bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Opportunities and Challenges Prior to Transitioning to Digital Pathology: An Interview Envisioning Study with 11 Pathologists
Authors: Patterson Emily S. , Mansour Lauren , Gurcan Metin N. , Li Zaibo , Parwani Anil
Published: September 2019

There is growing interest in implementing whole-slide imaging (WSI) for primary diagnosis. Ten subspecialized pathologists (2-39 years of experience) were interviewed from diverse subspecialty areas in a large academic medical center. Relevant semi-structured interview questions included image quality, workflow, and usability during clinical use. Analysis revealed that WSI implementation would raise some concerns: 1) delaying turn-around time for preliminary diagnoses as well as final reports, 2) delaying access to order ancillary tests, which could impact scheduling for some patients for follow-on surgery, 3) making it hard to track what has been reviewed and at what level of magnification, 4) potentially increase wrist pain from using a mouse or neck pain while viewing the monitor, and 5) increase vulnerability when a computer, monitor, or network goes down. However, WSI implementation would enable 1) increased flexibility for slide access remotely during nights, weekends, and work trips, 2) easier consults among peers and with mentors, 3) easier detection and recovery when images are routed to the wrong person, 4) creating digital libraries, including previous slides from a current patient, and 5) giving greater access to images for presentations, publications, and to other clinical personnel. Implementing digital slides and associated workflow will introduce many challenges and barriers. Studies such as the current one are much needed to explore the pathologist’s perspective on these workflow and implementation challenges prior to and during the installation of the digital pathology systems. These perspectives are important to understand in order to improve the experience of the pathologists and lab personnel as they interact with these systems.
Impact of Electronic Medical Records on Patient-Provider Communication
Authors: Zahabi Maryam , Lyman Adriana
Published: September 2019

Previous research found electronic medical records (EMRs) to have negative impact on patient-provider (PP) communication. However, very few studies were focused on specific age ranges especially young generation. The objectives of this study were to: (1) assess the perception of young adults and healthcare providers regarding the effect of EMRs on PP interaction; and (2) investigate the use of cognitive modeling as an analytical tool to predict the impact of EMRs on PP communication. Findings suggested that young adults have positive opinion regarding the use of EMRs during outpatient visits. Cognitive task perfor-mance modeling has the potential to predict visual, cognitive, and motor demands associated with using EMRs. Future studies should be conducted to improve the generalizability of findings.
Digital Divide Among Caregivers of Chronic Disease Patients
Authors: Olagoke Ayokunle , Kaur Harveen , Hughes Ashley M.
Published: September 2019

Expansive and rapid growth of technology creates unprecedented patient access to health information, including timely communication with care providers via patient portals and the ability to access information regarding specific disease(s) (e.g., cancer). However, several forms of digital engagement with health providers require access and use of reliable internet access. A “digital divide” is used to describe demographic differences which contribute to a patient’s use or disuse of patient portals; prior research have noted disparities in lack of reliable internet access. Despite the prevalence of informal caregivers in patient care, little is known about internet access and use among informal caregivers of patients with chronic disease. This study leveraged the 2017 Behavioral Risk Factor Surveillance System (BRFSS) dataset to determine population level characteristics of caregiver factors which may contribute to their internet access and use. Findings illuminate informal caregivers primarily care for patients with illnesses relating to aging, including dementia. We also found that non-use of the internet (NUI) was higher among caregiver groups who informally provided care between 20-39 hours/week as opposed to those with 0-8 hours of provided care each week. Unlike caregivers of asthma, cancer and dementia; caregivers of substance use, diabetes, HIV and chronic respiratory disease patients reported higher NUI. Future studies should target the specific needs of informal caregivers such that tools promoting patient engagement and access to resources do not unintentionally neglect this user group.
Digital Healthcare: Moving beyond the data input/out problem toward enhancing clinical judgment
Authors: Flach John , Reynolds Peter , Duryee Libby , Young Bryan , Graley Jeff
Published: September 2019

The design of digital information management systems for healthcare presents developers with several formidable engineering challenges. These systems must manage huge amounts of data and support communications across disparate platforms and divisions within a healthcare organization. They must ensure that data is kept private, secure, and available to the right people at the right time. However, as shown in other complex systems (e.g., nuclear power), simply making data available may be insufficient. The goals in designing digital healthcare as a ‘cognitive system’ are to present patient information in more meaningful ways, to help healthcare professionals become more productive, and to support healthcare professionals with clinical decision making. This paper describes how principles of cognitive systems engineering (CSE) and user experience (UX) design were applied to Cardiac Consultant, an interactive cardiovascular risk calculator, with those goals in mind.
Beyond Disease: Technologies for Health Promotion
Authors: Holden Richard J. , Valdez Rupa S.
Published: September 2019

