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Über dieses Buch

This book discusses the latest advances in human factors and ergonomics, focusing on methods for improving quality, safety, efficiency, and effectiveness in patient care. By emphasizing the physical, cognitive and organizational aspects of human factors and ergonomics applications, it reports on various perspectives, including those of clinicians, patients, health organizations and insurance providers. The book describes cutting-edge applications, highlighting the best practices of staff interactions with patients, as well as interactions with computers and medical devices. It also presents new findings related to improved organizational outcomes in healthcare settings, and approaches to modeling and analysis specifically targeting those work aspects unique to healthcare. Based on the AHFE 2016 International Conference on Human Factors and Ergonomics in Healthcare, held on July 27-31, 2016, in Walt Disney World®, Florida, USA, the book is intended as timely reference guide for both researchers involved in the design of healthcare systems and devices and healthcare professionals aiming at effective and safe health service delivery. Moreover, by providing a useful survey of cutting-edge methods for improving organizational outcomes in healthcare settings, the book also represents an inspiring reading for healthcare counselors and international health organizations.



Erratum to: Examination of the Validity of Anatomical Knowledge Associated with Daily Lifestyle Issues: A Comparison Between Perspectives of Anatomy and Nursing Researchers

Masaaki Takayanagi, Manami Nozaki, Reiko Mitsuya, Teruko Takayanagi, Fumi Sato

Human Factors and Ergonomics in Surgery


Analysis of Surgeons’ Muscle Activity During the Use of a Handheld Robotic Instrument in Laparoendoscopic Single-Site Surgery

The objective of this study is to assess the surgeon’s performance and ergonomics during the use of a robotic-driven handheld laparoscopic instrument in intracorporeal suturing tasks as well as in digestive and urological laparoscopic procedures performed through single-site surgery, and comparing it with the use of conventional instruments. Seven right-handed experienced surgeons took part in this study. Four surgeons performed nine urethrovesical anastomoses on an ex vivo porcine model and three surgeons a partial nephrectomy and a sigmoidectomy on an in vivo animal model. Surgeons used both conventional laparoscopic instruments and the robotic instrument. Execution times, leakage pressure for the anastomosis, surgical complications and surgeons’ muscle activity were measured. Similar results in surgical performance and ergonomics were obtained using conventional laparoscopic instruments and the robotic instrument. Muscle activity of the biceps was significantly higher using the robotic instrument during both surgical procedures.

Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo

Assessing the Influence of Personal and Organizational Factors on Surgeon’s Performance: A Study on Surgeons’ Perceptions

In the emerging area of Human Reliability Analysis (HRA) applications in healthcare, a critical issue is the suitability or proper application of the existing taxonomies of Influencing Factors (IFs). The aim of the present study is twofold: (i) providing surgeons’ views about the IFs to be implemented in HRA applications to surgical procedures; (ii) assessing surgeons’ perception of the influence of personal and organizational factors on surgical performance in different surgical contexts (open and MIS surgery). The study methodology involved focus group and individual interviews for the former, a survey for the latter. Twenty IFs were identified as relevant for the surgical context, among a preliminary list of categories taken from extant literature. The difference of the perceived influence in the two surgical contexts, i.e. open vs laparoscopic, resulted significant for five Ifs: verbal interruptions; rude talk and disrespectful behaviors; unclear or failed communication; poor coordination; poor situation awareness.

Rossella Onofrio, Paolo Trucco

Human Reliability Analysis (HRA) for Surgery: A Modified HEART Application to Robotic Surgery

HRA studies in healthcare highlight that PSF (or Influencing Factors—IFs) taxonomies in HRA techniques have been developed and validated in industrial contexts, and as such are not fully applicable to healthcare contexts. In this paper, a modified version of Human Error Assessment and Reduction Technique (HEART), has been developed and tested through an application to the robotic surgical Radical Prostatectomy procedure. Personal and organizational factors were modeled and assessed through an IFs taxonomy validated in the surgical domain, and then systematically translated into the corresponding Error Producing Conditions (EPCs), typical of the HEART method. The results confirmed the importance of adapting HRA methods to the healthcare sector, and added detailed information on what are the most relevant factors that should be captured by an HRA method when applied to surgery. Additionally, the analysis revealed that team related factors have the highest influence on surgeons’ performance (i.e. increase of Human Unreliability Rate) in the context of different surgical tasks.

Paolo Trucco, Rossella Onofrio, Antonio Galfano

Prospects and Problems of Smart Glasses as Tools for Surgery

The feasibility and problems of using smart glasses (SMG) in surgery were investigated in this study. The prospects and challenges of SMG in surgery are as follows. The advantages of SMG are that various kinds of medical information can be provided, including surgical navigation and consultation with other physicians. Since SMG are hands-free, they are clean and safe to use in surgical practice. The challenges and unresolved problems of SMG are ergonomic problems such as eyestrain and fatigue, and technical problems such as Internet security and electromagnetic interference. Further collaborative investigation and development of the technology and ergonomics of SMG are important for their successful application in surgery.

