bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Question of Knowledge in Evidence-Based Design for Healthcare Facilities: Limitations and Suggestions
Authors: Rashid Mahbub 
Published: February 2015

OBJECTIVE: To help designers and researchers and other proponents of evidence-based design (EBD) overcome limitations concerning knowledge categorization and acquisition of evidence-based design (EBD). BACKGROUND: The evidence-based design (EBD) approach for healthcare facilities has been widely embraced by both designers and researchers in recent years; however, there are some limitations concerning knowledge categorization and acquisition of EBD. These limitations include an overemphasis on empirical knowledge gained by experimental research, a narrow focus that excludes design knowledge generated outside healthcare and allied fields, and a lack of interest in empirical knowledge gained by qualitative studies. In order to overcome these limitations, the proponents of EBD must acknowledge that design knowledge relevant to healthcare design can be found in disciplines unrelated to healthcare; that design knowledge does not always need empirical validation; and that design knowledge of the semantic kind can be more easily accessed and understood through qualitative studies. CONCLUSIONS: To reassess the foundations of knowledge of EBD with moderated skepticism is necessary because there are philosophical and analytical problems yet to be overcome in delivering on the promises of EBD. To question and reassess the foundations of knowledge base of EBD is not necessarily to deny its value, but rather to stimulate a judicious and balanced appraisal of its limitations so that, in future, we are able to take necessary steps to overcome these limitations.
The Role of the Hospital Environment in the Prevention of Healthcare-Associated Infections by Contact Transmission
Authors: Steinberg James P. , Denham Megan E. , Zimring Craig , Kasali Altug , Hall Kendall K. , Jacob Jesse T. 
Published: February 2015

OBJECTIVE: This article describes the role of the hospital environment in the spread of pathogens by direct and indirect contact. In addition, the prevention of transmission through interventions involving the built environment is discussed. BACKGROUND: The hospital environment can become contaminated with pathogenic microorganisms, some of which can persist for long periods of time. Although contamination is common, the contribution of the hospital environment to the development of healthcare-associated infections remains unclear. In part spurred by the development of newer technologies to enhance environmental cleaning or to prevent contamination, research into the role of the environment in causing healthcare-associated infections has accelerated. TOPICAL HEADINGS: A review of the recent literature finds an increasing body of evidence implicating contaminated surfaces in patient care areas in the transmission of pathogens and the development of infections. Single-patient rooms and optimally placed alcohol hand rub dispensers and other design features can mitigate infection risk. Enhanced environmental cleaning including touchless technologies and self-cleaning surfaces can reduce environmental contamination and may prevent infections. CONCLUSIONS: The hospital environment contributes to transmission of pathogens in hospitals and to the development of healthcare-associated infections. Newer technologies to prevent environmental contamination or to enhance cleaning are promising although additional studies with the endpoints of reduction of infections are needed before the role of these technologies is known.
Rehabilitation Centers in Change: Participatory Methods for Managing Redesign and Renovation
Authors: Lahtinen Marjaana , Nenonen Suvi , Rasila Heidi , Lehtelä Jouni , Ruohomäki Virpi , Reijula Kari 
Published: February 2015

OBJECTIVE: The aim of this article is to describe a set of participatory methods that we have either developed or modified for developing future work and service environments to better suit renewable rehabilitation processes. We discuss the methods in a larger framework of change process model and participatory design. BACKGROUND: Rehabilitation organizations are currently in transition; customer groups, financing, services, and the processes of rehabilitation centers are changing. The pressure for change challenges the centers to develop both their processes and facilities. There is a need for methods that support change management. METHODS: Four participatory methods were developed: future workshop, change survey, multi-method assessment tool, and participatory design generator cards. They were tested and evaluated in three rehabilitation centers at the different phases of their change process. RESULTS: The developed methods were considered useful in creating a mutual understanding of the change goals between different stakeholders, providing a good picture of the work community's attitudes toward the change, forming an integrated overview of the built and perceived environment, inspiring new solutions, and supporting the management in steering the change process. CONCLUSIONS: The change process model described in this article serves as a practical framework that combined the viewpoints of organizational and facility development. However, participatory design continues to face challenges concerning communication between different stakeholders, and further development of the methods and processes is still needed. Intervention studies could provide data on the success factors that enhance the transformations in the rehabilitation sector.
The Influence of Ambient Scent and Music on Patients' Anxiety in a Waiting Room of a Plastic Surgeon
Authors: Fenko Anna , Loock Caroline 
Published: February 2015

