Advances in Human Factors and Ergonomics in Healthcare and Medical Devices

Inhaltsverzeichnis

1. Frontmatter

2. Healthcare Advancement and Patient Safety

   1. Frontmatter

   2. Artificial Intelligence and Humanistic Medicine: A Symbiosis

      Jawahar (Jay) Kalra, Zoher Rafid-Hamed, Patrick Seitzinger

      Abstract

      Medicine is a human endeavor aided by a sophisticated set of diagnostic tools. Healthcare systems are challenged with incorporating new and unfamiliar technology into existing systems of practice. As diagnostic tools such as artificial intelligence have entered the realm of clinical practice, new opportunities have arisen to optimize healthcare delivery. Overreliance on AI may lead to the dehumanization of medicine. However, with appropriate implementation, AI can free up time and resources to allow healthcare providers to focus on aspects of care that are unique humanistic. Effective medical practice requires availability of data, application of information, and appropriate clinical judgement. A large portion of modern patient care takes place without the presence of the patient. AI has shown the potential to synthesize and summarize vast amounts of data from medical records, clinical trials, and best-practice guidelines. By tailoring all available data to each case, AI can serve as an asset in enhancing diagnostic accuracy and increasing the efficiency of healthcare delivery. However, clinical decisions made between patients and their physicians cannot be reduced to a set of parameters, code, or logic trees. Clinical judgment and the implementation of available information remains necessarily human tasks. Only through a strong therapeutic relationship built on trust and empathy can shared decision making and compliance be attained. We propose a framework through which AI and humanistic medicine can build on one another to create a symbiosis of the highest possible caliber of patient care and healthcare quality.

   3. Global Trends in Clinical Practice and Healthcare Delivery: Opportunities for Growth and Innovation

      Patrick Seitzinger, Zoher Rafid-Hamed, Jawahar (Jay) Kalra

      Abstract

      Balancing efficiency with healthcare quality is an emerging concern around the world. Deep-seated feedback loops are being realized in healthcare systems around the world, driving physician burnout, unnecessary healthcare costs, and suboptimal clinical outcomes. These are not localized or insignificant issues – they are present across cultures, continents, and all medical disciplines. Physician burnout is nearly doubling the rate of medical errors, and physicians involved in major errors are experiencing a threefold increase in suicidal ideation. As the complexity of health systems increases around the world, these trends continue to evolve and perpetuate one another. We have recommended that through non-punitive and interdisciplinary approaches, medical error can be properly disclosed, addressed, and mitigated in future practice. Systemic strategies to optimize healthcare delivery include shifting focus to the quality of care rather than productivity while fostering innovation in clinical practice and policy.

   4. Healthcare Delivery: Leveraging Artificial Intelligence to Strengthen Healthcare Quality

      Patrick Seitzinger, Zoher Rafid-Hamed, Jawahar (Jay) Kalra

      Abstract

      The capabilities of artificial intelligence (AI) in medicine are expanding at an unprecedented pace. AI has the potential to serve as an invaluable asset in harnessing large amounts of data to generate new diagnostic models, inform clinical decision making, and to expand the capabilities of modern medicine. AI has proven beneficial in various fields of diagnostic medicine including radiology, pathology, and laboratory medicine. AI programs have been shown to increase workflow without compromising accurate identification of abnormalities. Aspects of human error in medicine can be mitigated through the use of machine learning programs to serve as quality assurance and failsafe strategy. The advent of AI in healthcare carries many ethical, legal, and accountability challenges. These challenges include issues of transparency, data security, informed consent, and liability. Lack of familiarity with AI systems and fear of unforeseen consequences warrants caution in the implementation of these new tools. However, undue delays in the implementation of AI may unnecessarily hinder the progress of medicine and limit the level of care that can be provided to patients. Healthcare providers should ensure they are well-positioned to adapt to this new technological era of medicine by remaining up to date on the implications of technological advances. Medical education will require continuous revaluation and adaptation to ensure learners gain the appropriate digital literacy to function effectively in AI-assisted medical practice. The implementation of these technologies into healthcare systems represents the greatest healthcare transition of our time. Optimizing this transition in a growing number of medical disciplines will require tactful implementation and diligent risk management.