Health promotion is defined by the World Health Organization as “the process of enabling people to increase control over their health and its determinants, and thereby improve their health.” This is different from the bulk of formal healthcare processes, which are characterized by the treatment of an established disease. Much important human factors research and practice has been done to improve the healthcare delivery process and increasingly human factors professionals are also involved in work on health promotion. Such work has included examining the use and usability of wearable fitness tracking devices, studies of online health information seeking by healthy individuals, and human factors research on social robots for older adults, to name but a few examples. We discuss human factors applications in health promotion, focusing on examples from technology-related research.
After Visit Summary: Not an Afterthought
Authors: Sieferd Edward , Mohanty Nivedita , Holden Richard J.
Published: September 2019

The After Visit Summary (AVS) is provided to patients after clinical visits to summarize what happened during the visit and guide future care. Despite its potential to improve shared decision-making, self-management, and communication, the design of the typical AVS is not optimized to communicate useful information in an understandable way. The AVS usability challenge is magnified in vulnerable patient populations such as those served by community health centers (CHCs). The purpose of this research was to evaluate and refine a redesigned AVS intended to better communicate information to CHC patients.
Measuring Performance in an Electronic Health Record (EHR) based Simulation Using the Situation Awareness Global Assessment Technique
Authors: Rasooly Irit , Orenstein Evan , Grundmeier Robert , Muthu Naveen
Published: September 2019

Simulation is an educational approach well suited to development of knowledge and decision-making skills for emergent or infrequent scenarios. Electronic Health Record (EHR) based simulation, in which participants retrieve information from a simulated EHR, provides an authentic training environment with fidelity to the typical clinical decision-making process and has been associated with enduring changes in EHR use patterns. However, we do not know whether these behavior changes reflect better decision-making. We aimed to develop a measure of pediatric resident performance in an EHR based simulation using the Situation Awareness Global Assessment Technique (SAGAT).
Applying UCD and ZET to Develop a Cloud-Based Real Time Solution for Air Quality Monitoring and Its Effects on Child and Maternal Health in Mongolia
Authors: da Nobrega Raphael Mendonca , De Vera Kristina , Sereeter Ulziisaikhan , Chuluunbaatar Bataa , Abdallah William Abi , Heikens Alex , Morita Plinio
Published: September 2019

Air pollution is responsible for 4.2 million premature deaths every year. Studies have proven that Ulaanbaatar, the capital city of Mongolia, is one of more polluted cities in the world. As a result, Mongolia is suffering from major public health challenges. Mongolia currently lacks quality data, evidence and information to analyze and understand the full impact of air pollution on maternal and child health. This lack of understand has led to Family Health Centres (FHCs) and hospitals in Mongolia to be overwhelmed and unprepared to adequately treat air pollution related diseases. In response to this problem, UNICEF Mongolia and Ubilab will use User-Centered Design (UCD) and Zero-effort technology to create an online platform that will use predictive analytics to strengthen the understanding of the impact air pollution has on maternal and child health. This platform will better prepare healthcare practitioners to deal with the public health consequences associated with air pollution and the data generated from this platform will be used to inform policy, health care reforms, and develop educational materials. This study is a great opportunity to demonstrate how UCD and ZET can be effective to achieve goals within a global health perspective, but it would be challenging to overcome the economic and cultural barriers in the design and implementation process. However, if successful, this would enhance collaboration between environment and health-related institutions and can be implemented anywhere in the world, especially in areas where air pollution is a major problem.
Can Eye Tracking be Used to Predict Performance Improvements in Simulated Medical Training? A Case Study in Central Venous Catheterization
Authors: Chen Hong-En , Bhide Rucha R. , Pepley David F. , Sonntag Cheyenne C. , Moore Jason Z. , Han David C. , Miller Scarlett R.
Published: September 2019

Manikins have traditionally been used to train ultrasound-guided Central Venous Catheterization (CVC), but are static in nature and require an expert observer to provide feedback. As a result, virtual simulation and personalized learning has been increasingly adopted in medical education to efficiently provide quantitative feedback. The Dynamic Haptic Robotic Trainer (DHRT) trains surgical residents in CVC needle insertions by simulating various patient profiles and presenting personalized feedback on objective performance. However, no studies have examined the learning gains of the personalized learning feedback or the relation of feedback to what the user is focusing on during the training. Thus, this study was developed to determine the effectiveness of the current personalized learning interface through a long-term investigation with 7 surgical residents. The eye tracking analysis showed that residents spent significantly more time fixated on percent aspiration throughout the study; the more time participants spent looking at the Number of Insertions, Percent Aspiration and the Angle of Insertion on the DHRT GUI, the better they performed on subsequent trials on the DHRT system.
Predicting Mortality with Applied Machine Learning: Can We Get There?
Authors: Patterson Emily S. , Hansen C.J. , Allen Theodore T. , Yang Qiwei , Moffatt-Bruce Susan D.
Published: September 2019