Kazuhiko Shinohara

Human Factors and Ergonomics and Healthcare Professionals


A New Elderly Clothing Design Reduces Nurse Aides’ Occupational Injury in Nursing Homes

Nurse aids assist the elderly to dress for a long time, they always get work-related musculoskeletal disorders (WMSDs) owing to inappropriate application of force. The purpose of this study is to design a new elderly clothing to reduce the cumulative damage of nurse aids from assisting the elderly dressing effectively. We designed two new elderly clothes with two different methods, one is Morphological Analysis (design A) and the other is Co-design (design B). Design A uses Velcro to join fabric to reduce the time nurse aids spend on finding cords. Design B is a one-piece cloth which wear from front in order to reduce unnecessary rotate of joint. Results showed that design B spend the least time. The shortage of design A is it will take time to separate Velcro when they stick together. Design B should care more about elderly’s perception, sense of security and exposure, especially for the heavy elderly.

Wen-Yu Yang, Fong-Gong Wu, Adam Book

Bedside Dialysis and the Occupational Safety and Health Impact on the Healthcare Worker in an Acute Hospital

In an acute hospital, staff from the Renal Dialysis Centre (RDC) transported haemodialysis machines to patients in various wards to enable bedside dialysis. The bedside service was provided for patients who were not suitable for transfer to the RDC due to their medical condition. The haemodialysis machines, together with the Reverse Osmosis (RO) water machines were transported from the RDC to the wards on a daily basis. The objectives of the study were to evaluate the ergonomic stress on the staff transporting the machines; and any other occupational safety concerns that may arise from the transfers.

Wai Kuen Kam, Mohd Fahmy bin Abdul Kader Alkaff, Paige Geek Pei Tan

Biomechanical Evaluation of Patient Handling Jobs in Healthcare: A Case Study in India

The principles of ergonomics can be applied to the study and design for the components of any worksystem involving human(s) and machine(s) embedded in environment. Performance of healthcare is considered one of the sectors of industry heavily relying on humans performance that is mainly controlled by the way the human-machine interaction or interface is designed. Even though sophisticated diagnostic equipment and system may replace manual tasks, a large number of jobs like patient handling, OPD operations, nursing, etc., are irreplaceable by machines. In such a scenario, it becomes important to look at these jobs from an ergonomic point of view and identify potential risks associated with the jobs that the hospital assistants carry out on a daily basis. Patient-handling is one such job which has been covered in much of the ergonomic literature. Many alternative postures for manual unassisted handling as well as ergonomic designs of stretchers and wheelchairs have been discussed by researchers. In this paper, dynamic biomechanical models of the work postures of several health-care hospital assistants while carrying out tasks such as lifting patients from beds to stretchers, or placing them on wheelchairs, or giving support through shoulders during physical diagnosis of the patient are presented. Since the hospital assistants have to work with patients of several different anthropometry, weight, etc., these may exert a potential risk for them to acquire low-back pain (LBP) and other Musculoskeletal disorders because of sudden and inappropriate postures.

Dharmendra Sharma, Pradip Kumar Ray, Esha Saha

Difference in Problem-Solving Thought Concerning the Infection Control of Japanese Nurse and Indonesian Nurse: Comparison of the Result by 4M4E Matrix Analysis

In nursing world, the opportunities when a nurse with a different background interchanges increased. Regardless of a country, it may be said that the safety management of the patient is a main premise of the nursing. We focused on the infection management and compared problem-solving thought for the infection management of the Indonesian nurse and Japanese nurse using 4M4E model. As a result, we understood that they were common basically. The nurse Indonesian tended to demand the intervention to an individual and an offer of the knowledge. On the other hand, the Japanese tended to consider systematically. The expansion of each other’s fields of vision would be expected by using each strength and continuing cross-cultural communication.

Manami Nozaki, Hiromi Ogasawara, Reiko Mitsuya

Examination of the Validity of Anatomical Knowledge Associated with Daily Lifestyle Issues: A Comparison Between Perspectives of Anatomy and Nursing Researchers

Although anatomical knowledge is vital in nursing practice, it is considered to be difficult to understand. Therefore, we attempted to arrange anatomical knowledge based on the framework of nursing to enable students to learn anatomical knowledge. Anatomical knowledge associated with eight lifestyle issues were considered to be necessary by nursing and anatomy researchers were recorded, and concordance rates were examined. Therefore, we confirmed the validity of the learning content. However, results suggested that a prospective, multifaceted study is required.

Masaaki Takayanagi, Manami Nozaki, Reiko Mitsuya, Teruko Takayanagi, Fumi Sato

Study of Suitability of Computer Workstations Design for Nurses’ Work Content

The majority of published research about EMR systems regarding nurses and their clinical tasks have centered on their attitudes toward EMR systems, which have generally been positive and accepting. There is a lack of studies that would consider dimensions of clinical tasks, human factors, and available equipment to determine how nurses work with EMRs. The goal of this study was to investigate how suitable the design of computer workstations is in terms of hardware selection for nurses’ work content. This was a mixed-method study (focus groups and online survey) to collect data. The survey tool was distributed among 600 nurses in a rural hospital and a series of two-way, three-way chi-square and logistic regression analysis were conducted to investigate the correlation between the human factors aspects of the clinical tasks (work content) and nurses’ preference of computing device and location. The findings from 61 responses illustrated a significant correlation between cognitive and interaction design aspects and the preferred type of computer workstations. This means that better understanding of cognitive and interaction design aspects of clinical tasks by nurses as well as managers and computer software developers is critical in workstation design, resource allocation, better quality of care and patient safety.

