Healthcare and Medical Devices

AHFE International

Accelerating Open Access Science in Human Factors Engineering and Human-Centered Computing

Healthcare and Medical Devices

book-cover

Editors: Jay Kalra

Topics: Healthcare and Medical Devices

Publication Date: 2024

ISBN: 978-1-964867-06-9

DOI: 10.54941/ahfe1004830

Articles

Exploring Intraoperative Cognitive Biases in Cardiac Surgery Teams

This study focuses on understanding the influence of cognitive biases in the intraoperative decision-making process within cardiac surgery teams, recognizing the complexity and high-stakes nature of such environments. We aimed to investigate the perceived prevalence and impact of cognitive biases among cardiac surgery teams, and how these biases may affect intraoperative decisions and patient safety and outcomes. A mixed-methods approach was utilized, combining quantitative ratings across 32 different cognitive biases (0 to 100 visual analogue scale), regarding their “likelihood of occurring” and “potential for patient harm” during the intraoperative phase of cardiac surgery. Based on these ratings, we collected qualitative insights on the most-rated cognitive biases from semi-structured interviews with surgeons, anaesthesiologists, and perfusionists who work in a cardiac operating room. A total of 16 participants, including cardiac surgery researchers and clinicians, took part in the study. We found a significant presence of cognitive biases, particularly confirmation bias and overconfidence, which influenced decision-making processes and had the potential for patient harm. Of 32 cognitive biases, 6 were rated above the 75th percentile for both criteria (potential for patient harm, likelihood of occurring). Our preliminary findings provide a first step toward a deeper understanding of the complex cognitive mechanisms that underlie clinical reasoning and decision-making in the operating room. Future studies should further explore this topic, especially the relationship between the occurrence of intraoperative cognitive biases and postoperative surgical outcomes. Additionally, the impact of metacognition strategies (e.g. debiasing training) on reducing the impact of cognitive bias and improving intraoperative performance should also be investigated.

Roger Dias, Steven Yule, Ryan Harari, Marco Zenati

Conference Proceedings

A Structured Approach to Clinical Pathway Mapping (CPM): a Case Study of a Postoperative Patient Controlled Analgesia (PCA) pump

This study describes an evidence-based Clinical Pathway Mapping (CPM) visualisation method that can be used to enhance healthcare quality in the face of complex systems and constrained resources. The CPM visualisation method we are proposing highlights the connection among the key components of the healthcare work system – individuals, tasks, tools, technology, physical environment, and organisational conditions. When seeking to innovate a clinical pathway by adding or changing a (technological or procedural) component, practitioners need to consider that changes in one component will affect the others, so being able to map and visualise such the relationship among the components is essential to patient safety and care delivery. We present the CPM method using a case study focused on a new Patient-Controlled Analgesia (PCA) pump in the postoperative sector. Feedback was gained through semi-structured interviews with stakeholders from four NHS Trusts in the UK. By evaluating the device's effect on post-operative procedures, the research produced a thorough picture of the postoperative environment as it exists today. We identified the two most likely scenarios of use and carried out a work system analysis to investigate these scenarios in detail and implications for the healthcare work system’s components. This analysis facilitated the identification of new criteria necessary for the device's effective integration into NHS Hospitals. The study emphasises the benefits of utilizing a human and system centred process for visualisation, identifying areas for development, and improving the security and effective application of emerging medical technologies.

Massimo Micocci, Tayana Soukup, Hannah Kettley-linsell, Shayan Bahadori, Shanshan Zhou, Simon Walne, Simone Borsci, Peter Buckle, George Hanna

Conference Proceedings

Challenges and Uncertainties in Violence Risk Assessment: A Critical Examination of Practice and National Guidelines in Norway's Specialist Mental Health Services

In recent years, there have been several serious incidents in Norway where individuals with serious mental disorders have committed murder after being discharged from psychiatric care units. Several of these incidents have been subject to scrutiny by governmental oversight bodies and have sparked significant societal debates.The Norwegian Directorate of Health recommends the implementation of structured clinical violence risk assessments for patients with severe mental disorders being considered at risk of conducting violence. Reports from oversight authorities have highlighted instances where either violence risk assessments were not conducted prior to patient discharge or where assessments were inadequate. Violence risk assessments in mental health care remain a highly debated topic among professionals. This paper does not explore whether violence risk assessments are appropriate for use in violence prevention efforts or the quality of various assessment tools. Through the analysis of oversight reports and other documents, shortcomings, and errors in the assessment of violence risk in specialized health services are identified, often attributed to lack of expertise and time constraints. This paper questions how incorrect use of violence risk assessment tools can increase uncertainty and how there may be a potential gap between national professional guidelines for violence risk assessments and actual practice. Therefore, it argues for a thorough investigation to evaluate the need for revision of national guidelines or implementation of measures to ensure that clinicians have the necessary expertise and resources to conduct violence risk assessments.

