J. Kalra, Zoher Rafid-Hamed, Lily Wiebe, Patrick J Seitzinger
Medical errors are a significant public health concern that affects patient care and safety. Highlighted as a substantial problem in the 1999 Institute of Medicine report, medical errors have become the third leading cause of death in the United States of America. Failure to inform the patient of adverse events caused by a medical error compromises patient autonomy. Disclosure of adverse events to patients and families is critical in managing the consequences of a medical error and essential for maintaining patient trust. When errors occur, healthcare practitioners are faced with the ethical and moral dilemmas of if and to whom to disclose the error. Healthcare providers face these disclosure dilemmas across all disciplines, locations, and generations and have far-reaching implications on healthcare quality and the progress of medicine. We have previously reported the Canadian provincial initiatives encouraging open disclosure of adverse events and have suggested its integration into a 'no-fault' model. Though similar in content, the Canadian provincial initiatives remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. The purpose of this study was to review and compare the disclosure policies implemented by individual health care regions/authorities in various parts of Canada to identify quality issues related to medical error disclosure based on several ethical and professional principles. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners balance the moral complexities involved in error disclosure. Effective communication between health care providers, patients, and their families throughout the disclosure process is integral in sustaining and developing the physician-patient relationship. We believe that the disclosure policies can provide a framework and guidelines for appropriate disclosure, leading to more transparent practices. We suggest that disclosure practice can be improved by creating a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient's right to an honest disclosure and be implemented as part of the standard of care.
{"title":"Medical Error Disclosure: A Quality Perspective and Ethical Dilemma in Healthcare Delivery","authors":"J. Kalra, Zoher Rafid-Hamed, Lily Wiebe, Patrick J Seitzinger","doi":"10.54941/ahfe1002107","DOIUrl":"https://doi.org/10.54941/ahfe1002107","url":null,"abstract":"Medical errors are a significant public health concern that affects patient care and safety. Highlighted as a substantial problem in the 1999 Institute of Medicine report, medical errors have become the third leading cause of death in the United States of America. Failure to inform the patient of adverse events caused by a medical error compromises patient autonomy. Disclosure of adverse events to patients and families is critical in managing the consequences of a medical error and essential for maintaining patient trust. When errors occur, healthcare practitioners are faced with the ethical and moral dilemmas of if and to whom to disclose the error. Healthcare providers face these disclosure dilemmas across all disciplines, locations, and generations and have far-reaching implications on healthcare quality and the progress of medicine. We have previously reported the Canadian provincial initiatives encouraging open disclosure of adverse events and have suggested its integration into a 'no-fault' model. Though similar in content, the Canadian provincial initiatives remain isolated because of their non-mandatory nature and absence of federal or provincial laws on disclosure. The purpose of this study was to review and compare the disclosure policies implemented by individual health care regions/authorities in various parts of Canada to identify quality issues related to medical error disclosure based on several ethical and professional principles. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners balance the moral complexities involved in error disclosure. Effective communication between health care providers, patients, and their families throughout the disclosure process is integral in sustaining and developing the physician-patient relationship. We believe that the disclosure policies can provide a framework and guidelines for appropriate disclosure, leading to more transparent practices. We suggest that disclosure practice can be improved by creating a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient's right to an honest disclosure and be implemented as part of the standard of care.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115736688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The possibility of conducting human factors validations remotely becomes increasingly important, not only due to the COVID-19 pandemic. However, there is a lack of research addressing the reliability of remotely obtained data in the field of medical products. Observability seems to be a key factor and has therefore be ensured in remote setups. This research focuses on producing and analyzing first data to compare lab-based and remote-based setups. The goal is to evaluate if and under which circumstances human factors validations of medical devices could be conducted remotely and which methodological aspects must be considered. In a simulated human factors validation / usability test, two lab-based and two remote-based conditions were investigated. The lab-based observer was present in the test room during the evaluation. Afterwards, the session’s recording could be reviewed as a second variant of the lab-based observation. The remote-based observer had the recording as a resource for observation only and the chance to review it afterwards as a second condition. The observations were based on a simulated human factors validation for two different medical products (device and software). The main basis for data analysis was an observation protocol in which the individual actions to be performed were categorized by the two observer groups according to classification derived from FDA’s