There is growing interest in using AI-based algorithms to support clinician decision-making. An important consideration is how transparent complex algorithms can be for predictions, particularly with respect to imminent mortality in a hospital environment. Understanding the basis of predictions, the process used to generate models and recommendations, how to generalize models based on one patient population to another, and the role of oversight organizations such as the Food and Drug Administration are important topics. In this paper, we debate opposing positions regarding whether these algorithms are ‘ready yet’ for use today in clinical settings for physicians, patients and caregivers. We report voting results from participating audience members in attendance at the conference debate for each of these positions obtained real-time from a smartphone-based platform.
A Toolkit for Evaluating Interventions to Improve Decision Making: The Garden Path Approach
Authors: Fernandez Simon , Militello Laura , Sushereba Christen , Bahner David , Barrie Michael , Patterson Emily S.
Published: September 2019

We propose a toolkit for objectively evaluating the effectiveness of new technologies for improving human cognitive performance. In complex socio-technical systems such as nuclear power generation and air traffic management, garden path scenarios have been effectively used to anchor initial inaccurate hypotheses that are then monitored for movement towards the correct hypotheses as increasing evidence over time makes it easier to change the diagnosis. The time to come to an accurate diagnosis in a well-crafted simulation scenario with an initial inaccurate anchor hypothesis is an objective, repeatable measure of performance for the macrocognition function of sensemaking. The time to verbalize the recognition of critical cues, which becomes increasingly less subtle over time, as well as the time to move from the inaccurate diagnosis at one of the correct diagnoses in the complete diagnostic set can all be reliably measured and compared in an across-subject study design. Modifications with conceptually matched scenarios using within-subject designs can also be employed if asymmetric learning effects are managed.
Patient and Provider Comfort and Concerns in Mobile Health Application Use in Healthcare
Authors: Call Mark , Dolman Sarahfaye , Miller Kristen
Published: September 2019

Early implementation of telehealth and mHealth technologies have illustrated the positive potential impact these technologies can have on the healthcare domain. Leveraging mobile device capabilities has the potential to facilitate patient engagement and improve provider-to-patient communication, thus improving patient outcomes. A cross-sectional study surveyed provider and patients to gauge mobile use regarding current mHealth activities as well as concerns and comfort of both parties when using this technology. Results revealed that age, income, type of insurance, and employment mediated either patient comfort and concerns; whereas provider role was the only factor mediating provider concerns. Patients had significantly higher levels of concern when compared to providers. These results can be leveraged to focus effort in implementing and developing telehealth and mHealth technologies.
Usability of a Home-Use Blood Pressure Monitor System: An Evaluation of the Device and Instructional Materials
Authors: Chong Isis , Cha Jackie , Peng Frank , Yu Denny
Published: September 2019

Although advancements in home-use technologies have allowed users to take control over how they monitor their health, their likely inexperience with such technologies can lead to use errors. The study aimed to determine the usability of a home-use blood pressure monitor, which included the device and instructional materials. Nineteen participants completed a 45-minute study which included an out-of-the-box handling scenario without moderator facilitation. The primary goal of this scenario was to determine if participants would be able to classify their heart rate reading obtained from the heart rate monitor as either low, average, or high in accordance to the thresholds set by the device. Although a majority of users were able to complete the use scenario, users nonetheless experienced major use errors and had difficulty with correctly placing the blood pressure cuff on their arm or inadvertently inflated the cuff when simply trying to turn on the device. There were also differences in the instructional materials such as how users should place the cuff around their arm. These inconsistencies were exacerbated by ambiguous wording without any pictorial clarifications. Additionally, 10% of users were unable to locate information on how to interpret their blood pressure readings. These findings highlight the importance of studying the usability of at-home blood pressure monitors to ensure more accurate health monitoring of users.
The Impact of Noise and Message Content on Message Elaboration of Psychiatric Help-Seeking Information – A Pilot Study
Authors: Neo Jeffrey , Shepley Mardelle , Niederdeppe Jeff , Won Andrea Stevenson
Published: September 2019