Naska Xas

Conference Proceedings

Artificial Intelligence in Medication Management for Alzheimer's Patients in China

This study provides a comprehensive overview of artificial intelligence (AI) in China's pharmaceutical Alzheimer's management by examining past research. The focus is on critical factors that affect medicine adherence and major AI breakthroughs and trends. A systematic analysis examines how artificial intelligence can monitor medication adherence, give reminders, and discover drug interactions. These apps may improve patient adherence, therapeutic efficacy, and quality of life. However, literature gaps emphasise the need for more research. In conclusion, future projects should address these gaps to serve patients better, improve treatment outcomes, and navigate ethical and policy issues, advancing Alzheimer's drug management.

Xinyue Zhang, Rafiq Elmansy, Jingyang Liu

Conference Proceedings

Exploring Self-Medication Practices Among Undergraduate University Students: A Qualitative Descriptive Study

The findings of this study underscore the critical role of human factors and ergonomics in understanding and addressing the issue of self-medication among undergraduate university students. The aim of the presented qualitative descripted study was to explore the self medication and to assess practices among undergraduate university students of Viña del Mar from Chile. Method: A self-administered questionnaire consisting of 13 items was distributed to 342 participants through quota sampling, distributed in the following fields of study: Biotechnology Engineering (5), Manufacturing and Industrial Design Engineering (15), Computer Engineering (32), Industrial Maintenance Engineering (19), Industrial Safety and Environmental Engineering (10), Business Administration Technician (22), University Technician in Food (3), University Technician in Biotechnology (8), University Technician in Construction (25), University Technician in Environmental Control (5), University Technician in Electricity (25), University Technician in Electronics (17), University Technician in Renewable Energies (8), University Technician in Informatics (29), University Technician in Industrial Maintenance (24), University Technician in Automotive Mechanics (24), University Technician in Industrial Mechanics (18), University Technician in Mining and Metallurgy (29), University Technician in Engineering Projects (6), University Technician in Chemistry with a Mention in Analytical Chemistry (7), and University Technician in Telecommunications and Networks (11). The 342 participants (mean age=22 ± 2.3 years, Male: Female ratio=1.07:1), 71 were engineering and 271 were technician students. Self-medication was reported by 85.4% students. The most common reason for self-medication was lack of time to go to the doctor (49%). On the other hand, students (72%) use medications without prescription when symptoms appear, and the majority (75%) go to the doctor if the symptoms persist after self-medication. Commonly used medicines were analgesics (62.3%), antipyretics (21.1%) and antibiotics (11%). which are reflections of insufficient knowledge and wrong beliefs. Conclusion: Prevalence of self-medication is high in the Undergraduate University Students, despite majority being aware of its harmful effects. There is a need to educate the youth to ensure safe practices. Strict policies need to be implemented on the advertising and selling of medications to prevent this problem from escalating. Interventions must be put in place to educate on appropriate medicine use. National education programmes about the dangers of self medication use and restriction of antibiotics without prescriptions should be the priority including all paper components such as references, appendices, acknowledgements.

Rodrigo Dominguez, Alex Rojas, Enrique Calderón, Dany Bahamondes, Catalina Torrejon, Aylin Astudillo, Macarena Santander

Conference Proceedings

Exploring the Usability and User Experience of the Symptom Checker Interface

The symptom checker is an application designed to assist patients in self-assessment and provide recommendations on whether they should see the doctor. In the United States, many healthcare websites have provided symptom checkers as a service, whether for educational purposes or to enhance the patient's healthcare experience. Research indicates that symptom checkers must be more transparent and accessible for the users. Users must be able to trust the recommendations of the symptom checker for it to be effective. Therefore, the aim of this study is (1) To test whether the symptom checker can provide users with practical medical advice through clinical cases and (2) To examine whether the interface and features of the symptom checker affect user trust and experience.This study surveyed medical websites that currently offer symptom checkers. Two symptom checkers were ultimately selected for the study based on the symptom checker coverage of medical conditions, diagnostic accuracy, and appropriateness of medical advice. A total of 30 participants were invited to participate in the experiment to evaluate the usability of the symptom checker interfaces. Six clinical vignettes were provided during the experiment as scenarios of symptom inquiries. The evaluation methods included: (1) Tasks performed by think aloud method, (2) completing the questionnaire of SUS (System Usability Scale), UEQ (User Experience Questionnaire), and a DAS(Decision Attitude Scale), (3) conducting semi-structured interviews to gain in-depth insights into participants' experiences, perceptions, and recommendations regarding their interactions with the symptom checker.The results revealed that the SUS scores of the two symptom checkers were 67.5 (Grade D) and 47.5 (Grade F), respectively, failing to meet the acceptable standards of the SUS score. Furthermore, the pragmatic and hedonic quality of the UEQ scale didn't meet the criteria. Through the semi-structured interview, we found that: (1) participants' accuracy in identifying diseases was only 48% and 53%, and the majority of participants indicated that they would consider the results of the symptom checker just a suggestion. (2) 70% of participants thought detailed descriptions of symptoms and treatment methods could help increase trust and understanding of the conditions. (3) 67% of participants indicated that human body model feature assistance helped describe their physical condition. These results help us understand user behavior in the symptom checker interface and their sense of trust in the symptom checker, providing valuable insights for future design improvements.