   5. An mHealth Approach to Addressing Health Inequity

      Martina A. Clarke, Sajda Qureshi, Timi Barone, Yi Qi, John R. Windle, Jason Combs, Paul Burger

      Abstract

      Little is known at the local level how mHealth interventions support consumers’ goal of a healthy lifestyle and the impact of mHealth interventions on providing equitable care. This paper investigates: 1) the social determinants of health (SDOH) that affect the ability of people to be healthy and 2) clinicians use of mHealth interventions to facilitate equitable provision of healthcare. Socioeconomic and health data was collected from all 93 Nebraska counties. A positive correlation was found between the ability of people to be healthy and their access to health insurance and fresh food. A correlation was also discovered between poverty and the ability of people to be healthy and access food. A mobile app was then developed to provide information on available community resources for patients of a student-run free clinic. The contribution of this study is determining how mHealth can be used as a sustainable health equity intervention.

   6. Design Direction of Proton Radiotherapy Hospital

      Xinxiong Liu, Yuan Liu

      Abstract

      It has been proven that humanization plays a key role in hospitals and other environments. Enhancing the humanistic atmosphere in hospitals can help improve mood and reduce stress. Therefore, this article designs the waiting area so that the waiting area can reduce the patient’s anxiety and other negative emotions, and enhance the patient’s confidence in treatment. Due to the similarities between current general radiotherapy and proton therapy, this article sorts out the design directions and design methods of many cancer hospitals. At the same time, the author conducts a questionnaire interview on the behavior of patients during the waiting time before radiotherapy through field investigations in the radiotherapy department of the tumor hospital, To further explore the needs of patients in the waiting area, in order to find the direction of the interior design of the waiting area of the proton radiotherapy hospital in the future, and provide a reliable basis for the design direction of the proton hospital in the future.

   7. Inclusive-Resource Center Specialists’ Mental Health

      Oksana Kravchenko, Maryna Mishchenko, Yuliya Klymenko, Maksym Kuzmenko, Nataliia Potapchuk

      Abstract

      The article analyzes the impact of special conditions of professional activity on the individual’s mental health. The purpose of this article is to study the impact of special conditions of professional activity on the inclusive resource centres specialists’ mental health indicators. The experimental study was conducted based on inclusive resource centres of the Cherkasy region. The method of interview, Leontev’s test of semantic-life orientation, purpose in life test methodology; manual of instructions for the purpose in Life test, Bojko’s diagnosis of the emotional burnout level, emotional burnout syndrome in professional communication have been used in the course of research. The participants’ survey of the experimental study allowed identifying socio-psychological factors that affect their mental health. The analysis of the basic social and psychological factors influencing person’s mental health of various conditions of its activity has been carried out.

3. Healthcare Issues and Risk Assessment

   1. Frontmatter

   2. The Benefits of Standardization in Healthcare Systems

      Nancy Lightner, Tandi Bagian

      Abstract

      The benefits of standardization in manufacturing and automated environments are clear as the use of the same material and processes produces the same output. Buying in bulk reduces per piece cost and customer satisfaction increases with lower cost and product consistency (include cost of change, e.g. training cost). Outputs of healthcare systems are patient outcomes, which are not products; patients have unique circumstances and possible treatment for episodes throughout their lives. This study presents the elements of a healthcare system and discusses how standardization increases efficiency and effectiveness of each element. The elements studied are infrastructure processes, care processes, supplies and equipment and facility layout. Characteristics considered are patient outcome, safety, provider and patient satisfaction and cost.