Human Factors Guidance. Five human factors professionals in the lab-based and the remote-based setup respectively, with prior knowledge about both products in focus of the evaluation, generated the protocol data. The datasets from the lab-based and the remote-based observations were compared regarding their level of agreement. In addition, the quality of observations was assessed by comparing them to a sample solution, including the effect of the setups on the observers’ cognitive workload. Descriptively assessed, any-two agreement and Cohen´s κ calculations showed differences in observations of the lab-based vs. remote-based setup that became smaller when potentially critical actions were in focus. For the medical software less than 10% of the observations differed compared to around 15% for the medical device considering only critical use errors. The quality of observations was slightly higher when the observer was on-site, and better overall for the medical device compared to medical software regarding percentual agreement with the sample solution. Interestingly, a particularly high cognitive workload occurred when the medical device was observed remotely comparing the total NASA-TLX scores between the setups. Findings do not seem to strongly favor either lab-based or remote-based setups. For the medical device, the lab-based observation seemed to be more appropriate while for the medical software the result is not clear. However, remote observation performed better for the medical software than for the medical device. Observing the evaluation remotely and verifying
{"title":"Comparison of Lab- and Remote-Based Human Factors Validation – A Pilot Study","authors":"Karoline Johnsen, Bernhard Wandtner, M. Thorwarth","doi":"10.54941/ahfe1002128","DOIUrl":"https://doi.org/10.54941/ahfe1002128","url":null,"abstract":"The possibility of conducting human factors validations remotely becomes increasingly important, not only due to the COVID-19 pandemic. However, there is a lack of research addressing the reliability of remotely obtained data in the field of medical products. Observability seems to be a key factor and has therefore be ensured in remote setups. This research focuses on producing and analyzing first data to compare lab-based and remote-based setups. The goal is to evaluate if and under which circumstances human factors validations of medical devices could be conducted remotely and which methodological aspects must be considered. In a simulated human factors validation / usability test, two lab-based and two remote-based conditions were investigated. The lab-based observer was present in the test room during the evaluation. Afterwards, the session’s recording could be reviewed as a second variant of the lab-based observation. The remote-based observer had the recording as a resource for observation only and the chance to review it afterwards as a second condition. The observations were based on a simulated human factors validation for two different medical products (device and software). The main basis for data analysis was an observation protocol in which the individual actions to be performed were categorized by the two observer groups according to classification derived from FDA’s Human Factors Guidance. Five human factors professionals in the lab-based and the remote-based setup respectively, with prior knowledge about both products in focus of the evaluation, generated the protocol data. The datasets from the lab-based and the remote-based observations were compared regarding their level of agreement. In addition, the quality of observations was assessed by comparing them to a sample solution, including the effect of the setups on the observers’ cognitive workload. Descriptively assessed, any-two agreement and Cohen´s κ calculations showed differences in observations of the lab-based vs. remote-based setup that became smaller when potentially critical actions were in focus. For the medical software less than 10% of the observations differed compared to around 15% for the medical device considering only critical use errors. The quality of observations was slightly higher when the observer was on-site, and better overall for the medical device compared to medical software regarding percentual agreement with the sample solution. Interestingly, a particularly high cognitive workload occurred when the medical device was observed remotely comparing the total NASA-TLX scores between the setups. Findings do not seem to strongly favor either lab-based or remote-based setups. For the medical device, the lab-based observation seemed to be more appropriate while for the medical software the result is not clear. However, remote observation performed better for the medical software than for the medical device. Observing the evaluation remotely and verifying ","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127472560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamalatharsi Mutuura, Mario Niederhauser, Nico Erb, Freddie Van Den Anker
In healthcare, point-of-care testing, i.e., diagnostic testing at the time and place of patient care, allows for early diagnosis and therefore timely treatment of various diseases. These on-site tests are particularly beneficial to people living in remote areas and those with limited mobility. Our study focused on the design of a service for older people, whereby ambulatory care and telemedicine consultations are based on point-of-care testing. Its aim was to elicit user requirements, specifically for the use case of iron deficiency in older people. A textual scenario was developed which formed the foundation for the simulated or “enacted” scenario, with both undergoing participatory evaluations. A wide range of “socio-technical” requirements were elicited that are expected to be crucial for the implementation of this service. Based on content analysis they were categorized into technology-, people-, organization- and environment-related requirements. The results are discussed regarding the specific use case and methods used.