Wei An Lin, Meng-Cong Zheng, Li-Jen Wang

Conference Proceedings

Explainable Hybrid Machine Learning Technique for Healthcare Service Utilization

In the era of data, predictive and prescriptive analytics in healthcare is enabled by machine learning (ML) algorithms. The varied healthcare entities pose challenges in the inclusion of ML predictive models in the rule-based claims processing system. The hybrid ML algorithm proposed in this research article is for handling huge volumes of data in predicting a member’s utilization of Medicaid home healthcare service. The member’s demographic features, health details and enrolment details are generally considered for building the utilization model though health details may not be available for new members. It is also a widely accepted fact that health outcomes are driven also by social and environmental features, furthermore, the analysis of Medicaid home healthcare service data proved the same. Hence various social temporal features such as their living place, federal poverty level, etc., are also considered for predicting the member expenditure in Medicaid home healthcare services. The home healthcare service utilization model predicts the member expenditure in home healthcare services in the subsequent years with the ability to peer group members in a home healthcare service considering the member demographics, their morbidities, and the socio-temporal features. In the home healthcare services utilization prediction modelling, the methodology of segmenting the input features using a clustering algorithm provides labels for the classification algorithm contributing to the accuracy of predicting the member expenditure. The clique clustering algorithm used in the model training phase discovers the similarities in member characteristics and provides labels for the extreme gradient boosting tree classifier. The best curve fitting function for each class is chosen either as linear or logarithmic or exponential or Gaussian in the training phase. The proposed hybridization of Clique clustering, Extreme Gradient Boost Tree classification, and Curve fitting algorithms address the lean availability of member information during enrolment for determining the member utilization of home healthcare services by their expenditure. The proposed hybrid home healthcare service utilization model, ‘Auto-labelled Boosted Regressor’ (ALBR), achieved an AUROC of 0.98 and an AUPRC of 0.90. The complexity of the hybrid ML model, ALBR, necessitated that the decisions and actions of the ML model is explainable to healthcare decision/policy makers. Post-hoc explainable ML methods approximate the behaviour of the complex ML technique using ALBR model as a black box by extracting relationships between sub-spaces of the feature values and the predictions. The home healthcare services utilization model is explained across frequent as well as the infrequent sub-spaces of the feature values using the extrapolated Medicaid home healthcare services data. The comparison of the relationship of the sub-spaces in the categorical features such as living facility, disability, and gender with the utilization for the training data and validation data shows similarity. Conclusively, the main contributions of this work are listed as follows:i.Formulate ML technique for increasing the effectiveness and robustness against data uncertainties in the prediction of home healthcare services utilization by a member.ii.Build explainable ML solutions and exhibit the use of visualizations for the post-hoc explainability of the ML models that would benefit the stakeholders

Ephina Thendral Surendranath

Conference Proceedings

Enhancing Accessibility in Mexican Healthcare: A Versatile Lift and Walking Aid System