Farman A. Moayed, April Savoy, Celeste Turpen

Human Factors and Ergonomics in Healthcare Systems


A Flexible Toolkit for Evaluating Person-Centred Digital Health and Wellness at Scale

The Delivering Assisted Living Lifestyles at Scale (dallas) program was a large-scale, nationwide deployment of digital health and wellbeing products and services in the UK. Telehealth, telecare, mobile apps, personal health records, and assisted living technology were implemented by four large multi-stakeholder consortia and a multidimensional evaluation was carried out across the lifecycle from examining co-design and redesign of services through to rolling out services via statutory, private and consumer routes. A flexible toolkit of descriptive, process and outcome measures was developed and iteratively refined throughout the program. This approach enabled a longitudinal mixed-methods evaluation, underpinned by a robust social theory of implementation called ‘Normalization Process Theory’. There remains uncertainty about the best approaches to real world digital health evaluation. This program provided a unique opportunity to develop the knowledge base and toolkit of qualitative and quantitative methods necessary to evaluate person-centered digital health technologies deployed at scale.

Marilyn McGee-Lennon, Matt-Mouley Bouamrane, Eleanor Grieve, Catherine A. O’Donnell, Siobhan O’Connor, Ruth Agbakoba, Alison M. Devlin, Sarah Barry, Annemieke Bikker, Tracy Finch, Frances S. Mair

Application of Lean Six Sigma Concepts to Medicine Dispensation of Public Health Centers

For years, Brazilian public health has been focus of criticism due to its overall precariousness. One of the methodologies utilized to try to improve this processes is the lean healthcare, a theory derived from lean manufacturing, a heritage of Toyota production model. In the first semester of 2015, a project was developed with the department of medicine dispensation of a midsize city from São Paulo. The project had for objective mapping a process and its optimization, utilizing Industrial Engineering concepts. A diagnosis following the steps of DMAIC methodology was done. After mapping process and task analysis, the project consisted in a time study, leading to the utilization of 2-sample t hypothesis test utilizing Minitab software. From the diagnosis recommendations were made for process improvement in medicine dispensation. As main results there was: statistical proof of alternative hypothesis proposed, related to the amount of time used at filling out prescription forms.

Marina Pazeti, Leonardo Calache

Lean Healthcare as a Tool for Improvement: A Case Study in a Clinical Laboratory

In the current days the health services area presents difficulties in managing processes and staff. High costs, long queues, few qualified professionals, poor services quality and other growing problems in the population’s access to health services. Great part of these difficulties comes from waste in services management and these represent a problem to be solved. Mapping the management processes is a priority involving the services provided by the sector. This paper aims to conduct a study on Lean Healthcare in a clinical laboratory in order to improve its processes management. As a result, it develops a discussion guided by practical results and difficulties from the point of view of concepts of human, quality and process optimization factors, emphasizing also the variable social system under study. Application steps are presented, such as value stream process mapping and improvement opportunities.

Karine Borges de Oliveira, Eduardo Ferro dos Santos, Lucio Veraldo Garcia Junior

Virtual Communities of Practice Success in Healthcare Sector: A Comparative Review

Many organizations including health care sector, have failed to attain the expected benefits from the knowledge management (KM) initiatives or projects. One of the KM initiatives in health care sector is virtual communities of practice (VCoPs), where practitioners conduct discussions and share experience online. Presently, there is no accepted or overall conceptual framework that addresses the important aspects of effective KM in a way to assist specifically the virtual communities in KM, reflecting the need to review the literature pertaining the VCoPs measurement in order to extract the main taxonomy from the literature. The review shows that research on VCoPs should take into account technical, social, semantic, human, and effectiveness dimensions in measuring the VCoPs success.

Haitham Alali

Overlook of Patient Time Log Entry Errors During Emergency Department Processes

Patients visiting emergency departments need appropriate medical care on time from the point of arrival to discharge. Time logs are essential for keeping track of patient status during the visit. The accuracy of time logs is not supposed to be compromised to the speed of data entry. The objective of this study was to investigate how falsely patient time logs were entered during emergency department processes. Data omissions and false entries of time logs were considered to estimate the likelihood of data entry errors. Results showed that omission errors were occurred at the doctor’s examination process and false entry errors at the registration process. The modality change of data entry from keying data to voice activated data entry would be a suggestion to reduce the false time log data entry at emergency department processes.

Byungjoon B. J. Kim

Incentives for the Acceptance of Mobility Equipment by Elderly People on the Basis of the Kano Model: A Human Factors Perspective for Initial Contact with Healthcare Products

Personal mobility, such as, for example, the ability to get up and sit down independently, decreases by age. In Germany, one out of ten people older than 75 years needs long-term care and thereby support in personal mobility. Within the age group of 80+ years this number increases even more. Personal immobility is one of the main reasons for the necessity of a caregiver. To improve older persons’ independent mobility, supporting technical devices like walking sticks, walkers and wheel chairs established themselves. However, these devices can just be used after the patient gets up or sits down. For these special situations, technical solutions are also available. They are able to support a user even during situations in which he or she needs to be lifted. But they are not used frequently due to various reasons such as high costs and high stigmatization potential. In this study, the Kano model was used to analyze different customer requirements for initial contact with such a technical mobility aid. Investigated requirements were, for example, design, acceptance of mobility aids’ sharing solutions, usability and usage sites of such aids. The study revealed individual design to be an attractive customer requirement whereas a pooling solution and hence sharing the mobility aid leads to a decreased customer value. All in all, this study stresses customers’ acceptance of mobility aids and identifies several customer requirements for a positive initial contact.