OBJECTIVE: This study investigates the influence of ambient scent and music, and their combination, on patients' anxiety in a waiting room of a plastic surgeon. BACKGROUND: Waiting for an appointment with a plastic surgeon can increase a patient's anxiety. It is important to make the waiting time before an appointment with the surgeon more pleasant and to reduce the patient's anxiety. Ambient environmental stimuli can influence people's mood, cognition, and behavior. This experimental study was performed to test whether ambient scent and music can help to reduce patients' anxiety. METHODS: Two pre-studies ( n = 21) were conducted to measure the subjective pleasantness and arousal of various scents and music styles. Scent and music that scored high on pleasantness and low on arousal were selected for the main study. The field experiment ( n = 117) was conducted in the waiting room of a German plastic surgeon. The patients' levels of anxiety were measured in four conditions: (1) without scent and music, (2) with lavender scent; (3) with instrumental music; (4) with both scent and music. RESULTS: When used separately, each of the environmental factors, music and scent, significantly reduced the level of patient's anxiety compared to the control condition. However, the combination of scent and music was not effective in reducing anxiety. CONCLUSIONS: Our results suggest that ambient scent and music can help to reduce patients' anxiety, but they should be used with caution. Adding more ambient elements to environment could raise patients' level of arousal and thus increase their anxiety.
A Hospital's Contemporary Art Collection: Effects on Patient Mood, Stress, Comfort, and Expectations
Authors: Karnik Meghana , Printz Bellamy , Finkel Jennifer 
Published: February 2015

OBJECTIVE: It is not firmly established whether an art collection of diverse subject matter, media, and imagery in the hospital environment can play a significant role in mitigating the psychological stresses and physical pain associated with a hospital visit, or whether it improves patients' satisfaction with their care. The variety of contemporary art displayed in the institution investigated in this paper served as a case study to assess the qualitative and quantitative effects of such a collection on patient health and experience. We sought to assess whether the diversity in subject matter, imagery, and media would positively affect patient mood, comfort level, stress level, and expectation of visit. BACKGROUND: Previous research concluded that nature art (i.e., representational depictions of nature) has positive effects on patient health outcomes. Studies to date have assessed the effects of individual units of artwork rather than that of an art collection as a whole. METHODS: A survey was sent to 4,376 members of an online Patient Panel, comprised of patients who volunteer to evaluate their experiences at Cleveland Clinic. For this study, Panel members were screened based on whether they had been to the Main Campus in the past 12 months. RESULTS: A majority of respondents noticed the artwork, had improved moods and stress levels due to the artwork, and reported that the art collection positively impacted their overall satisfaction and impression of the hospital. CONCLUSIONS: Our findings demonstrate that this particular collection has a significant effect on the patient experience and on self-reported mood, stress, comfort, and expectations. These results suggest that patients may respond positively to the diversity of the collection, and to other types of art in addition to nature art.
Environmental Cues: Their Influence within Assisted Living Facilities
Authors: Wood-Nartker Jeanneane , Guerin Denise A. , Beuschel Emily 
Published: February 2015