   3. How Might We Think About Safety? Inviting Deeper Reasoning Through Elaborative Inquiry

      Timothy Arnold, Helen J. A. Fuller, Stuart C. Gilman, William P. Gunnar

      Abstract

      Frameworks in which we think and facilitate learning experiences about safe operations in healthcare are essential for planning for and practicing safety management. The community of practitioners who study safe operations has for some time described the danger of preponderantly focusing on information from safety reporting systems. Yet in practice there is a tendency towards this very preoccupation. Furthermore, we have not experienced learning environments designed to challenge this presupposition or encourage learners to critically reflect on the effect that institutionalized thinking may have on work-as-done in patient safety management. This paper describes a learning experience designed to interactively and incrementally invite collective discussion into diverse conceptualizations of safety. We review limitations and the subsequent influence of these conceptualizations of safety on systems design. The success of these conversations will be defined by how future generations think about and piece together this puzzle we call safety.

   4. The Flip Side of the Coin: Potential Hazards Associated with Standardization in Healthcare

      Helen J. A. Fuller, Timothy Arnold

      Abstract

      Healthcare has a lengthy history of quality improvement efforts. Perhaps due to the success of standardization methods in fields such as manufacturing and aviation, similar approaches are often proposed in healthcare quality improvement initiatives. However, fundamental differences can make the translation to use in healthcare challenging. In manufacturing, the outcome is typically a product with a certain range of tolerances; in healthcare, the goal is to maintain or restore a biological system to some desired state. In addition, people, an inextricable part of the healthcare system, are generally more complex and inherently variable than other components of a system. Patients, providers, and more all have unique needs and capabilities that must be accounted for during systems design, making standardization efforts different than in other industries. This paper discusses how different types of standardization may introduce hazards and opportunity costs as they interact with various elements of a healthcare system.

   5. Interoperability in Healthcare Systems: The Application of HRO Principles in New Technology Implementation in Digital Healthcare

      Yalda Khashe, Maryam Tabibzadeh

      Abstract

      Digital health has been a developing area of healthcare delivery in recent years and the COVID-19 pandemic has significantly accelerated its expansion. One of the significant aspects of digital health is the quality of care that patients receive virtually and the impact of technology on patient safety. However, addressing patient safety in virtual, or digitally delivered, care is not yet commensurate with the rapid growth of digital health driven by COVID-19. In this study, we consider Digital Health as not a distinct modality of care, but rather as a tool to bridge gaps in existing care delivery systems. We first discuss the interoperability between and across Digital Health systems and then discuss the application of High Reliability Organizations (HRO) principles as a mechanism to reinforce weak interconnections to achieve systems interoperability and integration.

   6. Preliminary Wear Trial of Posture Training Bracewear for Older Adults with Degenerative Scoliosis (ADS)

      Linda Yin-Ling Sit, Joanne Yip, Kenny Yat-Hon Kwan

      Abstract

      Bracing treatment is the most commonly recommended treatment for patients with adult degenerative scoliosis (ADS) to stabilize the movement of their spine and provide support to the lumbar area. This paper reports a case study of a 55-year-old female patient with ADS who participated in a wear trial with a posture training bracewear. After donning the brace for 2 h, an in-brace x-ray is taken to compare the immediate effects of bracing to determine the pre and post treatment results. Aside from radiographic imaging, the anterior and posterior trunk symmetries are measured on three-dimensional images of the subject taken pre and post treatment and compared, which show that the posture training bracewear can provide immediate reduction of the spinal curvature. Apart from the reduction in spinal curvature, the patient also shows a more symmetric trunk after wearing the brace for 2 h.

   7. Using Exoskeletons to Assist Medical Staff During Prone Positioning of Mechanically Ventilated COVID-19 Patients: A Pilot Study

      Serena Ivaldi, Pauline Maurice, Waldez Gomes, Jean Theurel, Lien Wioland, Jean-Jacques Atain-Kouadio, Laurent Claudon, Hind Hani, Antoine Kimmoun, Jean-Marc Sellal, Bruno Levy, Jean Paysant, Serguei Malikov, Bruno Chenuel, Nicla Settembre

      Abstract

      We conducted a pilot study to evaluate the potential and feasibility of back-support exoskeletons to help the caregivers in the Intensive Care Unit (ICU) of the University Hospital of Nancy (France) executing Prone Positioning (PP) maneuvers on patients suffering from severe COVID-19-related Acute Respiratory Distress Syndrome. After comparing four commercial exoskeletons, the Laevo passive exoskeleton was selected for use in the ICU in April 2020. The first volunteers using the Laevo reported very positive feedback and reduction of effort, confirmed by EMG and ECG analysis. Laevo has since been used to physically assist during PP in the ICU of the Hospital of Nancy, following the resurgence of COVID-19, with an overall positive feedback.