{"title":"User Requirements for a Health Care Service Based on Point-of-care Testing in the Context of Ambulatory Care and Telemedicine for Older People","authors":"Kamalatharsi Mutuura, Mario Niederhauser, Nico Erb, Freddie Van Den Anker","doi":"10.54941/ahfe1002098","DOIUrl":"https://doi.org/10.54941/ahfe1002098","url":null,"abstract":"In healthcare, point-of-care testing, i.e., diagnostic testing at the time and place of patient care, allows for early diagnosis and therefore timely treatment of various diseases. These on-site tests are particularly beneficial to people living in remote areas and those with limited mobility. Our study focused on the design of a service for older people, whereby ambulatory care and telemedicine consultations are based on point-of-care testing. Its aim was to elicit user requirements, specifically for the use case of iron deficiency in older people. A textual scenario was developed which formed the foundation for the simulated or “enacted” scenario, with both undergoing participatory evaluations. A wide range of “socio-technical” requirements were elicited that are expected to be crucial for the implementation of this service. Based on content analysis they were categorized into technology-, people-, organization- and environment-related requirements. The results are discussed regarding the specific use case and methods used.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132122828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dementia is a chronic, degenerative, incapacitating disease that affects millions of people yearly. People with dementia require constant supervision and assistance, unfortunately, most caregivers are informal since professional healthcare can be unaffordable. We believe that this burden could be alleviated using a chatbot. Chatbots have seen an increase in use in healthcare over the past decade and they have been proven especially effective dealing with mental health disorders and chronic conditions. However, there is still room for improvement regarding their intelligence when compared to other cutting edge conversational agents and there are barely any bots that support Spanish. Furthermore, there are fewer chatbots specialized for people with any type of dementia. Alzheimer’s being the most common one, this research’s goal is to determine what features and characteristicsa chatbot for people with Alzheimer’s dementia should have. A comparative analysis of healthcare chatbots and development tools was conducted as groundwork for the design. An underdeveloped instance of said chatbot was implemented as a proof of concept, the architecture proposed allows for progress to be made on the chatbot without compromising its integrity. All the development was done using Azure tools, namely the bot framework composer, which was sufficient for the intended purposes but it poses serious limitations.
{"title":"Design and proof of concept of chatbot for people with dementia","authors":"Agustin Pumarejo Ontañon, Rogelio Bustamante-Bello, Sergio Navarro Tuch, Ariel Lopez Aguilar, Lili Marlene Camacho Bustamante","doi":"10.54941/ahfe1003484","DOIUrl":"https://doi.org/10.54941/ahfe1003484","url":null,"abstract":"Dementia is a chronic, degenerative, incapacitating disease that affects millions of people yearly. People with dementia require constant supervision and assistance, unfortunately, most caregivers are informal since professional healthcare can be unaffordable. We believe that this burden could be alleviated using a chatbot. Chatbots have seen an increase in use in healthcare over the past decade and they have been proven especially effective dealing with mental health disorders and chronic conditions. However, there is still room for improvement regarding their intelligence when compared to other cutting edge conversational agents and there are barely any bots that support Spanish. Furthermore, there are fewer chatbots specialized for people with any type of dementia. Alzheimer’s being the most common one, this research’s goal is to determine what features and characteristicsa chatbot for people with Alzheimer’s dementia should have. A comparative analysis of healthcare chatbots and development tools was conducted as groundwork for the design. An underdeveloped instance of said chatbot was implemented as a proof of concept, the architecture proposed allows for progress to be made on the chatbot without compromising its integrity. All the development was done using Azure tools, namely the bot framework composer, which was sufficient for the intended purposes but it poses serious limitations.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131055083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Woodier, Charlotte Burnett, P. Sampson, I. Moppett
The aim of this study was to understand how the transport industries of aviation, rail and maritime have implemented near-miss management systems, and the impact of their learning from near misses. Grounded Theory, augmented by a scoping review, was used to generate the theory and principles behind how the industries manage near misses. The paper summarises the key findings from the scoping review and the themes identified through interviews with safety/human factors leads across various transport organisations. The findings provide insights into how healthcare might better manage near misses. However, the findings also challenge healthcare perceptions that other industries have perfected safety, and the specific value of near misses if used in isolation. The paper finishes by recommending safety management systems in healthcare.