OBJECTIVE: This observational study examined the relationship between the number of environmental sensory cues within assisted living facilities (ALFs) and the number of falls by residents, using Lawton's environmental press theory as framework. BACKGROUND: A result of declining physical health is unintentional injury, for example, falling, which is one of the leading causes of death for older adults. Physical limitations increase largely due to age-related physical and sensory decline, which can increase the risk of people falling. Therefore, fall prevention becomes essential ( Willis, 2000 ). METHODS: On-site interviews were scheduled with 140 ALF directors located in the lower peninsula of Michigan. The researchers collected physical environmental data using a sensory cue checklist on a subset of rooms, for example, Lounge/Living Room, Dining Room, Corridor, Public Restroom, and Foyers in ALFs, because of the prevalence of falls within these rooms. RESULTS: Findings showed that fall rates and environmental cues sometimes have a negative correlation. A positive correlation was found between the number of residents living in an ALF and the mean number of cues included in the overall environment. Finally, there were a greater number of environmental cues incorporated when design professionals were involved. CONCLUSIONS: The need to control for facility size and for some room types when relating environmental cues to falls became clear. In addition, design professionals should have a thorough understanding of the nature of the facility and the need to control some factors in facilities, especially when including environmental cues.
Messages from Space: An Exploration of the Relationship between Hospital Birth Environments and Midwifery Practice
Authors: Hammond Athena D. , Homer Caroline S. E. , Foureur Maralyn 
Published: February 2015

OBJECTIVE: To explore the relationship between the birth environment and the practice of midwifery using the theoretical approach of critical realism. BACKGROUND: The practice of midwifery has significant influence on the experiences and health outcomes of childbearing women. In the developed world most midwifery takes place in hospitals. The design and aesthetics of the hospital birth environment have an effect on midwives and inevitably play a role in shaping their practice. Despite this, knowledge about midwives' own thoughts and feelings regarding the design of hospital birth environments is limited. METHODS: An exploratory descriptive methodology was used and 16 face-to-face photo-elicitation interviews were conducted with practicing midwives. Audio recordings were made of the interviews and they were transcribed verbatim. Thematic analysis, informed by the theoretical framework of critical realism, was undertaken. RESULTS: Midwives identified cognitive and emotional responses to varied birth environments and were able to describe the way in which these responses influenced their practice. The overarching theme of “messages from space” was developed along with three sub-themes: messages, feelings, and behaviors. Midwives' responses aligned with the three domains of a critical realist world-view and indicated that a relationship existed between hospital birth environments and midwifery practice. CONCLUSIONS: The design of hospital birth rooms may shape midwifery practice by generating cognitive and emotional responses, which influence the activities and behaviors of individual midwives.
Comparative Analysis of Hospital Energy Use: Pacific Northwest and Scandinavia
Authors: Burpee Heather , McDade Erin 
Published: February 2015

OBJECTIVE: This study aimed to establish the potential for significant energy reduction in hospitals in the United States by providing evidence of Scandinavian operational precedents with high Interior Environmental Quality (IEQ) and substantially lower energy profiles than comparable U.S. facilities. These facilities set important precedents for design teams seeking operational examples for achieving aggressive energy and interior environmental quality goals. This examination of operational hospitals is intended to offer hospital owners, designers, and building managers a strong case and concrete framework for strategies to achieve exceptionally high performing buildings. BACKGROUND: Energy efficient hospitals have the potential to significantly impact the U.S.'s overall energy profile, and key stakeholders in the hospital industry need specific, operationally grounded precedents in order to successfully implement informed energy reduction strategies. This study is an outgrowth of previous research evaluating high quality, low energy hospitals that serve as examples for new high performance hospital design, construction, and operation. Through extensive interviews, numerous site visits, the development of case studies, and data collection, this team has established thorough qualitative and quantitative analyses of several contemporary hospitals in Scandinavia and the Pacific Northwest. Many Scandinavian hospitals demonstrate a low energy profile, and when analyzed in comparison with U.S. hospitals, such Scandinavian precedents help define the framework required to make significant changes in the U.S. hospital building industry. METHODS: Eight hospitals, four Scandinavian and four Pacific Northwest, were quantitatively compared using the Environmental Protection Agency's Portfolio Manager, allowing researchers to answer specific questions about the impact of energy source and architectural and mechanical strategies on energy efficiency in operational hospitals. RESULTS: Specific architectural, mechanical, and plant systems make these Scandinavian hospitals more energy efficient than their Pacific Northwest counterparts. More importantly, synergistic systems integration allows for their significant reductions in energy consumption. CONCLUSIONS: This quantitative comparison of operational Scandinavian and Pacific Northwest hospitals resulted in compelling evidence of the potential for deep energy savings in the U.S., and allowed researchers to outline specific strategies for achieving such reductions.
Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation
Authors: Manganelli Joe , Threatt Anthony , Brooks Johnell O. , Healy Stan , Merino Jessica , Yanik Paul , Walker Ian , Green Keith 
Published: February 2015