Recent studies reported that 4.9 % of the Mexican population has a disability and/or limitations in their social participation; 48% of these being related to motor limitations (INEGI, 2020). The town of Tlajomulco de Zúñiga, which is located in one of the biggest states of the country with predominantly low-income communities, faces a variety of difficulties regarding access to healthcare services and rehabilitation treatments. Access to private physiotherapy amenities is limited, and public services are often overloaded and distant from specialized clinics.Currently, there are various systems in existence to assist people with motor disabilities, such as Patient Lifts for transfer, Standers, and even Parallel Bars for physical therapy. Regardless of the many benefits they may have, these devices usually lack the proper adaptability and inclusion for patients of all ages. Bars may be too high and wide for pediatric patients in the case of Parallel Bars or height level may be too short for tall patients in the case of many Patient Lifts and Standers, among other issues. On account of these considerations, the project focuses on the design and construction of a lift and walking aid system that combines all the benefits of the existing tools and systems into a single one with the purpose of providing a solution to one of the main challenges of interprofessional care that patients with mobility impairments face every day in Mexico. The proposal aims to develop a patient lift targeted towards the rehabilitation clinic located at the University of Tlajomulco de Zúñiga, with the goal of addressing multiple needs with a single and versatile device. It includes various features, such as switchable parallel bars and mechanisms that allow adaptation to the patient's specific needs, ensuring a proper walking and physical rehabilitation by providing stability and support; coupled with the use of a harness for patient's transfer and standing assistance. The system’s design is established considering patients’ anthropometric criteria and spatial measurements of the workspace, which ensures the safe and effective application of the device. This initiative would benefit the clinic by equipping healthcare providers with essential tools, optimizing equipment distribution, reducing costs, and most importantly, improving the quality of life for patients. Furthermore, the device's adaptability and versatility facilitates the incorporation of different accessories, such as the infinity band for rehabilitation in the same place, force platforms to measure strength in both extremities and monitoring systems for precise progress tracking during therapy.

Danna Greeksaida García Hernández, Valeria Catalina Siordia Ortiz, Alondra Alejandra Vargas Villalpando, Alex Ander Iñiguez Velasco, Sergio Alberto Valenzuela Gomez

Conference Proceedings

Muse Alpha: AI-based Preliminary Diagnosis for Cognitive Thought Patterns

Recent issues of medication misuse and abuse have prompted research into utilizing big data and artificial intelligence to aid psychiatrists in determining medication dosages. Muse Alpha contributes through high-quality data collection, AI-based patient similarity analysis, and a patient-centric conversation approach. This includes the extraction of patterns of negative thoughts, achieving up to 87.5% accuracy in guiding conversations. The goal is to overcome the limitations of brief one to one interactions between doctors and patients, ensuring more accurate medication prescriptions. Discovering patterns of negative thoughts and conveying them visually to the doctor assists in providing an accurate diagnosis of the patient's condition and aids in the precise diagnosis of medication for the patient.

Hyeseong Park, Myung Won Raymond Jung, Minji Kim, Jihye Kim

Conference Proceedings

Patient Centered Care: Medical Error Disclosure Guidelines Across Canada

The quality of healthcare is an emerging concern worldwide. Despite attempts to minimize adverse events and medical errors, the disclosure of medical errors by health professionals remains a significant challenge. We have previously reported that international policies and the Canadian Provincial College of Physicians and Surgeons both encourage the open disclosure of adverse events and have suggested its integration into a ‘no-fault’ model. Disclosure policies can provide a framework and guidelines for appropriate disclosure, leading to practices that are more transparent. The purpose of this study was to review, evaluate, and compare individual policies across Canadian health regions to provide guidelines for the best possible medical error disclosure policy. We evaluated the policies of each health region using the following five criteria (an apology or expression of regret, support for the patient, avoidance of blame, avoidance of speculation, and support for providers) which are considered critical to designing patient centered guidelines for medical error disclosure. The majority of provincial and territorial health regions (7 out of 11) have implemented disclosure policies that include all of the evaluated criteria. In Eastern Canada, more than 90% of the disclosure policies included an apology, patient support, and avoidance of blame, while more than 80% included avoiding speculation and providing support for providers. Similarly, in Western Canada, more than 80% of policies contained an apology, patient support, and avoidance of speculation, while provider support was found in at least 60% of surveyed policies. In Nunavut and the Northwest Territories, all policies contained an apology, patient support, avoidance of speculation, and provider support. On average, health region disclosure policies included an apology (98%), patient support (98%), avoidance of speculation (95%), provider support (92%), and avoidance of blame (90%). Designing best practice error disclosure policy requires integrating many aspects, including bioethics, physician-patient communication, quality of care, and team-based care delivery. We suggest that disclosure practice in Canada move toward a uniform, patient centered approach that addresses errors non-punitively to encourage medical error disclosure, reduce medical errors, and improve patient safety.

