, we discuss the interactions of providers with AI and how HFE can influence these interacting components to patient safety.
Team trust and performance in pediatric trauma
Authors: Coppola Sarah , Webster Kristen , Gurses Ayse
Published: September 2020

Pediatric trauma cases involve multiple healthcare workers and a complicated coordination of care. The differing roles and changing hospital schedules means that trauma teams are constantly changing and each trauma case may involve a new team. Trust in these dynamic, high stakes environment is important for team performance. A survey on team trust, psychological safety, and team learning behavior was circulated by email to all roles that respond to the highest level trauma at a large, Midatlantic, level 1 pediatric trauma center. Seventy-seven participants responded and represented the emergency department, pediatric intensive care unit, surgery, respiratory therapy, pharmacy, technician, child life, social work, and spiritual care. The respondents generally scored high on measures of psychological safety; however, the majority (69%) did not agree that it was safe to take a risk on the team. Similarly, the respondents scored high on measures of team trust. Measures of team learning varied with the majority responding neither agree nor disagree on “In this team, someone always makes sure that we stop to reflect on the team's work process,” “People in this team often speak up to test assumptions about issues under discussion,” and “We invite people from outside the team to present information or have discussions with us”. The results show that these responses also vary by role and home department, but these differences were not statistically significant. Understanding current perceptions of team trust and learning will allow for targeted interventions to improve team communication and performance in pediatric trauma.
IRL relational dependence in Swedish trauma teams- a Social Network Analysis of communication
Authors: Fornander Liselott , Kaukkanen Kati , Molin Ida , Nilsson Lena , Karlsson Karin Björnström , Wåhlin Isis Amer , Bergren Peter
Published: September 2020

Functional teamwork in trauma resuscitation teams is essential for team performance and the quality of care. Challenging situations put strain on the teams, which can affect how coordination is achieved. Proposedly there is a relation between the adapted social structure of the team and the acquisition of a common mental model in the team, which facilitates task performance. From other studies it is proposed that the equality of reliance between team members and an open-structure of information sharing is coupled to the possibility of establishing shared goals and situational awareness within the team. This would correspond to low centralization in teams. This study assessed the social structure of IRL teams from trauma resuscitations through a Social Network Analysis (SNA) of communication. The analysis revealed that the examining physician was the most prominent communicator. However, the teams had over-all high degrees of centrality on more than one of its parts, making them high in centralization but not “star-like”. The study provides a snapshot of social relations IRL and hints about future possibilities of studying the dynamics of social interaction in emergency teams.
Application of a Participatory Ergonomic Approach for Scaling Handoff Redesign: A Pilot Feasibility Study
Authors: Gliga Louise , Lynch Isaac , Preble Richard , Greilich Philip
Published: September 2020

Transitions of care between clinical areas are potentially dangerous events in healthcare. This is especially true in high risk areas, such as between the operating room (OR) and the intensive care unit (ICU). Despite the existence of best practice guidelines for perioperative handoffs, scaling up successful pilots remains a challenge. To more effectively address this limitation, we tested the feasibility of using a participatory ergonomic approach for scaling handoff redesign and implementation in an academic medical center. A multidisciplinary unit-based change team of representatives and influencers was supported by a guidance team of leaders, coaches and subject matter experts through a structured implementation process (plan, engage, execute, reflect). The participatory design incorporated a modified Delphi technique, simulation, and facilitated debriefing to elicit feedback in multiple iterative cycles. The redesigned handoff became the preferred approach by frontline clinicians across the involved disciplines and resulted in a sustained improvement in conformance to unit-determined handoff best practices. The success of this feasibility pilot has led to the support of a diffusion pilot for scaling up handoff redesign within the health system. The study supports further investigation of using a participatory ergonomics approach to engage frontline clinicians and executive leadership to scale complex sociotechnical change, like handoffs and care transitions.
Assessing Whether Recognition Skill Development is Enhanced with Augmented Reality-Based Training as Compared to Traditional Training: A Laboratory Study
Authors: Hernandez Olivia K. , San Miguel Christopher E. , Militello Laura , Sushereba Christen , Wolf Steve , Allen Theodore T. , Bahner David , Amin Sabrina , Mansour Lauren , Chirumamilla Varshita , Patterson Emily S.
Published: September 2020