OBJECTIVE: This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more useful, usable, and actively assistive over-the-bed table. BACKGROUND: Manganelli et al. (2014) generated a list of 74 needs for use in developing an actively assistive over-the-bed table. This present study assesses the value and importance of those needs. METHODS: Fourteen healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process. A mixed methods qualitative approach used methodological triangulation to confirm the value of the findings and ratings to establish importance. Open and closed card sorts and a Delphi study were used. Data analysis methods included frequency analysis, content analysis, and a modified Kano analysis. RESULTS: A table demonstrating the needs that are of high importance to both groups of subject matter experts and classification of the design challenges each represents was produced. Through this process, the list of 74 needs was refined to the 37 most important need statements for both groups. CONCLUSIONS: Designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients.
Positioning Patient Status Monitors in a Family Waiting Room
Authors: Margolies Rebecca , Gurnaney Harshad , Egeth Marc , Fink Nicole , Soosaar Jennifer , Shames Adam , Rehman Mohamed 
Published: February 2015

Objective: To determine where to place patient status displays for family members in the operating room family waiting room at The Children’s Hospital of Philadelphia. Methods: We calculated the percentage of seats from which wall monitors placed in hypothetical positions would be usable. We validated the usability of the new monitors by observing nonemployees’ use of monitors in the waiting room 1 week before and 1 week after implementation. Results: Compared to the legacy monitor, the new monitors were observed to be used from more locations within the waiting room and more people were observed to use the new monitors soon after entering the waiting room. Conclusions: Seemingly trivial decisions like where in a waiting room to place monitors can be informed by careful data collection and the consequences can observably impact communication between hospital staff and family members waiting for loved ones in surgery.
Sex-Specific Predictors of Intra-articular Injuries Observed During Anterior Cruciate Ligament Reconstruction
Authors: Kluczynski Melissa A. , Marzo John M. , Rauh Michael A. , Bernas Geoffrey A. , Bisson Leslie J. 
Published: February 2015