Jay Kalra, Zoher Rafid-Hamed, Bryan Johnston, Patrick Seitzinger

Conference Proceedings

Stepped Wedge Design Analyses under Pandemic`s Period Effect: Alternative Approach using Non-specific Neck Pain Intervention Data

Use of stepped wedge design (SWD) trials have increased exponentially over the past decade (Hooper & Eldridge, 2020). Concomitantly, due to the increasing prevalence of neck pain in the workforce, interventions are necessary and have to be evaluated. Stepped-wedge designs are adaptive, so they can and should adjust to externalities. For example, the COVID-19 pandemic introduces a period effect that could perturb the design. To understand SWD`s potential vulnerability to the secular trend of a pandemic (or other period effect in future conductance), we compare a classical SWD analysis to an item-response theory (IRT) approach that only utilizes before-after segments of the data collected. Understanding the relative-advantages of classical SWD analyses may hold import for recommendations regarding continuous data collections (i.e., response burden) under “known” externalities in future research. Several complex analytic approaches to SWDs have previously been reviewed, but a complementary approach may be a more advanced measurement theory (Li & Wang, 2022). For example, Li and Wang note that SWD analyses can be classified as either conditional (cluster-specific) or marginal (population-averaged) regression models (2022). Both of these models, however, are rooted in classical test theory. In complement, a model-based measurement approach, IRT may be adopted for analysing SWD data (Embretson, 1999). IRT assumptions enable accounting for secular trends in the SWD design, so long as within-cluster equality constraints are appropriately applied. For example, regardless of regression-based model, Li & Wang note that high-quality SWDs should report ICCs, as well as modeling assumptions for secular trends and random-effects (2022). IRT`s distribution-free parameter estimates enables meaningful assessment of change regardless of baseline values (Embretson & Poggio, 2012).RESEARCH QUESTIONS: Should all participants continue to be measured after intervention (burdensome measurement)? Can we impose a different analysis (2-time point, uncontrolled BA) on the stepped wedge design to obtain period/event-robust effect estimates? Specifically, a before-after extension of IRT`s bifactor model for assessing change is applied to the current dataset (Cai, 2010). SAMPLE & METHODS. The dataset comes from a nationally funded project entitled NEXPRO (Aegerter et al., 2022). This may be classified as a “closed-cohort” variant of SWDs (Li & Wang, 2022). In a closed-cohort design, a suitable population is identified at the beginning of the study with repeated follow-up measurement after cross-over, but no adjustments are made in terms of participant attritions and consequent additions. Approximately half of our sample (n = 120 with 4 measurements, 480 measurements) comprises employees working in the health-system education context with common neck problems. The outcome measure is the European Quality of Life instrument (EQoL-5D-5L). Three analytic estimates are reported: 1) We compare classic SWD analyses (n=296) with 2) IRT estimates from before-after segments (n=194) of the dataset, and 3) A classical paired t-test. Effect size estimates and standard errors are reported to allow interpretations of estimate bias and power, respectively. The classic SWD analysis served as “gold standard” comparator for accurate estimates that takes full power-advantage of all measurements. Specifically, a generalized linear mixed-effects model with robust estimates was used, entering random-intercepts for repeated-measurement and fixed-effects for cluster, time, and intervention to estimate changes in EQoL. RESULTS. Our “gold standard” SWD analysis yielded a significant effect of Cohen`s d = .29, SE = .009. In comparison, our newly proposed IRT model yielded a similarly significant effect of Cohen`s d = .31, but with power loss as indicated by a higher SE = .19. Finally, our “crude”, classical paired t-test yielded a greater effect size of Cohen`s d = .36, SE = .007. For IRT, the average-relative parameter bias was 7% and considered below the ignorable 10-15% threshold (Rodriguez, Reis, & Haviland, 2016). For paired t-test, the average-relative parameter bias was an unacceptable 24%.DISCUSSION. IRT reduces bias but loses power due to measurement specification. Thus, if researchers are interested in obtaining accurate (unbiased) intervention-effect estimates and wish to reduce response burden by ignoring follow-up (or pre-advanced) measurements (perhaps due to pandemic externalities, lengthy measurements, or vulnerable populations), then the IRT approach would be appropriate, if sacrificing power and potential statistical significance.CONCLUSION. An IRT-alternative to SWD designs with before-after data yields unbiased effects, but loses power. The IRT approach may be replicated in another SWD design outside of the COVID-19 "period externality" to understand it`s potential under “normal” study conditions.