{"title":"Improving healthcare-system safety through near misses: learning from transport industries","authors":"N. Woodier, Charlotte Burnett, P. Sampson, I. Moppett","doi":"10.54941/ahfe1002117","DOIUrl":"https://doi.org/10.54941/ahfe1002117","url":null,"abstract":"The aim of this study was to understand how the transport industries of aviation, rail and maritime have implemented near-miss management systems, and the impact of their learning from near misses. Grounded Theory, augmented by a scoping review, was used to generate the theory and principles behind how the industries manage near misses. The paper summarises the key findings from the scoping review and the themes identified through interviews with safety/human factors leads across various transport organisations. The findings provide insights into how healthcare might better manage near misses. However, the findings also challenge healthcare perceptions that other industries have perfected safety, and the specific value of near misses if used in isolation. The paper finishes by recommending safety management systems in healthcare.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130984643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seasonal Affective Disorder (SAD), also known as seasonal depression, is a subtype of depression in which the patient is affected by hours of daylight received during specific seasons. Besides the classic symptoms of a depressive disorder, SAD causes hypersomnia and cravings for carbohydrates. SAD is caused by several psychological and biological mechanisms of which the shift of the circadian rhythm caused by an imbalance of melatonin is one. This specific mechanism can be treated using bright light therapy. During daily light therapy sessions, the user is subjected to a strong light source directed to the eyes. Although bright light therapy (BLT) is proven to be an effective non-pharmaceutical treatment, compliance and motivation of patients is low.In this paper, we analyse the specific needs and wishes of seasonal depression sufferers, to gain an understanding in the ways in which the light therapy market is currently lacking. By conducting in-depth interviews as well as diary surveys and field research, insights were collected to map the users’ needs and experiences. After a short analysis of the technical specifications and market segments of daylight lamps, a list of requirements was composed to support the design process of a new, innovate light therapy system in which there is a clear focus on user experience.This paper contributes to the literature on light therapy and SAD, offering a new user-centred angle to the theoretical line-up of research papers in order to increase therapy compliance and improve user experience during light therapy sessions.
{"title":"A Product-Service System Approach to Light Therapy for Treatment of Seasonal Depression","authors":"Kaat Kenis, Ivo Dewit","doi":"10.54941/ahfe1002127","DOIUrl":"https://doi.org/10.54941/ahfe1002127","url":null,"abstract":"Seasonal Affective Disorder (SAD), also known as seasonal depression, is a subtype of depression in which the patient is affected by hours of daylight received during specific seasons. Besides the classic symptoms of a depressive disorder, SAD causes hypersomnia and cravings for carbohydrates. SAD is caused by several psychological and biological mechanisms of which the shift of the circadian rhythm caused by an imbalance of melatonin is one. This specific mechanism can be treated using bright light therapy. During daily light therapy sessions, the user is subjected to a strong light source directed to the eyes. Although bright light therapy (BLT) is proven to be an effective non-pharmaceutical treatment, compliance and motivation of patients is low.In this paper, we analyse the specific needs and wishes of seasonal depression sufferers, to gain an understanding in the ways in which the light therapy market is currently lacking. By conducting in-depth interviews as well as diary surveys and field research, insights were collected to map the users’ needs and experiences. After a short analysis of the technical specifications and market segments of daylight lamps, a list of requirements was composed to support the design process of a new, innovate light therapy system in which there is a clear focus on user experience.This paper contributes to the literature on light therapy and SAD, offering a new user-centred angle to the theoretical line-up of research papers in order to increase therapy compliance and improve user experience during light therapy sessions.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129545380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Proton radiotherapy is currently a more advanced tumor treatment method in radiotherapy, which can accurately eliminate tumor cells while reducing damage to surrounding healthy cells. However, anxiety and depression often occur in cancer patients during treatment. On the one hand, it will cause the displacement of the lesion and affect the effect of radiotherapy. On the other hand, negative psychology is not conducive to physical rehabilitation. In this paper, the principle of environmental psychology is used to guide the design of indoor environment of radiotherapy from the perspective of visual and auditory senses. Through the influence of environment on psychology, the purpose of calming the mood of patients and improving the therapeutic effect is achieved, and it provides support and reference for the design of humanized radiotherapy room space in the future.