The decision to access healthcare resources and psychiatric treatment may be impacted by information provided in the external environment. For messages about depression, how and where messages are delivered may be critical to whether an individual seeks help. In this study, participants were placed in a simulated environment and asked to provide ratings of state anxiety, message elaboration, psychiatric help-seeking intentions, mental health anxiety, trait anxiety, and attitudes towards psychiatric help-seeking after 30 minutes. Overall, the study revealed that (1) the subjects in a high noise condition reported a higher level of state anxiety than subjects in a low noise condition, and (2) the effect of state anxiety on message elaboration depends on anxiety-relatedness. The study improves our understanding of the relationships between state anxiety, mental health anxiety, and trait anxiety. The results also offer implications for mental health communication as a critical path to depression treatment.
Patients in Pain: The Effects of Oxytocin on Trust and Decision Making
Authors: Long Preston A. , Freeman Harry
Published: September 2019

Oxytocin (OT) is a naturally occurring hormone produce by the hypothalamus. While a growing body of work has focused on the role of OT in modulating human social cognition, a somewhat neglected but promising area of study is how OT effects pain perception and pain behavior. Animal studies consistently support OT as an analgesic but human studies are few and somewhat mixed. The current study explores whether the analgesic effect of OT diminish maladaptive decision making associated with pain, both directly and indirectly. At the same time, pain-related positive social behaviors such as trust and cooperation, may be heightened under the influence of oxytocin. Intranasal OT (24 IU) versus placebo trials were separated by a one-week washout period. The primary outcome measures include three indicators of change in social capital, including trust, cooperation, and safety perceptions. Furthermore, the analgesic effect of OT on pain sensitivity is evaluated in the context of interactive effects with pro social decision making. Behavioral rating scales examined delayed discounting, impulsivity, and loss aversion. In addition to behavioral measures, urine samples were collected to assess subject OT saturation and saliva samples were collected to test for genetic markers associated with pain and trust. We first examined if OT has a main effect (i.e., generalized) on pain perception and secondly, if pain-related social behavior is moderated by OT. Results support OT as a potential analgesic. Additionally, OT may not only act to relieve pain but may also reinforce other adaptive social behaviors exhibited by people in pain.
Drowsy Driving Among Shift Work Nurses: A Qualitative Data Analysis
Authors: Smith Alec , Sasangohar Farzan , McDonald Anthony D. , Bonuel Nena , Shui Holly , Ouko Christine , Lazaro Lorelie
Published: September 2019

Drowsy driving claims many lives every year. While all drivers are susceptible to the problem of drowsy driving, the nurse population is of particular concern. Studies have shown the severity of drowsiness for night shift nurses both at work and on the drive home. Many work and non-work factors contribute to the drowsiness that nurses experience. This study used a semi-structured interview approach to gain the perception and experiences of nurses concerning drowsy driving and possible interventions. Interviews were conducted at a large hospital in south central Texas with 30 night shift nurses. Visualizations depicting nurses’ responses are presented to aid in the understanding of the themes derived from the interviews. The nurses experience drowsy driving on a regular basis, use ineffective mitigation techniques and have differing preferences for an educational and technological intervention for drowsy driving. An emergent theme was how work and non-work factors work in conjunction to impact the nurses’ experiences of drowsy driving. Potential, implementable solutions regarding some of these factors are presented.
Evaluating Human Patient Simulation Fidelity and Effectiveness for Combat-Medical Training
Authors: Winner Jennifer , Millwater Teresa L.
Published: September 2019

Two leading causes of survivable combat deaths are hemorrhage and airway compromise. Although individual medical-training competency requirements are met using human-patient simulation (HPS), the evaluation of fidelity and HPS impact on training outcomes are not well documented. Research has documented physical fidelity concerns when comparing human anatomy to simulators, but has largely overlooked informational needs such as visual, auditory, and tactile cues for patient assessment. Training impact is often characterized by changes in confidence; however, the Dunning-Kruger effect suggests that overconfidence is pervasive. The purpose of this paper is to provide perspective on the research needs to ensure human-patient simulation meets the requirements for combat-medic training.
Association Between Perceived Workload and Adverse Body Posture
Authors: Nino Valentina , Marchak Frank , Claudio. David
Published: September 2019

Work Related Musculoskeletal Disorders (WMSDs) can be a result of complex interactions between physical, psychosocial, biological, and individual characteristics. However, the evidence on specific associations is still inconclusive. A previous study conducted at a Sterile Processing Department (SPD) in a local hospital established an association between perceived job demands and adverse body postures. However, causal inferences were not possible to establish given the study design. Consequently, the objective of this study was to determine if perception of mental workload causes workers to use more risky body postures. Objective and subjective assessment tools (REBA and NASA-TLX scores) were used as indicators of body postures and mental workload. The findings indicated that there is a positive relationship between the perception of workload (NASA-TLX scores) and adverse body postures (REBA scores) suggesting that people tend to adopt more awkward postures when they feel they are in a rush condition or they have more things to do
The Impact of a Training Device on Perception and Performance by Novice Users of an Autoinjector
Authors: Garafalo Jenna , Li Huiyang , Lau Michael
Published: September 2019