Matthew Kerry, Andrea Aegerter, Achim Elfering, Markus Melloh

Conference Proceedings

Evaluation of Patient Stress During Mammograms through Surface Electromyography Analysis

Regular mammograms are recommended for women to allow for early detection of breast cancer and in turn, proper treatment and improved prognosis of patients. However, the stress and discomfort associated with the procedure deter many women from routine screening. Most previous work attempting to characterize this pain utilizes subjective, questionnaire-based methods. The variability in methodology and subjectivity of these approaches requires a more objective strategy to fully understand mammogram related stress. Bio signals such as surface electromyography (sEMG) have been increasing in popularity as a means of quantifying various physiological states including stress and pain. This research presents the use of sEMG as a means of measuring the stress and discomfort experienced by biological females during a mammogram. N=25 healthy subjects were recruited to participate in a simulated procedure consisting of two different variations in machine design (compression paddle shape). Wearable sEMG sensors were placed on 14 different muscles and a multi-metric analysis was conducted to observe muscle activation and estimated stress between a relaxed state and the compressions of the procedure. Significantly activated muscles during the painful mammogram include the deltoid, infraspinatus, teres major, and trapezius upper fibers shown by the most responsive metrics derived. The illustration of intense activation of these muscles during the procedure along with the proposed bio signal analysis methodology can aid in advancing ongoing research and clinical efforts to make mammograms more comfortable and less stressful for patients by providing a more comprehensive understanding of the stress experienced.

Krystyna Gielo Perczak, Riley Mcnaboe, Hugo Posada-quintero

Conference Proceedings

Integrating Intelligent Control into Far UVC Wearable Garments for On-Demand Airborne Viral and Bacterial Protection

Far Ultraviolet C-range (Far UVC) emissions of sufficient intensity have been proven to successfully immobilize a vast family of airborne viruses and bacteria, while being harmless to humans. Recently, an innovative application of portable Far UVC light devices has been suggested in the form of wearable self-disinfecting garments for personal protection. While embedding a miniature Far UVC light fixture (e.g. Ushio's Care222®, Tokyo, Japan) into wearable garments such as vests and helmets can be a relatively straightforward engineering task, the very fact that the devices are battery-supplied implies that particular care and attention must be devoted to the design of an intelligent system for minimizing electrical power consumption based on direct need of use. The aim of this paper is to propose a design utilizing a contemporary microcontroller-based transmitter-receiver system to accomplish this task, and to test the resulting intelligent personal protection garments in real-life conditions. Two wearable garments embedding Ushio’s Care222® units were designed. In each garment, an Arduino-based microcontroller system was embedded along with infrared (IR) transmitter and receiver (Gikfun Infrared Diode LED IR Emission and Receiver for Arduino) to activate the Far UVC lamp when approached by another user wearing also such Far UVC garment if pre-programmed social distancing was violated. Both helmet- and vest-based disinfecting garments were prototyped and subsequently tested on three healthy volunteers working in routine laboratory conditions. The volunteers were encouraged to go about their regular daily work in the lab while wearing the intelligent Far UVC garments. Each volunteer signed consent forms required by the Research Ethics Committee of Howard Payne University. The intelligent Far UVC garment prototypes continuously performed reliably and safely. All three volunteers reported that the implements were minimally obstructive, and that they were able to perform routine multi-hour work in the lab continuously and without any impediment. The Far UVC light on each garment turned itself on only when a pre-programed social distancing (2 meters) was infringed, and turned themselves off when such distancing was exceeded. Due to the embedded intelligent control, power consumption was reduced allowing the garments to maintain operation for a full standard work day. An innovative intelligent control was designed, implemented, embedded and tested on Far UVC wearable garments for the purpose of continuous minimally-obstructive disinfection against airborne viruses and bacteria. The intelligent implements were found to be minimally obstructive by volunteers who wore them during their routine daily lab work.

Layton Pratt, Ryan Robertson, Martin Mintchev

Conference Proceedings

Clarification of drug-checking strategies for expert pharmacists based on gaze analysis

In Japan, a pharmacist who receives a physician’s prescription for a drug (1) checks the medical and pharmacological validity of the prescription; (2) prepares the drug; and (3) confirms that the drug has been prepared as prescribed, and that there are no quality issues. The aforementioned checkpoints (1) and (3) are particularly important for ensuring patient safety. Meanwhile, knowledge of checking is tacit and not shared among pharmacists. Therefore, a pharmacist’s gaze was analyzed to identify checking strategies based on expert gaze patterns. Gazing points in prescriptions during expert checks were measured in a clinical setting. Four participants had 20–30 years of experience as pharmacists. Consequently, four check strategies were identified. However, the check strategy differed, depending on the participant. This indicates that each pharmacist in charge of checking prescriptions has a different strategy, and that there are errors that are difficult to detect. In the future, it is necessary to verify the validity of these strategies in terms of safety, and to develop methods to educate novices in a well-balanced manner in each of these strategies.