{"title":"Design of Proton Radiotherapy Room Based on Environmental Psychology","authors":"Zikun Gao, Xinxiong Liu","doi":"10.54941/ahfe1002126","DOIUrl":"https://doi.org/10.54941/ahfe1002126","url":null,"abstract":"Proton radiotherapy is currently a more advanced tumor treatment method in radiotherapy, which can accurately eliminate tumor cells while reducing damage to surrounding healthy cells. However, anxiety and depression often occur in cancer patients during treatment. On the one hand, it will cause the displacement of the lesion and affect the effect of radiotherapy. On the other hand, negative psychology is not conducive to physical rehabilitation. In this paper, the principle of environmental psychology is used to guide the design of indoor environment of radiotherapy from the perspective of visual and auditory senses. Through the influence of environment on psychology, the purpose of calming the mood of patients and improving the therapeutic effect is achieved, and it provides support and reference for the design of humanized radiotherapy room space in the future.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"207 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121471567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Boukhechba, Mingyue Tang, B. Bowman, J. Zoellner, E. Abdel-Rahman
Background:End Stage Kidney disease (ESKD) patients must follow unique dietary restrictions. The most onerous of these is the need to restrict fluid intake. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations with diagnoses of heart failure and pulmonary edema, increased hospital length of stay, and increased total cost of care. Fluid intake control is a bedrock component of treatment for ESKD Patients, but continues to be a major challenge for patients, healthcare providers, and organizations. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations and increased total cost of care. The goal of this work is to investigate the feasibility of leveraging smartwatch technology to monitor fluid consumption of ESKD patients outside of the clinic. Adequate assessment of fluid intake of patients with ESKD on HD and offering timely feedback to patients and clinicians has the potential of curbing the extra fluid intake, hence reduce mortality and morbidity, and hopefully cut the costs of the need of frequent hospitalizations and/or extra dialysis treatments.Methods:We have designed a smartwatch app called Fluisense (available on Android play store,, https://play.google.com/store/apps/details?id=com.mob.fluisense) to help ESKD patients monitor their fluid intake. Fluisense helps patients record Fluid intake logs in an intuitive manner. Fluisense also collects sensor data such as mobility, acceleration, and heart rate to investigate biomarkers indicative of fluid overload. To the best of our knowledge, this is the first work leveraging smartwatches to monitor fluid accumulation of ESKD patients.N=15 ESKD patients were given an Android smartwatch with Fluisense pre-installed and were asked to log their fluid intake through the app by choosing from a list of predefined volumes each time they consume any liquid. The app computed and displayed the self-reported daily volume intake to help patients monitor their own fluid consumption. Patients received text messages twice a day (9am and 8pm) to remind them to use the watch. We also recorded patients’ weights before and after each of the thrice weekly dialysis sessions. The sum of self-reported interdialytic fluid intake was computed and compared against the interdialytic weight gain recorded in the clinic.Results: Patients recorded Fluids in 214 days out of 259 total days (i.e., 83% compliance rate). The average self-reported interdyalitic fluid consumption is 51 oz +/-64, and the average interdialytic weight gain is 2.67 kg +/- 1.56. We found a moderate but significant correlation between the self-reported fluid volumes and the interdialytic weight gain (r=0.363, P<0.001, r2=0.06). A deep learning method has also been designed to predict the interdialyctic weight gain from sensor data. Results validated through leave one subject out cross validation show an F1 score of 91 at predicting the level of w
背景:终末期肾病(ESKD)患者必须遵循独特的饮食限制。其中最繁重的是需要限制液体摄入。液体控制不良的后果包括死亡率和发病率的增加，诊断为心力衰竭和肺水肿的频繁住院，住院时间的延长，以及总护理费用的增加。液体摄入控制是ESKD患者治疗的基本组成部分，但对患者、医疗保健提供者和组织来说仍然是一个主要挑战。液体控制不良的后果包括死亡率和发病率增加、频繁住院和总护理费用增加。这项工作的目的是研究利用智能手表技术监测ESKD患者在诊所外的液体消耗的可行性。充分评估HD患者的液体摄入量，并及时向患者和临床医生提供反馈，有可能抑制额外的液体摄入量，从而降低死亡率和发病率，并有望降低频繁住院和/或额外透析治疗的成本。方法:我们设计了一款名为Fluisense的智能手表应用程序(可在Android play store，， https://play.google.com/store/apps/details?id=com.mob.fluisense)，以帮助ESKD患者监测他们的液体摄入量。Fluisense帮助患者以直观的方式记录液体摄入日志。Fluisense还收集传感器数据，如流动性、加速度和心率，以研究指示流体过载的生物标志物。据我们所知，这是第一次利用智能手表来监测ESKD患者的液体积聚。N=15名ESKD患者获得了预装Fluisense的安卓智能手表，并被要求通过应用程序记录他们的液体摄入量，每次他们摄入任何液体时，都要从预定义的数量列表中进行选择。该应用程序计算并显示自我报告的每日摄入量，以帮助患者监测自己的液体消耗。患者每天(上午9点和晚上8点)收到两次短信，提醒他们使用手表。我们还记录了患者每周透析三次前后的体重。计算自我报告的透析间期液体摄入量的总和，并与临床记录的透析间期体重增加进行比较。结果:患者在总共259天中的214天记录了液体(即，83%的依从率)。自我报告的平均两期液体消耗量为51盎司+/-64，平均两期体重增加2.67公斤+/- 1.56。我们发现自我报告的液体量与透析间期体重增加之间存在中度但显著的相关性(r=0.363, P<0.001, r2=0.06)。还设计了一种深度学习方法，用于从传感器数据中预测透析间期体重增加。通过交叉验证的结果显示，在预测体重变化水平方面，F1得分为91。结论:利用基于智能手表的传感技术对ESKD患者进行液体监测是一种很有前途的解决方案。这可能与这项技术的易用性和其测量的生态有效性有关，因为它们是在发生的时候收集的，减少了回忆偏差。