Immersive technology such as virtual, augmented, and mixed reality has been used in entertainment. Applying this technology for educational purposes is a natural extension. We tested the ability of immersive technology to enhance medical education within a scenario about progressively worsening tension pneumothorax using a virtual patient. The goals of the study were 1) to determine whether those in the experimental group were better able to differentiate between normal and abnormal perceptual cues, and 2) to obtain feedback about the Augmented Reality (AR) training experience. For this study, the control group received traditional textbook training about tension pneumothorax. The experimental group received the same textbook training plus the AR tension pneumothorax scenario. An augmented reality headset was used to display a virtual patient on a table for the experimental group participants. All participants completed a pre and post-training knowledge test. Changes in the score of the accuracy from pre-post tests were used to establish whether the experimental group was better able to classify the perceptual cues. All participants responded to questions about the training experience at the end of the session. We discuss whether adding augmented reality training allowed medical students to better discern between abnormal and normal cues, and report our insights for what learning objectives AR can support in simulation-based training.
A Simplified System Usability Scale (SUS) for Cognitively Impaired and Older Adults
Authors: Holden Richard J.
Published: September 2020

We present the 10-item Simplified System Usability Scale (SUS) for Cognitively Impaired and Older Adults, which we have used in several studies since 2016. The Simplified SUS is a revised version of the SUS, a brief, psychometrically valid, and widely used global measure of usability. To improve the ease of administration, the Simplified SUS rewords 9 of 10 SUS items and replaces the original SUS question about inconsistency with a question about confusion. The Simplified SUS retains the SUS's 10-item design, five-item agreement-based Likert scale, and alternating valence of positively worded odd items and negatively worded even items. Because of this, the Simplified SUS can be interpreted the same way as the traditional SUS. The Simplified SUS is an example of an off-the-shelf human factors method adapted for work with vulnerable populations and usable by practitioners or researchers without human factors training.
Assessing Decision Support Needs of those in Mental Health Crisis Utilizing Cognitive Task Analysis
Authors: Johnson Amanda J. , Bisantz Ann M. , Reynolds Amy L. , Meier Scott T.
Published: September 2020

Extended Abstract

Previous research has shown that mental health diagnoses can impact cognitive functioning and decision-making abilities (Bosaipo et al 2017; Stergiopoulos et al 2015; Bora and Pantelis 2015; Rock et al 2014). Decision making difficulties can be particularly problematic when individuals in mental health crises are faced with decisions about their safety and wellbeing. Despite research establishing cognitive and decision-making difficulties for this population, there is an absence in the literature concerning decision support needs of those individuals. Human factors professionals possess a unique set of methods and skills to address these needs and support individuals to make healthier, safer decisions using the latest technologies. This research was part of a larger project aimed at design of a decision support based mobile application that would support individuals during mental health crises. Other phases of the research will include additional user requirements gathering, iterative prototyping, heuristic evaluation, and user testing.
Comparative Effectiveness of Best Practice Alerts with Active and Passive Presentations: A Retrospective Study
Authors: Valvona Sharon N. , Rayo Michael F. , Abdel-Rasoul Mahmoud , Locke Linda J. , Rizer Milisa K. , Moffatt-Bruce Susan D. , Patterson Emily S.
Published: September 2020

We assess the relationship of active or passive presentation of Best Practice Advisories (BPAs) for hospital clinicians with compliance rates of recommended actions. We identify the design characteristics of alerts that can be used to assess the effectiveness of design choices with superior usability. Alerts in Electronic Health Records (EHRs) are frequently overridden by healthcare providers. Identifying characteristics of effective alerts can increase the frequency that actions recommended in evidence-based care guidelines are done, reduce user frustration, and improve interface usability along with the willingness to use alerts. We conducted a retrospective analysis of data for 11 BPAs between June 2014 and May 2015. The outcome measure was the percent correspondence with recommended actions. A repeated measures regression model was used for the correlation of the BPA presentation type with the outcome measure. The BPA presentation type was significant such that the odds are 7.7 times greater that a recommended action would be taken by a provider with an active BPA presentation type after adjusting for whether an action was required. Active presentation alerts achieve higher compliance rates. CDS alerts that actively interrupted the provider’s workflow were associated with a higher compliance rate with recommended actions.
A Comprehensive Survey of Preference for Personal Health Record Features in Patients with Diabetes
Authors: Knisely Benjamin M. , Vaughn-Cooke Monifa
Published: September 2020

Individuals with diabetes often do not adequately adhere to self-management regimens. Personal Health Record (PHR) systems can aid patients with diabetes in managing their disease by encouraging patient provider communication, providing education and lifestyle information, and providing tools for disease management. While demonstrated to be a useful tool, PHR acceptance among chronic disease patients is low. This study investigated the influence of certain patient characteristics on interest in PHR features. Patients were asked to rate how often they would likely use certain PHR features. Statistical analysis was performed on the data. The analysis revealed several patterns regarding desired features for patients with respect to patient knowledge, technology experience, and health state. Designers of these systems should consider how these factors can influence system use. Strategies for encouraging patients to continually use these systems should also be considered.
A Design of Mobile Application for Ultrasound Bladder Monitoring System Based on Usability Engineering
Authors: Park Sangeun , Oh Hyungyeong , choi Jeonguk , Jang Wonseuk
Published: September 2020