Yoshitaka Maeda

Conference Proceedings

Investigating the Barriers of High Quality of Care in Virtual Visits Using the AcciMap Framework

The COVID-19 pandemic caused a dramatic shift to telehealth in the U.S. and increased the demand for this modality of care. Although the peak in telehealth usage declined after the COVID-19 surge was over, it has remained an integral part of medical care. Quality of care has been a top priority for healthcare delivery systems. However, addressing this aim is not yet commensurate with the rapid growth of digital health. This paper focuses on virtual visits, as one of the main categories of telehealth, and provides a systematic analysis to enhance quality of care. It uses the AcciMap framework, originally developed by Rasmussen in 1997 for systematic incident investigation, to analyze barriers of high quality of care in virtual visits. It then provides recommendations to address some of those barriers.

Maryam Tabibzadeh, Mohammad Mokhtari

Conference Proceedings

Words about work performance and the company they keep

In the study of safety and specifically in patient safety, there are many perspectives about the concept of “human error”. People have shared their concerns about the risks of using the term “human error” when referring to undesirable outcomes in work systems. Yet, this construct is still often used when communicating causation about undesirable work performance and accidents. Although, there has been a call for renewed or refreshed conceptualizations of work performance and safety (Safety II), it has only slowly taken hold. To facilitate awareness about these concepts, understanding the subtilties of language could help with how communication is shaped. Describing and fostering language awareness around safety II and resilience engineering may help facilitate dialogue and linguistic alignment around these concepts. To this end, we extract Medline abstracts that contain keywords “human error”, “resiliency”, “safety II”, and “resilience engineering.Natural language pipelines were created and explored using different techniques for viewing different levels of linguistic features. To accomplish this analysis, we extracted local features, contrastive features (Arnold, 2022), and co-occurrences. We also performed sentiment analysis on sentence extracts. Finally, a Naïve Bayes text classifier was trained for distinguishing between sentences that included the word “error” or “resiliency” and top linguistic features (words) that were strongly associated with each group were collected.2400 titles/abstracts were extracted that included the term “human error”, 4552 titles/abstracts were extracted that included the term “resiliency”, and 181 titles/abstracts were extracted in which the full text contained “safety II” or “resilience engineering”. Sentences that contained the word “error” also included the following words that were important to the text classifier “accidents”, “mistake”, and “wrong”. These words suggest the presence of a judgement statement. Whereas sentences that included the word “resiliency” were more likely to include words such as “family”, “community”, “coping”, and “mindfulness”. Preliminary findings suggest that sentences that contain the word “error” are much more likely to be classified as negative during sentiment analysis compared to sentences that contain “resiliency” which are more likely to suggest positive sentiment. Sentences from abstracts that contained the word “resiliency” were diverse in description and often in the context of explaining some characteristic of mental healthcare services. Although the use of resiliency in this context is not necessarily referring to that of “resilience engineering”, there is a possible opportunity for the safety science and human factors communities to learn from the language of healthcare. The use of the term “resiliency” and companion words when used to describe aspects of healthcare refer to patients’ capabilities and characteristics for adapting to changing conditions. Borrowing words and expressions, when sensible, from clinical domains for sharing perspectives on systems safety may resonate with healthcare professionals and help facilitate communication.In migrating to newer conceptual environments for studying safety, we will require newer linguistic expressions for communicating these concepts. Linguistic expressions that speak to people in a language they understand could help with this transition. Describing and discussing the words attached to concepts about safety could help fuel critical dialogue and ways of understanding our world.

Tim Arnold, Helen Fuller, Ruth Reeves

Conference Proceedings

Human Factors Validation of Collaborative Medical Workflows Through Multi-User Workflow Simulation: A Case Study in Interventional Radiology

This paper challenges the traditional focus on individual 1on1 sessions during workflow simulations and usability testing, which often fail to capture the collaborative nature of medical workflows. To overcome this, a human factors and workflow simulation lab was developed within the research campus STIMULATE. The paper describes the conception, development, and operational capabilities of the lab particularly focusing on collaborative human factors assessment. A novel methodology, based on hierarchical task analysis, is introduced. It breaks down complex workflows into subtasks and assigns them to specific user groups, such as Radiologists and Radiologic Technologists, capturing the intricacies of user interactions in specialized medical environments. The lab’s first validation study is presented using the example of the simulation of an image-guided interventional liver biopsy. The study demonstrates the lab's ability to accurately replicate a high percentage of tasks performed by medical professionals in complex procedures, thereby confirming its effectiveness in modelling collaborative medical workflows. It emphasizes the importance of detailed task-level workflow segmentation for analysing human-machine and human-human interactions and introduces specific metrics for measuring usability dimensions like effectiveness, efficiency, and satisfaction.