C. Brandl, P. Rasche, C. Bröhl, S. Theis, M. Wille, C. M. Schlick, A. Mertens

Human Factors and Ergonomics in Healthcare Safety


Engaging and Effective Staff Training to Improve Patient Safety and Satisfaction

Improving patient safety and increasing patient satisfaction are top priority concerns for healthcare institutions. Alarm fatigue is also a key and very problematic issue. Developing programs to address these problems often involves making system-wide cultural changes, but changing institutional culture can be challenging. Use of animation and storytelling to inspire emotional “buy in” from staff, combined with an efficient and engaging multimedia training program, can allow for rapid and cost-effective cultural change. A “culture of safety” is established yielding improvements in patient safety and satisfaction while decreasing alarm fatigue for clinical staff.

Gregg Alexander, Patrick Baker

Methodology of Care Humanitude in Promoting Self-care in Dependent People: An Integrative Review

The aging of the population has led to an increase in the prevalence of chronic degenerative diseases and dependence. We need to implement humanized health care that will improve the quality of life and well-being of these people and help maintain their autonomy and self-care.: To identify the implications of the caring in Humanitude in promoting self-care in the dependent person. Integrative review of the literature of the period between 2007 and 2015, using the databases Medline, EBSCO and Google Scholar. In using the PI[C]OD methodology and criteria for inclusion and exclusion, we obtained 54 items where 7 were selected for analysis. There are several health benefits in the promotion of self-care, by applying the Humanitude caring philosophy, mainly regarding the relationship between the nurse and the patient. It is essential to develop further studies focused on the implications of caring in Humanitude in self-care in the dependent person.

Rosa Cândida Carvalho Pereira Melo, Daniela Sofia Carvalho Fernandes, Joana Sousa Albuquerque, Mariana Nunes Duarte

Application of User Experience Map and Safety Map to Design Healthcare Service

Design for healthcare service involves two critical issues: imbed safety and expected user experience. Many researches have already been conducted in this area but mostly consider these two issues separately. This paper described a study in 2015 with Chinese designers who work on healthcare service design, to find out the advantage and disadvantage of the methods they used. Obvious unbalanced consideration between safety and experience has been found in their design process. Based on this result, through case study and theoretical analysis, a possibility to combine the experience map of EBD and safety map of FMEA to help designers coping with healthcare service design issues efficiently is proposed. The initial model of this method is discussed and presented in this paper.

Jinhua Li, Long Liu, Yayan Zheng

An Assessment on the Level of Knowledge of Biosecurity Measures in the Academic Environment

Students are susceptible to a number of risks of illness and accidents during the professional learning process. This study had as objective to assess the level of knowledge of biosecurity protection measures of students at an occupational therapy course. Using the field research method, data were collected by means of a questionnaire on biosecurity, means of protection and immunization. The sample consisted of 62 students. We obtained the following results: 64 % knew the term ‘biosecurity’; 43.55 % reported hand hygiene as a means of protection; 37.1 % used personal protective equipment (PPE), and only 16.13 % reported immunization as a means of protection. With this study, it became evident that adhesion fell short of the measures necessary to protect the student, and the need for the inclusion of the biosafety topic in the professional training process.

Berla Moreira de Moraes, Adílio Moreira de Moraes, Betanea Moreira de Moraes, Vanessa Mesquita Ramos

Methods to Characterize Operating Room Variables in Robotic Surgery to Enhance Patient Safety

Surgical team experience is an important determinant of operative outcome. However, even the most experienced team will not be familiar with all potential variability that could be encountered during a surgical procedure. Robotic surgery adds further complexity through advanced technology, additional equipment, intricate process steps, etc. One method that is crucial to understanding a robotic procedure is surgical observation, which can be used to identify the process flow and involved objects. Another method is task excursion analysis, a proactive approach to understanding system variability and key factors that may affect system performance and patient safety. Finally, a method must be used to efficiently present the gathered information to surgical teams. As rapidly evolving technology is introduced into health care systems, the adoption of these types of methods is necessary to ensure patient safety. This paper describes the proposed methodology for analyzing robotic surgery variability and provides some example data.