Patients with voiding dysfunction need continuous treatments as well as bladder ultrasonography, surgical procedures and medication. Ultrasound bladder monitoring healthcare system can help non-invasive treatment as a bladder training. This system uses wearable patch sensor so that patients can monitor their bladder volume as an indicator of voiding and be recommended voiding at a proper time. In this study, the mobile application for the system is designed and evaluated based on optimized clinical workflow and safety. This study included the design of clinical application models for users and the development of user interface complying with usability engineering process.
Enhancing Usefulness and Usability of a Clinical Decision Support Prototype for Antibiotic Stewardship
Authors: Patterson Emily S. , DiLoreto Giavanna N. , Vanam Rohith , Hade Erinn , Hebert Courtney
Published: September 2020

Human factors engineering can enhance software usefulness and usability. We describe a multi-method approach to improve clinical decision support (CDS) for antibiotic stewardship. We employed a heuristic review to generate recommendations to improve the usability of a prototype CDS to support empiric antibiotic prescribing in the hospital setting. We then engaged in a design improvement cycle in collaboration with software programmers, which resulted in additional enhancements to our prototype. Finally, we used the revised prototype during three walkthrough demonstration interviews with physician and pharmacist subject matter experts. These walkthrough interviews generated recommendations to improve the interface, functionality, and tailoring for groups of users. We discuss common elements of the recommendations for models for using clinical decision support in general.
Measuring Information Management at MCI Simulation: Instruments Evaluation and Comparison
Authors: Perry Omer , Jaffe Eli , Bitan Yuval
Published: September 2020

Introduction: Information management (also known as “communication” or “gathering and analyzing information”) is one of the core tasks of MCI (Mass-Casualty Incident) commanders during the chaotic prehospital phase.1 To train EMS (emergency medical service) personnel on how to manage an MCI efficiently, simulation drills are conducted in which participant performance is evaluated. As such, varied instruments have been developed to measure information management quality during MCI simulations. Since every instrument could lead to different results, our goal at the current study was to evaluate what are the advantages of applying each one of the instruments.

Methods: Three instruments were chosen for the current study: (1) The Self-Assessment Teamwork Tool for Students (SATTS), (2) a set of performance indicators aimed to be scored by an experienced observer, and (3) Dynamic Information Management Quantification Instrument (DIMQI) which allows quantifying information items. All instruments were applied to the same MCI simulation.

Results and Conclusions: Applying each of the instruments yielded a different layer of information. Thus, researchers and instructors consider using all three instruments as they are complementary to each other.
Using a Fuzzy Framework for applying King’s Theory of Goal Attainment to Improve Hospital Acquired Infection Resilience
Authors: Platt Lisa Sundahl , Fronczek Ann
Published: September 2020

This article explores techniques for estimating Hospital Acquired Infection prevention potential through strategic nursing care delivery design and applied fuzzy frameworks. To achieve this, it evaluates the use of Fuzzy Logic directed by King’s Theory of Nursing Goal Attainment for developing a HAI resilience process model. The purpose of this model is to estimate the performance of environment of care safety based on the ability of nurses to moderate risk and respond adaptively to certain types of hospital-onset infections through strategic workflow design. The aim of this proposed approach would be to help nurses and infection control specialists in healthcare settings better understand what accessible Systems Science-based frameworks may be instrumental for analyzing and forecasting infection control systems improvement. The benefit of using Fuzzy Frameworks in nursing workflow and environment of care planning is that it allows for the leveraging of crystalized intelligence nursing staff have about their patient demography and unit-based workflow. This process allows nurse work designers to introduce and test targeted process or physical improvement strategies that make sense for their unique circumstances while providing better insight into how these interventions may work holistically with all relevant environment of care operations. This approach is made more powerful when guided by trusted optimal nursing theoretical perspectives such as King’s Theory of Goal Attainment.
Understanding Practices and Critical Success Factors of FDA Human Factors Validation Projects – Preliminary Findings
Authors: Rojas Katia M. , Cosler Leon , Santos Daryl L.
Published: September 2020

Since the FDA published guidance on the application of human factors engineering to medical devices and combination products, the concerns about the quality and success of human factors validation projects have put a strain on key stakeholders. Failed HF validation submissions can have serious negative impact not only on manufacturers and HF service providers, but also on the regulatory system and patients. Previously, we remarked on the need for alignment between key stakeholders, and strategies that increase the quality and success of HF validation projects. Leveraging the application of project management was recommended for that purpose. However, there is currently no research about characteristics, practices and critical success factors of these projects. An online survey instrument was developed tailored to this specific context to inform the development of an industry-focused project management maturity assessment tool (which will be Phase II of this research). In this opportunity, the high-level, preliminary findings are presented and briefly discussed. This effort contributes much needed literature regarding the current practices and factors that influence the quality and success of FDA HF validation projects.
Mitigating Cardiovascular Risk Through User Informed Clinical Decision Support
Authors: Schubel Laura , Stein Lucy , Romero Ronald , Miller Kristen
Published: September 2020