{"title":"A Smartwatch Based system for Monitoring Fluid Consumption of End Stage Kidney Patients","authors":"M. Boukhechba, Mingyue Tang, B. Bowman, J. Zoellner, E. Abdel-Rahman","doi":"10.54941/ahfe1002101","DOIUrl":"https://doi.org/10.54941/ahfe1002101","url":null,"abstract":"Background:End Stage Kidney disease (ESKD) patients must follow unique dietary restrictions. The most onerous of these is the need to restrict fluid intake. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations with diagnoses of heart failure and pulmonary edema, increased hospital length of stay, and increased total cost of care. Fluid intake control is a bedrock component of treatment for ESKD Patients, but continues to be a major challenge for patients, healthcare providers, and organizations. The ramifications of poor fluid control include increased mortality and morbidities, frequent hospitalizations and increased total cost of care. The goal of this work is to investigate the feasibility of leveraging smartwatch technology to monitor fluid consumption of ESKD patients outside of the clinic. Adequate assessment of fluid intake of patients with ESKD on HD and offering timely feedback to patients and clinicians has the potential of curbing the extra fluid intake, hence reduce mortality and morbidity, and hopefully cut the costs of the need of frequent hospitalizations and/or extra dialysis treatments.Methods:We have designed a smartwatch app called Fluisense (available on Android play store,, https://play.google.com/store/apps/details?id=com.mob.fluisense) to help ESKD patients monitor their fluid intake. Fluisense helps patients record Fluid intake logs in an intuitive manner. Fluisense also collects sensor data such as mobility, acceleration, and heart rate to investigate biomarkers indicative of fluid overload. To the best of our knowledge, this is the first work leveraging smartwatches to monitor fluid accumulation of ESKD patients.N=15 ESKD patients were given an Android smartwatch with Fluisense pre-installed and were asked to log their fluid intake through the app by choosing from a list of predefined volumes each time they consume any liquid. The app computed and displayed the self-reported daily volume intake to help patients monitor their own fluid consumption. Patients received text messages twice a day (9am and 8pm) to remind them to use the watch. We also recorded patients’ weights before and after each of the thrice weekly dialysis sessions. The sum of self-reported interdialytic fluid intake was computed and compared against the interdialytic weight gain recorded in the clinic.Results: Patients recorded Fluids in 214 days out of 259 total days (i.e., 83% compliance rate). The average self-reported interdyalitic fluid consumption is 51 oz +/-64, and the average interdialytic weight gain is 2.67 kg +/- 1.56. We found a moderate but significant correlation between the self-reported fluid volumes and the interdialytic weight gain (r=0.363, P<0.001, r2=0.06). A deep learning method has also been designed to predict the interdialyctic weight gain from sensor data. Results validated through leave one subject out cross validation show an F1 score of 91 at predicting the level of w","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"85 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120901283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Value Based Health Care (VBHC) has recently become the leading conceptual approach to health care in the world, but no value-based healthcare programme has yet been established in Latvia. Despite the critical interest in the implementation of VBHC programmes on the part of the health sector stakeholders, still the key persons in VBHC programmes are physicians. Goal of research: To clarify the views of physicians and young physicians on values-based health care fundamental principles and their vision for their further inclusion in Latvian health care. Method: The research uses data from a survey conducted among physicians and young physicians who practice at Pauls Stradins Clinical University Hospital.Results: 42% of physicians responded that patient surveys on the effectiveness of treatment for certain groups of patients could help to improve the results of treatment; 51% of physicians responded that patient surveys on their experience during treatment can help to improve their treatment results; much more cautious were physicians regarding the question whether comparing the results of treatment between physicians teams/hospitals could help to improve the results – 39% replied ‘Yes’ and 24% ‘Rather yes than no’; similarly cautious was the reply to the question whether the voluntary public availability of treatment results from a medical treatment facility could have a positive impact on the visibility of the service provider – 31% replied ‘Yes’ and 25% ‘Rather yes’; the convincing 82% of replies were to the question whether an exchange of experience and knowledge in the team of physicians helps to improve the results of treatment; the convincing majority of 86% of physicians believe that a multidisciplinary team of physicians can help improve the