The study was conducted to understand the effects of having access to different training materials in the interim between training and first use of an injection device for 27 injection-naïve participants. Participants were told they would be giving themselves a real injection of saline in the return session, and were not told that they would use injection pads until after subjective data was gathered during session 2. This deception paradigm was used to increase the external validity of the study. Participants self-trained in one of three conditions based on what they were given to take home: instructions for use, mechanical trainer, and/or a training video. Participants self-trained in session 1, performed a simulated injection in the session 2 two weeks later, and completed three online surveys in the interim. In session 2, a majority of participants were able to achieve minimally acceptable performance to deliver the medication during the simulated use of the autoinjector. Participants who took home a mechanical trainer had fewer use deviations than those who did not have the trainer at home. This difference was only seen in injection specific subtasks; performance on pre- and post-injection subtasks was low across all groups. Intermittent practice with a mechanical trainer was seen to improve performance on subtasks involved in the motor performance of the injection itself but did not impact performance or compliance with other tasks important to the injection. More holistic training solutions may be required to impact other aspects of the injection beyond the injection itself. While performance differed, subjective ratings did not differ, showing an overconfidence bias that may affect a user’s ability to self-report competence in device use.
Guidelines for Mobile Health Applications
Authors: Abts Natalie A. , McNicol Stephanie A. , Branaghan Russell J.
Published: September 2019

Mobile health (mHealth) is a fast-growing industry that facilitates the management of healthcare by both patients and healthcare providers (Zapata, et al, 2015). The growing popularity of this platform and general lack of regulatory oversight has led to wide variation in adherence to sound human factors and usability principles. Thus, a set of guiding criteria would help developers streamline their processes through standardization. As part of a project referred to as the Xcertia Guidelines, a workgroup of industry experts and stakeholders developed guidelines for incorporating usability principles into the development of mHealth applications. Using an iterative process, the workgroup conducting research to generate content covering 10 distinct topic areas for a draft publication released in February, 2019. After an open comment period, an updated version of the guidelines will be released to the public.
A Framework for Communication in Complex Healthcare Environments: The Case of the Electrophysiology Lab
Authors: Garfield M. Robert , Tiferes Judith
Published: September 2019

Team communication challenges compound the complexity of healthcare environments. While there is a significant body of research on team interaction in surgical and operating room settings, there is limited research in more specialized use environments such as the electrophysiology (EP) lab where an interdisciplinary team supports the diagnostics and interventional correction of the heart’s electrical timing. This work proposes a novel framework to uncover and classify team communication pathways in complex healthcare environments via a case study of the EP lab. Designers of integrated medical systems should study the communication practices and communication barriers of intended users to drive better user needs and design inputs.
A Pilot Study of the Shape of a Mask Sheet for Adult Women With Their Mouths Open
Authors: Morishima Mika , Mitsuno Tamaki
Published: September 2019

Masks are used in daily life, as useful hygiene products, for purposes such as guarding against pollen and facilitating cough etiquette. When worn to prevent and control infection in daily life, it is important that the mask fits the wearer’s face perfectly. Even when the wearer is talking, the mask sheet must adapt to the wearer’s face. Therefore, the present study considers a mask sheet pattern with high fit performance for female wearers based on measured three-dimensional (3D) female facial shapes with the mouth either closed or open. Comparing the closed-mouth facial shapes with open-mouth ones, a mask sheet pattern is sought, deformation amounts of sheet area and length in the pattern while opened mouth.
A Narrative Review of FDA Human Factors Validation Requirement: The Needs of Key Stakeholders and Proposal of an Industry (Human Factors Service Providers) Maturity Assessment Tool
Authors: Rojas Katia M. , Cosler Leon , Santos Daryl L.
Published: September 2019

As part of a comprehensive Quality System Regulation (QSR), the human factors (HF) validation requirement by the Food and Drug Administration (FDA) is a relatively recent topic. Multiple issues and bottlenecks have emerged since the publication of the draft guidance in 2011. The scientific literature on the topic of ‘FDA HF validation requirement’ is mostly focused on HF methods to ensure success from that perspective. However, the development of across-the-board strategies that can address other critical factors is necessary. No previous scientific research has outlined and addressed the problems considering the QSR and the needs of key stakeholders. For that purpose, this effort presents a narrative review of how the HF requirement for medical devices and combination products developed, as well as the issues and the interventions that have taken place to address the bottlenecks. Some essential considerations such as notorious knowledge-based and process-based gaps are discussed. Similarly, because of the demands of a changing QSR, attention is brought to the need to align key stakeholders, namely manufacturers and HF service providers (HFSPs). Also, the development of an industry (HFSPs) maturity assessment tool and future research for that purpose are proposed.
How Does It All Unfold? The Role of Format Layout in the User Experience of Medical Instructions for Use
Authors: Williamson Rebecca
Published: September 2019