   8. Establishing a Relationship Between VOMS Performance and Changes in EEG Signatures for a Rapid Assessment and Diagnosis of Concussions

      Tristan Bennett, Jeff Feng

      Abstract

      This study aims to discover a possible relationship between electroencephalogram (EEG) signature changes as physiological indicators of one’s current state, and performance on the Vestibular Ocular Motor Screening (VOMS) assessment. A Muse 2 generated a baseline EEG scan for each participant, allowing for the collection of data associated with one’s brain activity. The subjects were then taken through several VOMS domain tests with a continued recording by the device. A comparable analysis was conducted between the participant’s baseline recording and VOMS recording with an intent to identify the consistent correlations in between. In conclusion the findings of this study show potential for characteristic brain activity patterns dependent upon what VOMS domain is being tested. Therefore, when any deviations from those features are observed, the likelihood of the presence of a concussion is much greater.

   9. A Case Study of Initial In-Brace Spinal Correction of Anisotropic Textile Brace and Boston Brace

      Charlotte Sze-ham Wong, Joanne Yip, Kit-lun Yick, Zerance Sun-pui Ng

      Abstract

      Adolescent idiopathic scoliosis (AIS) is a common spinal condition found in teenagers during their puberty years. To minimize the rate of spinal progression and the risk for the need of surgical intervention, AIS patients are often prescribed treatment based on the extent of their spinal curvature. Among treatment options, rigid braces are a universal and effective treatment device recommended for moderate AIS patients with a Cobb’s angle that is greater than 20° with Risser signs 0–2. Other options like non-rigid braces are less frequently used due to their ambiguous efficacy. To compare the effectiveness of non-rigid braces and proven rigid orthoses, in-brace spinal correction of anisotropic textile brace and Boston brace will be compared here. This case study shows that anisotropic textile brace provides a comparable initial in-brace correction as that of the Boston brace, a better corrective effect for coronal and sagittal imbalances, and even a higher acceptance of patient.

   10. Machine Learning Approaches to Predict Scoliosis

       Ruixin Liang, Joanne Yip, Kai-Tsun Michael To, Yunli Fan

       Abstract

       Scoliosis seriously affects the physical and mental health of patients. Therefore, machine learning approaches were used to predict whether the subject was scoliosis patient or not by physical characteristics and electromyography (EMG) ratios. One hundred and six subjects, including 33 healthy subjects and 73 subjects with scoliosis, have been involved in this study. However, only about half of the predictions were correct. This may because of the small dataset, and the relatively weak relationship between the features (age, height, weight, gender, and EMG ratios) and the occurrence of scoliosis. This present work served as an initial step for the application of artificial intelligence in scoliosis prediction. However, it is significant and necessary for a greater effort in this topic.

   11. Assessment of Relapse and Poly-Drug Use Among Heroin Addicts Patients Treated with the Methadone

       Wafae Idrissi Semlali, Tarik Ghailan, Khadija Karjouh, Ahmed Omar Touhami Ahami

       Abstract

       Methadone maintenance therapy has, as main objective, the reducing of heroin craving, managing poly-drug use to achieve a total abstinence. The objective is to evaluate the relapse and poly-drug use after inclusion in Methadone treatment.

       The results showed that the poly-drug use was significantly reduced after treatment concerning alcohol, cocaine and heroin, however, the consumption of tobacco and cannabis did not have a significant change. The rest of the substances had almost the same frequency. Relapse was assessed with (62%) of heroine intakes. Subjects with heroin-only or poly-drug use problems have a higher percentage of overdoses than others with (47%). The relapse and number of heroine uses is correlated with degree of the satisfaction toward the treatment.

       Poly-drug use is a primary problem should be a subject of in-depth research and main management to optimize the control of long-term dependence