results of treatment; as a positive response, can be considered that 63% of respondents think that reforms in health care may be initiated not only by the Ministry of Health. The most interesting answer would be to the question of what management strategies should be developed in the healthcare system, where the first place, with 349 points, was taken by the answer “Cooperation with external partners (manufacturers, scientific centres, insurers, IT and other service providers)”.Conclusions: The results of the survey show that the application of VBHC principles will not contradict to views of physicians on traditional management models in health care and their role in it.Proposals: However, prior to starting the introduction of VBHC programmes in Latvian health care, there are grounds for launching discussions on the benefits of VBHC compared to the traditional management model. Policy recommendations: For hospital management and health sector supervisors to avoid resistance of physicians to implementing VBHC, the strategy should focus not on VBHC resource-efficient programmes but on patient-centred healthcare.
{"title":"Is Latvia Ready For The Value-Based Healthcare Era?","authors":"Mara Petersone, I. Erins, Kārlis Ketners","doi":"10.54941/ahfe1002130","DOIUrl":"https://doi.org/10.54941/ahfe1002130","url":null,"abstract":"The Value Based Health Care (VBHC) has recently become the leading conceptual approach to health care in the world, but no value-based healthcare programme has yet been established in Latvia. Despite the critical interest in the implementation of VBHC programmes on the part of the health sector stakeholders, still the key persons in VBHC programmes are physicians. Goal of research: To clarify the views of physicians and young physicians on values-based health care fundamental principles and their vision for their further inclusion in Latvian health care. Method: The research uses data from a survey conducted among physicians and young physicians who practice at Pauls Stradins Clinical University Hospital.Results: 42% of physicians responded that patient surveys on the effectiveness of treatment for certain groups of patients could help to improve the results of treatment; 51% of physicians responded that patient surveys on their experience during treatment can help to improve their treatment results; much more cautious were physicians regarding the question whether comparing the results of treatment between physicians teams/hospitals could help to improve the results – 39% replied ‘Yes’ and 24% ‘Rather yes than no’; similarly cautious was the reply to the question whether the voluntary public availability of treatment results from a medical treatment facility could have a positive impact on the visibility of the service provider – 31% replied ‘Yes’ and 25% ‘Rather yes’; the convincing 82% of replies were to the question whether an exchange of experience and knowledge in the team of physicians helps to improve the results of treatment; the convincing majority of 86% of physicians believe that a multidisciplinary team of physicians can help improve the results of treatment; as a positive response, can be considered that 63% of respondents think that reforms in health care may be initiated not only by the Ministry of Health. The most interesting answer would be to the question of what management strategies should be developed in the healthcare system, where the first place, with 349 points, was taken by the answer “Cooperation with external partners (manufacturers, scientific centres, insurers, IT and other service providers)”.Conclusions: The results of the survey show that the application of VBHC principles will not contradict to views of physicians on traditional management models in health care and their role in it.Proposals: However, prior to starting the introduction of VBHC programmes in Latvian health care, there are grounds for launching discussions on the benefits of VBHC compared to the traditional management model. Policy recommendations: For hospital management and health sector supervisors to avoid resistance of physicians to implementing VBHC, the strategy should focus not on VBHC resource-efficient programmes but on patient-centred healthcare.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126666378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The three sets of premises imply the most general hypothesis about the supreme criteria of the value of global civilization. This hypothesis can be defined more concretely, but to ignore it would be to consent to self-destruction at our own request. Such a prospect is real in a much shorter time frame than the most optimistic (in fact naive) predictions of those trusting that humans en bloc will not allow this to happen.The first set (pessimistic) contains tragic experiences from the micro to the macro scale related to both the COVID-19 pandemic and the Russian aggression against Ukraine, which has been ongoing since February 24, 2022; also the history of mankind, the shortest description of which contains a multi-page list of dates and names of wars. The second (optimistic) contains the wisdom recorded in the Holy Books, philosophical writings, and constantly