Well-designed instructions for use (IFUs) reduce medical device risk and facilitate regulatory review. This study evaluated two common IFU formats (booklet and foldout) to identify benefits and drawbacks for comprehension and use. In an A/B usability test, 16 adults simulated the preparation of a dose of medicine and were asked to find critical information using instructions in each of the formats. They then compared the two formats and completed a standardized health literacy assessment. Our results showed that the foldout presented an accessible overview of the steps while the booklet showed ease-of-use benefits, particularly for those with lower health literacy scores. Our results indicate that physical design decisions impact the user experience, and that they should be carefully evaluated to provide an optimal IFU.
Methods for Utilizing Multidisciplinary Team to Create Novel Visual Alarm Designs That Improve Recognition of Patient Decompensation and Alarm Response
Authors: Horwood Chelsea R. , Fitzgerald Morgan , Moffatt-Bruce Susan D. , Rayo Michael F.
Published: September 2019

The overwhelming number of alarms on medical center floors are false and nonactionable. This leads to delay in alarm response and adverse events. Furthermore, current alarm technology does not have the ability to display patient trends, it only displays one isolated patient event. This paper focuses on describing the methods for creating novel visual displays that incorporates alarm technology and patient decompensation events. Through a multi-disciplinary team approach, that is centered on human factors and system engineers, a novel visual display was created that integrated current alarm technology with patient data. The new displays were better able to predict decompensation and alarm validity. It is crucial to integrate partners from all facets of the medical community and from human factors and system engineering to form an accurate understanding and modeling of patients
Exploring Relationships Between Nurse-Patient Interactions and Duration of Emergency Room Triage
Authors: Boxley Christian , Stein Lucy , Wynn Rachel , Miller Kristen , Ratwani Raj , Fegley Brett , Ratwani Krista
Published: September 2019

We observed nurse-patient interactions during triage in an emergency department over the course of a two-month period. After 161 observations, we found no significant correlation between the percentage of interaction attributed to the patient and the amount of time the patient spent in triage. Additionally, this study found no correlation between the types of questions the nurse asks and the time patients spend in triage.
Descriptive Analysis of the Design, Implementation, and Evaluation of Structured Anesthesia Handoff Protocols in Current Literature
Authors: Rickel Emily A. , Gisick Logan M. , Griggs Andrew C. , Simonson Richard J. , Keebler Joseph R. , Lazzara Elizabeth H.
Published: September 2019

The transfer of anesthesia patient information within a perioperative setting is susceptible to many barriers that prevent effective communication. Several studies have aimed to combat these barriers by successfully developing and implementing structured communication protocols. The purpose of this review is to provide a synthesis of the current state of literature in order to guide practice and future research into the development, implementation, and evaluation of anesthesia patient handoff protocols. Four databases were searched based on inclusion criteria, resulting in 33 studies that were reviewed for this analysis. Results show there are many methods used in current literature to design, implement, and evaluate anesthesia handoff protocols, suggesting little consensus for best practice. Future handoff studies should ensure they fully report all details associated with the development and evaluation of their anesthesia handoff protocols to promote replicability and guidance for other practitioners.
Score at the Door: A Retrospective Data Analysis of Sepsis scorinG Criteria in the Emergency Department
Authors: Bonk Christopher , Schubel Laura , Ferrell Brandon , Ramdeen Sanjhai , Littlejohn Robin , Ladkany Diana , Miller Kristen
Published: September 2019

The goal of this study was to assess the availability of the criteria of eight sepsis scoring methods (SIRS, NEWS, PRESEP, SOFA, qSOFA, SPEED, MEDS, and PIRO) within six hours of triage in the emergency department (ED). Data was analyzed through a retrospective collection of adult (age >18 years) patients presenting to the MedStar Washington Hospital Center (MWHC) emergency department between June 1, 2017 and May 31, 2018 and admitted with a sepsis or sepsis-related diagnosis that progressed to sepsis before discharge. Vital signs are frequently available upon arrival to the ED, while laboratory values tend to be available within three hours and often are not repeated again within the first six hours after arrival. The availability of patient data at different time points in a patient’s ED visit suggests that different scoring methods could be utilized to more effectively diagnose and accurately risk-stratify patients within the sepsis spectrum as more information about the patient becomes available.
How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate?
Authors: Doymaz Sule , Rizvi Munaza , Orsi Marguerite , Giambruno Clara
Published: September 2019

Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.
A Prospective Cross-Sectional Analysis of Construct Validity for the PALMPASS, A Brief Patient-Reported Outcome Measure for Psoriasis
Authors: Farahi Jessica M. , Lynn Darren , Anand Pratibha , Walsh Jessica A. , Hashim Mena , Duong Ryan , Dellavalle Robert P. , Reimold Andreas , Kerr Gail S. , Richards John S. , Chang Elizabeth , Kaushik Prashant , Dubreuil Maureen , Caplan Liron
Published: September 2019

Background:

While the Psoriasis Area and Severity Index (PASI) represents the most commonly used assessment tool for psoriasis severity, it has been criticized for its complexity in clinical practice.

Objective:

To validate a simplified 2-item patient-administered limited measure psoriasis area and severity score (PALMPASS) compared to standardized measure of psoriasis.

Materials and Methods:

This was a prospective observational survey of adult patients with psoriasis and psoriatic arthritis in Veterans Affairs Medical Center (VAMC) dermatology and rheumatology clinics participating in the Program to Understand the Longterm outcomes in SpondyloARthritis registry between January and June 2016 (n = 885). Patients at 7 US VAMCs (n = 363) completed a 2-item, 11-point PALMPASS questionnaire, assessing (1) how psoriasis affected the patient and (2) the degree of surface area involvement. Results from the PALMPASS were then compared to the PASI, the Psoriasis Symptom Inventory (PSI) and the Dermatology Life Quality Index (DLQI). Data were analyzed using Lin concordance, intraclass correlations, Spearman correlations, and linear regression.

Results:

Strong correlations existed between PALMPASS and PASI (Spearman ρ = 0.74, P < .001), PSI (Spearman ρ = 0.71, P = .001), and DLQI (Spearman ρ = 0.77, P < .001). Results were comparable in analyses based on intraclass correlations. Elevated C-reactive protein concentrations correlated with higher PALMPASS.

Conclusion:

The PALMPASS is a patient-reported instrument that demonstrates validity and serves as a reliable and simplified tool to guide evidence-based management.
The risk of asthma is increased among women with polycystic ovary syndrome: a twin study
Authors: Zierau Louise , Meteran Howraman , Backer Vibeke , Lindenberg Svend , Skytthe Axel , Thomsen Simon Francis
Published: September 2019

Background

Recent registry studies have demonstrated a higher prevalence of asthma among women with polycystic ovary syndrome (PCOS). We aimed to assess the association and heritability of PCOS and asthma in a Danish twin cohort.

Methods

Data for 32 382 female twins from the Danish Twin Registry were included. Twins with PCOS were identified by searching the Danish National Patient Registry for International Classification of Diseases-10 code E28.2. Asthma was diagnosed by questionnaires.

Results

103 (0.3%) women had a PCOS diagnosis. The risk of asthma was increased among women with PCOS compared with women without (18%versus9%, respectively; OR 2.11 (95% CI 1.13–3.96); p=0.02). After adjustment for age, body mass index, alcohol consumption and smoking status, the risk of asthma was still increased, but was no longer statistically significant (OR 1.54 (95% CI 0.75–3.17); p=0.24). Variance components analysis showed that shared environmental factors explained 49% (95% CI 24–68%) and unique environmental factors explained 51% (95% CI 32–76%) of the susceptibility to PCOS. For asthma, 44% (95% CI 28–61%) of the variance was explained by genetic factors, whereas 25% (95% CI 11–38%) was ascribable to shared environmental factors and 31% (95% CI 26–36%) to unique environmental factors.

Conclusion

The risk of asthma is twice as high among female twins with PCOS. The individual susceptibility to PCOS is mainly due to environmental factors and not genetics.
Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns
Authors: Khor Yet H. , Renzoni Elisabetta A. , Visca Dina , McDonald Christine F. , Goh Nicole S. L.
Published: September 2019

Domiciliary oxygen therapy is often prescribed for patients with hypoxaemia due to advanced lung disease, most commonly chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Long-term oxygen therapy (LTOT) trials conducted in patients with COPD in the 1980s remain the basis for clinical decisions and guideline recommendations regarding LTOT for patients with non-COPD conditions as there is a lack of high-quality evidence concerning its use in the non-COPD population. There is also a lack of evidence for the use of ambulatory and nocturnal oxygen therapy in patients with isolated exertional and nocturnal hypoxaemia. These deficiencies pose significant challenges in patient care, with consequent discrepancies in guideline recommendations and clinical approaches. In recent years, new studies have been and are currently being conducted to fill the gaps in our understanding and use of domiciliary oxygen therapy for other indications, including ILD. This article provides a comparison of the epidemiology and significance of hypoxaemia in patients with COPD and ILD, with an up-to-date review of current evidence regarding the role of different types of domiciliary oxygen therapy in these conditions.
Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties
Authors: Gäbler Martin , Ohrenberger Gerald , Funk Georg-Christian
Published: September 2019

Introduction

End-stage chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure are often treated by representatives from different medical specialties. This study investigates if the choice of treatment is influenced by the medical specialty.