Anthony M. Composto, Luke A. Reisner, Abhilash K. Pandya, David A. Edelman, Katrina L. Jacobs, Tandi M. Bagian

Low-Fidelity Simulation Versus Live Human Arms for Intravenous Cannulation Training: A Qualitative Assessment

In the military, as well as in civilian medical settings, the question of whether to use simulation versus live tissue remains in debate. The purpose of this paper is to examine qualitative data provided by students (n = 260) attending the Army’s Licensed Practical Nurse (LPN) program who completed peripheral intravenous cannulation (PIVC) training using either a Simulated Human Arm (SHA) (n = 135) or a Live Human Arm (LHA) (n = 124). Students provided subjective responses in a written format pertaining to their PIVC training method. Data patterns were assessed using Spradley’s semantic relationship approach. Results reveal that both those using a SHA and a LHA reported feeling confident following training, however the reasons for their confidence differed. Those using a SHA felt confident due to the opportunity to repeatedly practice on a simulated arm, while those learning on a LHA felt assured knowing they had performed PIVC successfully on a live human during LPN training.

Gary L. Boykin

Medical Device Design


Improving the User Experience of Medical Devices with Comparative Usability Testing

A comparative usability test is an evaluation that helps to determine how a particular product performs in relation to similar products by having end users attempt to complete the same set of tasks for each product. This type of usability test assesses if a product is better or worse than others from a usability perspective and reveals relative strengths and weaknesses. When conducting a comparative usability test, a number of variables make the execution more complicated than a standalone usability test. This paper identifies variables to consider, based on a recent comparative test involving three ultrasound systems. Some variables that need to be considered are defining and recruiting appropriate test participants, selecting a suitable test environment, preparing and executing training, creating consent forms, applying a proper test methodology, selecting usability metrics to capture, and analyzing data. This paper identifies what a comparative usability test can offer and the latest techniques of executing such a test.

Anneliis Tosine, Hala Al-Jaber

&You: Design of a Sensor-Based Wearable Device for Use in Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a psychotherapy treatment that trains an individual to adjust negative patterns of thinking and behavior associated with their disorder. In this paper, we present &You, a low-cost nonintrusive wearable device for use in CBT to assist patients with anxiety disorders. Our device reinforces habit forming processes by passively detecting measurable stress symptoms and notifying the user before a stimulus elicits a severe anxiety attack. Notifications are delivered as a series of brief vibrating pulses that can be stopped by tapping the device, which is strategically placed at the nape of the user’s neck. The gesture of deactivating the notification forces the wearer into a body position that naturally expands their chest and increases lung capacity, which directly calms the user and disrupts the user’s negative thought pattern.

Aaron McEuen, John Proffitt, Jorge D. Camba, EunSook Kwon

Framework Proposal Including HFE in Product Development Process: A Suitable Approach for the Brazilian Medical Equipment Industry

Brazilian Medical Industry is mostly comprised of small to medium-sized manufactures Small changes on requirements can pose a big challenge on their process. From December 2015 the IEC 60601-1-6 has become mandatory for all new medical equipment registration in Brazilian market. These two facts led to the development of this research, aimed at provide a framework to include HFE methods inside the product development process, while confirming with the standards. The framework should be simple to implement and provide practical information showing which tool to use at the right time, considering a device in development. The methods were selected based on previous Brazilian experiences and literature review. The final framework is constituted of 4 steps using 6 HFE methods, linked in such way that the information generated by one method can be used as input to the other method, minimizing work overhead, and documentation to the standard requirements.

Ana Paula Almeida, Rodrigo Almeida, Renata Custódio, Clarissa Trzesniak, Carlos Mello

A Systematic Approach to Improve the Reprocessing of Surgical Instruments

Hospital systems currently face challenges associated with insufficient cleaning and maintenance of surgical instruments. These instrument reprocessing challenges jeopardize patient safety, cause significant damage to reputation, and contribute to additional costs. Our team collaborated with doctors, nurses, instrument reprocessing technicians, and supervisors in the neurosurgical service and the Central Sterile Processing Department at a university hospital. We focused on how instrument “cleanability” and the configuration of instrument sets impact the effectiveness and efficiency of surgical instrument reprocessing. We developed an Excel-based set-configuration tool to aid in reconfiguring instrument sets to reduce the impact of bioburden. To validate the tool, we separated bioburden-prone instruments from the neurosurgical service’s most heavily used instrument set. We also developed a Cleanability Index to rate surgical instruments and sets based on their difficulty of cleaning.

Nina Scheinberg, Bill Zhang, Leah Raschid, Rama Mwenesi, Mark Grum, Moses Chan, Amy Cohn, Joseph DeRosier, James Bagian

Building Safety into Medical Devices: The Non-injectable Arterial Connector Preventing Wrong Route Drug Administration

A never event is a serious and preventable error in healthcare. Wrong route drug administration into the arterial line can cause significant injury to the patients hand. Analysis of the incident data showed errors occurred during levels of heightened stress when medication was required to be given urgently, however during these circumstances healthcare workers did not seem to recognize the arterial line despite being coloured differently to standard venous lines. By using human factors design principles it was possible to develop a solution which prevents wrong route drug administration into the arterial line and does not interfere with normal clinical practice. We highlight that it was possible to eliminate a serious error in healthcare around the world.