Background: Male patients tend to have more meniscal and chondral injuries at the time of anterior cruciate ligament (ACL) reconstruction than females. No studies have examined sex-specific predictors of meniscal and chondral lesions in ACL-injured patients. Purpose: To identify sex-specific predictors of meniscal and chondral lesions, as well as meniscal tear management, in patients undergoing ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from 689 patients (56.2% males) undergoing ACL reconstruction between 2005 and 2014. Predictors of meniscal tears, meniscal tear management, and chondral injuries were determined using multivariate logistic regression models stratified by sex. Predictors were age, body mass index (BMI; 25-29.99 and ≥30 vs ≤24.99 kg/m2), mechanism (contact vs noncontact) and type (high-impact sports [basketball, football, soccer, and skiing] and other sports vs not sports-related) of injury, interval from injury to surgery (≤6 vs >6 weeks), and instability episodes (vs none). Odds ratios and 95% CIs were reported. Results: Males had more lateral (46% vs 27.8%; P < .0001) and medial (40.2% vs 31.5%; P = .01) meniscal tears, as well as more lateral (72.1% vs 27.9%; P < .0001) and medial (61.4% vs 38.6%; P = .01) meniscectomies than females. For males, age predicted chondral injuries and medial meniscectomy; BMI ≥30 kg/m2 predicted medial meniscal tears; high-impact and other sports predicted medial meniscal tears, medial meniscectomies, and medial meniscal repairs; injuries ≤6 weeks from surgery predicted lateral meniscal repairs; and instability episodes predicted medial meniscal tears, medial tears left in situ, medial meniscectomies, and medial meniscal repairs. For females, age predicted chondral injuries, BMI ≥30 kg/m2 predicted lateral meniscectomies and repairs, and instability episodes predicted medial meniscectomies. Conclusion: Sex differences were observed. For males, predictors included age, BMI, sports-related injuries, injuries ≤6 weeks from surgery, and instability episodes. For females, predictors included age, BMI, and instability episodes.
Does Labral Size Correlate With Degree of Acetabular Dysplasia?
Authors: Gupta Asheesh , Chandrasekaran Sivashankar , Redmond John M. , Hammarstedt Jon E. , Cramer T. Luke , Liu Yuan , Domb Benjamin G. 
Published: February 2015

Background: Hip dysplasia has been shown to be a cause of early arthritis. The decrease in bony coverage has shown increased stress on the acetabular labrum as it shares an increased load. Purpose/Hypothesis: The purpose of this study was to divide a cohort of patients by radiographic measures of dysplastic and nondysplastic hips for comparison with regard to labral size at 4 anatomic locations. The hypothesis was that dysplastic hips will have significantly larger labral size compared with nondysplastic hips. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective study was conducted at a single institution. A total of 130 patients underwent hip arthroscopy during the study period from September 2011 to February 2012. Intraoperatively, arthroscopic measurements were taken at 4 quadrants on the acetabular clockface: anterosuperior (12-3 o’clock), anteroinferior (3-6 o’clock), posterosuperior (9-12 o’clock), and posteroinferior (6-9 o’clock). Three radiographic parameters for dysplasia were used to substratify the study population base: lateral center-edge angle (LCEA) ≤25° and LCEA >25°, acetabular inclination (AI) ≤10° and AI >10°, and anterior center-edge angle (ACEA) ≤20° and ACEA >20°. Results: For the LCEA ≤25° group, there were 28 hips with mean LCEA of 20.96° ± 3.40°. Patients with LCEA ≤25° had larger labral width in all 4 quadrants ( P < .05). For AI >10°, there were 12 hips with the mean AI 12.92° ± 2.50°. Patients with AI >10° had larger labral size in the posteroinferior quadrant only ( P < .05). For ACEA ≤20°, there were 4 hips with a mean ACEA of 11.25° ± 5.19°. The anteroinferior and posteroinferior quadrants had a significant increase in labral size when substratified by ACEA ≤20° ( P < .05). Conclusion: Labral size was significantly larger in dysplastic hips compared with nondysplastic hips. The posteroinferior quadrant labrum was larger in size in dysplastic hips, as measured by any of the 3 radiographic measurements of dysplasia. Hips with LCEA ≤25° had larger labra in all 4 quadrants.
Plasminogen associates with phosphatidylserine-exposing platelets and contributes to thrombus lysis under flow
Authors: Whyte Claire S. , Swieringa Frauke , Mastenbroek Tom G. , Lionikiene Ausra S. , Lancé Marcus D. , van der Meijden Paola E. J. , Heemskerk Johan W. M. , Mutch Nicola J. 
Published: February 2015

Key PointsUnder physiological flow rates, plasminogen primarily accumulates on fibrin(ogen), emanating from platelets and initiates fibrinolysis. Plasminogen is localized to defined “caps” on the surface of PS-exposing platelets in a fibrin(ogen)-dependent manner.