Methods

An online cross-sectional survey among four Austrian medical societies was performed, accompanied by a case vignette of a geriatric end-stage COPD patient with acute respiratory failure. Respondents had to choose between noninvasive ventilation (NIV), a conservative treatment attempt (without NIV) and a palliative approach. Ethical considerations and their impact on decision making were also assessed.

Results

Responses of 162 physicians (67 from intensive care units (ICUs), 51 from pulmonology or internal departments and 44 from geriatric or palliative care) were included. The decision for NIV (instead of a conservative or palliative approach) was associated with working in an ICU (OR 14.9, 95% CI 1.87–118.8) and in a pulmonology or internal department (OR 9.4, 95% CI 1.14–78.42) compared with working in geriatric or palliative care (Model 1). The decision for palliative care was negatively associated with working in a pulmonology or internal department (OR 0.16, 95% CI 0.05–0.47) and (nonsignificantly) in an ICU (OR 0.41, 95% CI 0.15–1.12) (Model 2).

Conclusions

Department association was shown to be an independent predictor for treatment decisions in end-stage COPD with acute respiratory failure. Further research on these differences and influential factors is necessary.
Factors associated with non-attendance at scheduled infant follow-up visits in an observational cohort of HIV-exposed infants in South Africa, 2012–2014
Authors: Ngandu Nobubelo Kwanele , Jackson Debra , Lombard Carl , Nsibande Duduzile Faith , Dinh Thu-Ha , Magasana Vuyolwethu , Mogashoa Mary , Goga Ameena Ebrahim
Published: September 2019

Background

Since 2001 the South African guidelines to improve child health and prevent vertical HIV transmission recommended frequent infant follow-up with HIV testing at 18 months postpartum. We sought to understand non-attendance at scheduled follow-up study visits up to 18 months, and for the 18-month infant HIV test amongst a nationally representative sample of HIV exposed uninfected (HEU) infants from a high HIV-prevalence African setting.

Methods

Secondary analysis of data drawn from a nationally representative observational cohort study (conducted during October 2012 to September 2014) of HEU infants and their primary caregivers was undertaken. Participants were eligible (N = 2650) if they were 4–8 weeks old and HEU at enrolment. All enrolled infants were followed up every 3 months up to 18 months. Each follow-up visit was scheduled to coincide with each child’s routine health visit, where possible. The denominator at each time point comprised HEU infants who were alive and HIV-free at the previous visit. We assessed baseline maternal and early HIV care characteristics associated with the frequency of ‘Missed visits’ (MV-frequency), using a negative binomial regression model adjusting for the follow-up time in the study, and associated with missed visits at 18 months (18-month MV) using a logistic regression model.

Results

The proportion of eligible infants with MV was lowest at 3 months (32.7%) and 18 months (31.0%) and highest at 12 months (37.6%). HIV-positive mothers not on triple antiretroviral therapy (ART) by 6-weeks postpartum had a significantly increased occurrence rate of ‘MV-frequency’ (adjusted incidence rate ratio, 1.2 (95% confidence interval (CI), 1.1–1.4), p < 0.0001). Compared to those mothers with ART, these mothers also increased the risk of ‘18-month-MV’ (adjusted odds ratio, 1.3 (CI, 1.1–1.6), p = 0.006). Unknown infant nevirapine-intake status increased the rate of ‘MV-frequency’ (p = 0.02). Mothers > 24 years had a significantly reduced rate of ‘MV-frequency’ (p ≤ 0.01) and risk of ‘18-month-MV’ (p < 0.01) compared to younger women. Shorter travel time to health facility lowered the occurrence of ‘MV-frequency’ (p ≤ 0.004).

Conclusion

Late initiation of maternal ART and infant prophylaxis under the Option- A policy and extended travel time to clinics (measured at 6 weeks postpartum), contributed to higher postnatal MV rates. Mothers older than 24 years had lower MV rates. Targeted interventions may be needed during the current PMTCT Option B+ (lifelong ART to pregnant and lactating women at HIV diagnosis) to circumvent these risk factors and reduce missed visits during HIV-care.