As the volume of data within the electronic health record (EHR) increases, there is an evident need for user-friendly and efficient clinical decision support tools developed to assist with patient assessment. Risk calculators, specifically for atherosclerotic cardiovascular disease (ASCVD), are examples of surveillance tools that intend to quantify and predict patient risk of suffering a cardiovascular event. However, despite reported frequent use by clinicians, risk calculators exist largely outside of the EHR, requiring external navigation and increasing the likelihood of user error. Using a mixed methods approach to development, the present research mitigates the challenges posed by external surveillance platforms and discusses the process of designing and optimizing a clinical tool intended to address ASCVD risk at the point of care. These methods ultimately resulted in a risk calculator with both provider- and patient-facing platforms, data autopopulating functionality, and customizable and flexible integration within the provider’s EHR workflow.
Cognitive Aids for Successful Implementation of Perioperative Handoff Improvement
Authors: Sparling Jamie L.
Published: September 2020

A handoff is the effective communication of essential information to enable transfer and acceptance of patient responsibility from one clinician (or group of clinicians) to another. These critical exchanges often occur during times of high cognitive load and are frequently plagued with distractions. Poorly executed handoffs are known to contribute to patient harm. Cognitive aids are tools, such as visual aids, mnemonics, or checklists, that are used to aid memory during cognitive tasks, and have been used as a component of many handoff improvement programs. To date, cognitive aids have been used to consistently improve both task adherence and team performance during simulated perioperative crises. Ongoing research is evolving towards relating these improvements with patient outcomes and informing optimal cognitive aid design. Despite limited evidence for applying cognitive aids specifically for handoff improvement, there is broad expert consensus endorsing their use as a component of effective handoffs. Important lessons from cognitive aid design and implementation include the use of a multidisciplinary team, iteratively improving the tool based on feedback, the use of clinician champions, and the importance of leadership support.
A continuum of human factors considerations, from medical device development to hospital implementation
Authors: Tran Fiona F. , Yin Shanqing
Published: September 2020

Today’s medical devices are the product of many human factors considerations. Beyond the device design, healthcare organizations increasingly incorporate usability as a factor in medical device procurement. Yet, organizations’ visibility into evidence of a product’s usability is often constrained to marketing materials or results of studies executed using in-house resources. In the process from medical device development to implementation in clinical environments, a communication gap remains between the human factors professionals in medical device development and those in healthcare organizations studying the same product for adoption and implementation. This gap limits organizations’ ability to accurately review product options. This gap also results in lost opportunities for healthcare organizations to inform manufacturers’ future medical device development. A new paradigm for communicating human factors work across the full continuum of the product life cycle is essential for both manufacturers and healthcare organizations seeking to improve patient safety and effective use.
Cost vs. Benefit: What does NVivo Video Analysis of EMR Simulations Add to Our Understanding of User Experience?
Authors: Lovelace Samantha , Trudel Chantal , Dulude Catherine , King W. James
Published: September 2020

Improving healthcare using phased, iterative and participatory methods requires time and resources to do comprehensively. The reality, particularly for practitioners, is that constraints related to human resources, cost and time may impact the rigor of data collection and analysis. Under such conditions, project teams may rely on tacit knowledge and expertise to fill in potential gaps in understanding and validate design decisions. But what kind of insights might emerge if we were freed from such constraints, and given the time to study a context in more detail? Our research group explored this question by using Computer Assisted Qualitative Data Analysis Software (NVivo) and qualitative research coding methods to analyze a sample of video data collected from a series of electronic medical record (EMR) workflow simulations that were originally used to support EMR implementation in a pediatric hospital. The results from the NVivo video analysis revealed some details not previously captured by initial data analysis methods, but at significant resource cost. A comparison of video analysis methods, findings and respective costs are compared and discussed in the context of design development and implementation.
Testing the Untestable: Mitigating Simulation Bias During Summative Usability Testing
Authors: Unger Nicholas R.
Published: September 2020

A literature review was conducted on the topic of sources of simulation bias, as it applies to test design and use scenario creation for simulated-use studies, on medical devices for FDA submission. When it comes to Summative Usability Testing, there isn’t room for simulation bias to impact the data collected. From working with clinicians to design more realistic/appropriate clinical scenarios, to traveling to medical simulation labs to set up a realistic operating room simulation, we, as researchers, are constantly learning and improving our testing designs to ensure that they are as realistic as possible. This poster will look at current research and study logistics to provide best practices for identifying common sources of simulation bias and mitigating those sources during your Summative Evaluation.