handed down in the distinguished departments of all arts; heritage of the so-called ‘higher culture’; groundbreaking scientific discoveries related to the protection of health and life. The third one (seemingly neutral, since tools in the ethical sense are intrinsically neutral, and the way they will be used is ultimately decided by man): technology that actually enables real-time communication of the entire human population, but the effective use of this technology while respecting the guiding criteria of universal human values requires competent and therefore responsible coordination.The hypothesis is: survival of humans and nature in a non-degenerate form and responsibility for coming generations. The open problem is to train and elect suitable coordinators and assign them with the mission of coordinating elements that, from the micro- to the macro scale, will form a whole, worthy of the name ‘safe civilization of wisdom’ (wisdom includes responsibility). In a sense, paradoxically, it makes sense to reverse the direction from macro to micro, according to the principle of ‘the example comes from the top’.While Innovative Agonology (in fact the first experts in this new science) provides a methodological basis, many detailed methods and recommendations, it is far from pointing to a way of imminently dealing with a phenomenon that Albert North Whitehead described 97 years ago in simple terms: „significant fact of the modern world is the discovery of a method of training professionals who specialize in particular areas of thought and progressively increase the sum of knowledge within their own limited research topics.” His words justify the caution expressed above about indicating a way to deal with the phenomenon of necessary coordination, precisely in the context of the hypothesis formulated: “The tasks of coordination are left to those who lack the strength or character to be successful in a particular field”.
{"title":"Hypothesis on the supreme value criteria of the global civilization","authors":"Paweł Piepiora, Roman Maciej Kalina","doi":"10.54941/ahfe1003498","DOIUrl":"https://doi.org/10.54941/ahfe1003498","url":null,"abstract":"The three sets of premises imply the most general hypothesis about the supreme criteria of the value of global civilization. This hypothesis can be defined more concretely, but to ignore it would be to consent to self-destruction at our own request. Such a prospect is real in a much shorter time frame than the most optimistic (in fact naive) predictions of those trusting that humans en bloc will not allow this to happen.The first set (pessimistic) contains tragic experiences from the micro to the macro scale related to both the COVID-19 pandemic and the Russian aggression against Ukraine, which has been ongoing since February 24, 2022; also the history of mankind, the shortest description of which contains a multi-page list of dates and names of wars. The second (optimistic) contains the wisdom recorded in the Holy Books, philosophical writings, and constantly handed down in the distinguished departments of all arts; heritage of the so-called ‘higher culture’; groundbreaking scientific discoveries related to the protection of health and life. The third one (seemingly neutral, since tools in the ethical sense are intrinsically neutral, and the way they will be used is ultimately decided by man): technology that actually enables real-time communication of the entire human population, but the effective use of this technology while respecting the guiding criteria of universal human values requires competent and therefore responsible coordination.The hypothesis is: survival of humans and nature in a non-degenerate form and responsibility for coming generations. The open problem is to train and elect suitable coordinators and assign them with the mission of coordinating elements that, from the micro- to the macro scale, will form a whole, worthy of the name ‘safe civilization of wisdom’ (wisdom includes responsibility). In a sense, paradoxically, it makes sense to reverse the direction from macro to micro, according to the principle of ‘the example comes from the top’.While Innovative Agonology (in fact the first experts in this new science) provides a methodological basis, many detailed methods and recommendations, it is far from pointing to a way of imminently dealing with a phenomenon that Albert North Whitehead described 97 years ago in simple terms: „significant fact of the modern world is the discovery of a method of training professionals who specialize in particular areas of thought and progressively increase the sum of knowledge within their own limited research topics.” His words justify the caution expressed above about indicating a way to deal with the phenomenon of necessary coordination, precisely in the context of the hypothesis formulated: “The tasks of coordination are left to those who lack the strength or character to be successful in a particular field”.","PeriodicalId":389399,"journal":{"name":"Healthcare and Medical Devices","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115555919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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