Maryanne Mariyaselvam, Arun Gupta, Peter Young

Mobile Technology Improves Therapy-Adherence Rates in Elderly Patients Undergoing Rehabilitation—A Crossover Design Study

In this publication the results of an empirical study are analyzes regarding the research question if a mobile application on a tablet computer, to support the drug intake and vital sign parameter documentation, affects adherence of elderly patients. For the achievement in the management of patients with hypertension adherence of their medication is essential. Patients with no prior knowledge of tablet computers and a coronary heart disease were included. All Patients were instructed personally into the mobile application “Medication Plan”, installed on an Apple iPad™. This study was performed in a crossover design with three sequences. The first sequence is the initial phase, followed by the interventional phase (28 days of using the app system) and at least the comparative phase (28 days of using a paper diary). The interventional and comparative phases were conducted alternately. Altogether, 24 patients (12 male; mean age 73.8 years) were registered. The subjectively assessed adherence (A 14 scale) was 50.0 before the study started (SD 3.44). After the enforcement of both interventions there was a significant increase, which was more pronounced after the intervention phase (54.0, SD 2.01) than the comparative phase (52.6, SD 2.49) (for all pairs p < 0.001). Furthermore, the medical conditions, or the number of drug intakes per day had no effect on the subjective adherence. For both blood pressure recordings (p < 0.001) and medication intake (p = 0.033) the obtained logging data showed a significantly stronger adherence for the medication-app than the paper diary system. The majority of participants (n = 22) denoted that they would like to use the medication-app in everyday life and do not need any further assistance. A mobile app for medication adherence strengthened objectively and subjectively metered adherence of elderly users folding rehabilitation.

A. Mertens, S. Becker, S. Theis, P. Rasche, M. Wille, C. Bröhl, L. Finken, C. Schlick

Development of the Elderly Healthcare Monitoring System with IoT

Stroke is a brain attack (or infarction of a portion of the brain) caused by the sudden disturbance of blood supply to that area. In recent years, even though the number of stroke-related deaths has been decreasing in Korea, the incidence of stroke is increasing, and the incidence increase with age. The chances of surviving from an acute and sudden infarction are much higher if the elderly people get emergency medical assistance within a few hours of occurrence. Elderly health monitoring and emergency alert system are mentioned as one of the main application areas of pervasive computing and biomedical applications. Moreover, a proactive elderly health monitoring system involves active capture of brain and body movement signals, signal analysis, communication, detection and warning processes. The primary objective of this research will be concerned itself with ambient assisted living issues for the successful detection and generation of alarms in cases of stroke onset, which will allow the timely delivery of medical assistance, to mitigate the long-term effects of these attacks.

Se Jin Park, Murali Subramaniyam, Seoung Eun Kim, Seunghee Hong, Joo Hyeong Lee, Chan Min Jo, Youngseob Seo

Development of an Intermittent Pneumatic Compression System to Manage Soft Tissue Mechanical Properties

The pneumatic compression system has demonstrated the potential to manage hypertrophic scar tissues using localized intermittent compressive forces. The underlying mechanism associated with these repeated, intermittent compressive forces is the remodeling capacity of collagen fibers of fibrous tissues in response to mechanical forces. Although intermittent compressive forces are clinically proven effective on managing hypertrophic scar, the optimal configurations of pressures and timing of intermittent compressive forces are largely unknown. In this study, we have developed a motor-driven ultrasound indentation system to apply programmable compressive forces and simultaneously assess soft tissue mechanical properties and responses. We further tested this system in various conditions with Institutional Review Board-approved protocols in human participants. The compressive force applied by the system was 40 mmHg on the skin of the forearm for 1 h with a frequency of 0.1 Hz. Soft tissue mechanical properties were assessed at three conditions, including (a) the forearm resting on the table with the wrist at a neutral position, (b) the forearm resting on the table with the wrist at 90° of extension or the maximal extension of the subject, and (c) forearm resting on the table with the hand holding a 1 kg weight. The effective Young’s modulus was calculated to characterize mechanical properties of forearm soft tissues. Before the 1 h intermittent compression treatment, effective Young’s modulus of conditions a, b, and c was 18.0, 11.3, and 16.8 kPa, respectively. After the treatment, the effective Young’s modulus of conditions a, b, and c was reduced by 13, 7, and 51 %, respectively. The results support our general hypothesis that intermittent compression therapy may modulate soft tissue properties (e.g. hypertrophic scar). Future work should investigate the long-term effect of intermittent compression therapy on modulating soft tissue properties in patients with hypertrophic scars.

Chi-Wen Lung, Tse-Yu Cheng, Yi-Jhen Li, Ben-Yi Liau, Yih-Kuen Jan

Healthcare Testing


Ergonomic Performance Measurement and Evaluation for Worksystems in Healthcare

The principles of ergonomics can be applied to the study and design for the components of any worksystem involving human(s) and machine(s) embedded in environment. As a first step towards exploring the enormous potential and concept of ergonomics at workplaces, many organizations, including healthcare systems, are required to take steps to institutionalize the process of implementing a framework to determine the level of ergonomic performance at their different workplaces. Relevance ergonomics-related factors of performance should be identified and assessed on a regular basis to improve the performance, productivity and reliability of any unit of analysis, and application of the concept of ‘remedial’ ergonomics in many areas, operations and factors of production or service may lead to substantial improvement in overall system performance. This paper highlights the details of an ergonomic performance measurement system developed for a hospital system in India.

Pradip Kumar Ray, Esha Saha

Development of a New Psychometric Scale (PYTHEIA) to Assess the Satisfaction of Users with Any Assistive Technology

This paper presents the early findings of a new psychometric scale called PYTHEIA. It was developed in Greek according to the most well known guidelines recommendations in order to assess the satisfaction of users with any assistive technology device (e.g. robotic, rehabilitation device, etc.). Field test studies were conducted with 147 subjects (inpatients and outpatients of a rehabilitation hospital) who were administered the original questionnaire. The scale is applicable in patients with different diseases, ages, and disabilities using various assistive devices. According to the inclusion criteria selected, all of them scored above 17 in the Mini Mental State Examination (MMSE). Intraclass correlation coefficient (ICC = 0.992), Pearson’s correlation (r = 0.984) and Cronbach’s α (α = 0.793) indicated sufficient reliability measures. Test-retest outcome showed great stability. The paired samples t-test between initial assessment and reassessment indicated no statistically significant differences (p value = 0.059). Various types of validity were also investigated. According to the results, PYTHEIA is a stable, valid and reliable instrument. Thus, it can be used to measure the satisfaction of patients with any assistive device. PYTHEIA uniqueness is that it can be used to assess not only the general satisfaction of the users with any assistive device, but also to evaluate independently any individual characteristic and functionality that the device may have. To this end, it can be used for evaluating also new and experimental developments (e.g. robotic assistive devices, etc.) in lab environment and can help researchers assess their products in terms of efficiency, comfort, quality, performance, ergonomics and usefulness as perceived by the end users.

Yiannis Koumpouros, Effie Papageorgiou, Alexandra Karavasili

A Study on the Methodology to Analyse and Prevent Medical Errors Due to Non-observance

It is necessary to tackle medical errors in order to provide safe healthcare. Medical errors are defined as departures from standards and can be divided into 2 categories: the first occurs even though workers follow standards, and the second occurs because they act contrary to standards and is called non-observance. Although some studies, as typified by error proofs, have been performed on the former, there are few studies on the latter. Therefore, errors due to non-observance chronically occur in hospitals. In this paper, we define non-observance as intentional departure from standards and discuss a mechanism generating non-observance. Furthermore, we propose a method to analyse non-observance and to prevent it by improving work methods and education.

Haizhe Jin, Masahiko Munechika, Masataka Sano, Chisato Kajihara, Han Chen, Fu Guo

Human Factors and Ergonomics in Environmental Design


Ergonomic Design of Bathrooms for People with Cerebral Palsy in the Philippines

Around 2–3 out of 1000 births in the Philippines are born with Cerebral Palsy that affects the brain leading to complications of one’s motor skills. Partnered with Philippine Cerebral Palsy Incorporated (PCPI), which has a current bathroom layout that failed to meet the standards set by the Philippines, the study proposes an ergonomic bathroom design for Cerebral Palsy patients. Anthropometric and biomechanical data of the patients were integrated to the derivation of the specific measurements of different parts of the bathroom. In addition, qualitative inputs for the design were also gathered. Combining both qualitative and quantitative measures, a bathroom design that conforms to Philippine standards was created. This application of ergonomics in Cerebral Palsy facilities is a step closer in allowing Filipino patients suffering from this condition to attain independence in activities that are part of a person’s daily routine.

Quirby Alberto, Brian Atanacio, Cyrill Cucueco, Ana Mercado, Benette Custodio

The Place of Health Design for Health Promotion: The Pediatrics Design Process Focus in Humanization at Santa Casa’s Hospital Montes Claros—Brazil

Child who remains long periods in hospital are the one that suffers most from the influence of hospitals, but is the largest contributors to the humanization of studies. This work has its origin in the project process of Santa Casa de Montes Claros—Brazil hospital analysis focus in the concepts of humanization. It analyses the relationship between the health pediatric environment and the importance of the proposals of the humanization programs dedicated to the admitted child. One APO (post-occupation analysis) was adopted with cognitive approach, in order to diagnose, describe and analyze the built environment, perception and environmental cognition from the point of view of users. As there is a lack of studies in Brazil about that, from the information obtained from this paper, you can to propose suggestions for structural improvements to the hospital that contributes to the effective healing process of patients.

Janice Gomes Zumba

Supporting Phobia Treatment with Virtual Reality: Systematic Desensitization Using Oculus Rift

An irrational fear is called a phobia. Cognitive therapy teaches patients how to respond to triggering stimuli, by relaxing their mind and entering a state of reduced anxiety. Some of these methods depend on patient’s imagination, since putting them in the situation or the object that triggers the anxiety (airplanes, spiders, public speaking, and dinosaurs) might be difficult. Our project proposes an interactive virtual reality system that enhances both the visual and hearing parts of the therapy, putting the patient in a virtual world where they can learn the proper techniques to learn how to respond to the anxiety triggers. We call our system VRPhobia. A prototype was created and it was evaluated with the aid of Cognitive Psychology therapists. The system takes into account the techniques used by the therapists and the training that the patient goes through. It works as a tool that enhances the therapy process.

José P. Monge, Gustavo López, Luis A. Guerrero

Intelligent Nano-Worlds: A New ICT Based Tool for Mental Health Care of Children Living Under Social Vulnerability

The latest estimates of UNICEF and United Nations present a complex picture related with children living under social vulnerability. Approximately, one-half of the estimated 57.4 million people displaced by war around the world are children, most of whom have been separated from their families. In the same line, many countries (especially the developing ones) present a lack of specialized professionals and resources to provide mental care and rehabilitation services. Thus, children who are under institutional care, frequently present some kind of resistance to the psychological intervention. On those grounds, this paper presents a new proposal with the aim of providing support for infant psychotherapy (diagnosis and intervention) focused on this vulnerable population. Our approach relies on the new idea of incorporating the “interactive and ludic nano-worlds” (that are special sceneries inside a micro-world focused on the patient’s profile). Likewise, the developed system uses intelligent ICT tools, and an expert system to generate automatically intervention guidelines. This proposal has been tested with 124 children and has reached encouraging results.

Fernando Pesántez-Avilés, Verónica Cevallos-León Wong, Vladimir Robles-Bykbaev, Ana Pacurucu-Pacurucu, Cristian Tapia-Jaya, Ismael San Andrés-Becerra, Estefanía Borck-Vintimilla, Paola Ingavélez-Guerra

Healthcare Communications and Logistics


Application of the Delphi Method in the Development of a Triage Method for Vulnerable People in Disaster

This paper introduces a new triage simulation method for use in the design phase of disaster triage method for vulnerable people. The proposed method is an online scenario-based triage simulation incorporates the Delphi method. The method was assessed to determine its effectiveness for obtaining knowledge to improve the design of a new triage method. The result showed that the method is effective for identifying the appropriate triage, consideration points, and the cases for which the appropriate triage is difficult to determine.

Taro Kanno, Chie Ishida, Yuko Kubo, Masako Saito, Mariko Ohara, Kayoko Kawahara, Takuya Yamamto, Kazuo Furuta

Usability Testing an Electronic Health Record: Lessons Learned and Ethical Considerations

Interface design professionals frequently conduct usability tests to measure how well users can accomplish certain tasks with a given interface and to identify areas of improvement for redesign efforts. Much of the literature on electronic interface usability tests relates to consumer products, but there are special considerations when performing a usability test on an interface used in health care such as an electronic health record. A recent project involved a usability test of the existing electronic health record in the Veteran’s Health Administration by 30 clinicians. Notable issues were the development of an appropriate clinical scenario, recruiting of representative clinicians, and determining how to address unexpected usability findings. The health care environment adds a particular ethical challenge that may not be present in other usability tests, because it is necessary to balance considerations of patient safety with protection of the clinician participants.

Helen J.A. Fuller, Kyle D. Maddox, Nancy J. Lightner

Demographics, Military Status, and Physical Health as Indicators of Personal Resilience Among U.S. Active Duty Service Members and Veterans

Personal resilience refers to the ability to constructively adjust and move forward with ones’ life following tragic events or situations. However, few studies have examined the characteristics of highly resilient active duty military or veterans. This study examined the relationships between personal resiliency scores (The Resiliency Scale), demographics, general Self-Reported Health (SRH), and health symptomatology (Patient Health Questionnaire-15) among 263 U.S. active duty and veteran service members. Pearson Product-Moment Correlations, an Analysis of Variance, and Regression Analysis were used with a significance level of 0.05. Results showed that active duty service members were more resilient than the veterans in this population (p < 0.05). Findings also demonstrated that a higher education level, longer time on active duty, higher SRH, and lower symptomology were correlated with (p < 0.05) and contributed to greater resilience [F(4, 258) = 26.18, p < 0.01), R2 = 0.54]. These results demonstrate the importance of health and education, perhaps pointing toward a protective qualities that may also include longer service time.

Valerie J. Rice, Baoxia Liu

Language Sample Analysis Framework Utilizing the Natural Language Toolkit and Social Media

In this paper we present the Analysis of Social Discourse Framework (ASDF), which utilizes the Natural Language Toolkit [1] (NLTK 3.0 documentation. to analyze language samples from children on the Autism Spectrum. For those whose anxiety prohibits them from providing speech samples in response to guided elicitation we utilize free form social media posts to obtain the language samples. To demonstrate the value of ASDF, we present a formative case study illustrating the collection of samples via social media posts and the resulting analysis. In addition to providing metrics traditionally used in speech sample analysis, ASDF provides new metrics made possible through natural language processing. ASDF is open source so it can be extended by researchers to include additional metrics and additional means of acquiring the data associated with these metrics.

Ahmad Abualsamid, Charles E. Hughes

Georeferencing in Logistics Transplant

It is important to know the receiver’s location in organ and tissue transplant procedure in order to optimize logistics of the transplant, allowing the preparation of the surgical procedure and the calculation of cold ischemia of the organ to be transplanted. This study refers to the first stage of this project that analyzes the usability of the geolocation system for the transplant system, allowing the sending of the location of the receptors for the medical staff; monitoring the location with the use of a map; offering multiple means of communication between the team and receiver. The methodology used was a survey, held in São Paulo/Brazil with 33 collaborators who used the tool for 90 days and evaluated the usability using the Usability Scale System. The partial results tests show that the usability meets the needs of collaborators.

Cristina Corrêa de Oliveira, Camila Inácio Belo da Silva, Antonio Rodrigues Carvalho Neto, Wellington Pinto de Oliveira
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