Benedikt Janny, Robert Klank, Julian Glandorf, Frank Wacker, Bennet Hensen, Julia Moritz

Conference Proceedings

Holograms for Minimally Invasive Surgery Training and Planning

The medical field has rapidly adopted Minimally Invasive Surgery (MIS) as a powerful alternative to traditional surgery as it reduces infection, pain, hospital stays, and costs. Despite these benefits, the in-depth knowledge of procedures coupled with the variety of tools used requires extensive training and technical planning for successful surgery. Prevailing Virtual Reality (VR) and Augmented Reality (AR) applications enable a broad spectrum of MIS training and pre-surgery planning. However, these currently existing systems are bulky, complex, and expensive and have had poor adoption rates in the field attributed to a lack of knowledge and financial barriers2. In this paper, we present a novel low-cost approach to develop a mobile hologram platform for MIS surgery training and potentially pre-surgery planning. Our developmental process consists of converting a patient's CT DICOM data to a 3D model using region of interest identification and volumetric or surface rendering. We prioritize realistic model texturing as the texture has a significant impact on visual perception and potential for use in medical diagnosis. The realistic 3D model can then be displayed on a variety of accessible devices such as mobile phones, 2D tablets, 3D tablets, and phone-based Google Cardboards or HUD headsets, all with their tradeoffs. The integration of models with devices can rely on different software for development, in our instances exploring the capabilities of Unity, Unreal, React, and XCode. Using this software, we then developed an overlay functionality that tracks aspects of the physical world and places the virtual 3D model on physical models of organs, mannequins, and/or live humans, allowing for real-world replications of medically relevant augmented scenes. An integral part of surgical practices is incisions that can cause blood flow. This is a feature we are mimicking with fluid dynamics and implementing using particle systems to yield a high-quality real-world medical training platform. To use these realistic models for MIS training, we developed specific controls based on ergonomics research that were suited for each platform. We experimented with approaches such as hand-tracking and touch-based screen gesture controls to tailor usability to device specifications. Finally, to improve perceptual adaptation, we focus on the disparate distance as it plays a critical role in user experience. Further development in user interactions and surgical design is required to allow for pre-surgical planning functionality on our applications.

Alexandra Poltorak, Charli Hooper, Yang Cai

Conference Proceedings

Back skin deformation during anaerobic exercises for ergonomics design application

The purpose of this study is to propose a muscular-based superficial skin deformation method to visualise the deformation of human back during resistance training, thus, to provide a reference for the back design of gym wear and wearable devices. Among the muscle groups, the back has numerous muscles and is a very difficult area to train, therefore, there is an urgent need for the study of the skin deformation of the back during anaerobic training. Several studies have been conducted on skin deformation during aerobic exercise, such as rowing and cycling using the division of anthropometric measurements, however, back muscle contractions in anaerobic exercise in which the skin deformation was caused by muscle movements need more exploration. In this study, eight regular trained males were instructed to perform three back training exercises: seated pulldown, seated row and standing pulldown. Their backs were marked points of 3 cm interval according to the surface division of the two major muscles: the trapezius and the latissimus dorsi. The statistics skin measurements of starting point and completion of the exercises were taken by 3D scanner Artec Eva. The mean, maximum values and standard deviation of the data were compared and analyzed according to muscle morphology and fibre bundle orientation. The results showed that the maximum deformation of trapezius, was 24.23% and 11.97%, 9.31% and 8.94%, 1.51% and 9.78%, for starting and completion in the horizontal, longitudinal and diagonal direction, respectively. For the latissimus dorsi, the greatest deformation manifested as 7.23% and 5.36 %, 14.59% and 8.52%,17.60% and 9.70% for starting and completion along the longitudinal and diagonal directions, respectively. These muscle-based deformation can be implemented in the design of prototypes in the corresponding regions to improve the dynamic fit during exercise.Both muscles showed different degrees of segmental deformation on the triangular shaped sides. The horizontal and longitudinal directions of the trapezius muscle show a state of compression in the whole segment during movement, but with the degree of compression ranging from 1.99% to 14.29% for each sub-segment. The oblique side of the trapezius showed a concentration of deformation in the lower half of the muscle, with a range of 10.83%-38.49%, while the latissimus dorsi shows a more uneven deformation dominated by the oblique upper third extrusion deformation. For the dramatic variable sub-regions, additional structures or strengthen materials should be taken into account to support the muscle, providing bracing forces for better muscle perception and avoid injuries.In this research, skin deformation characteristics during back anaerobic training were proposed and regional analysis based on muscle morphology and kinesiology are performed. These zoning values can be used as a reference for intelligent monitoring, so that the design of sensing accessories can be better matched. The visual mapping of results offered guidance for the cutting lines of tight fitness apparel prototype and the back structural design of sportswear, applying the deformation characteristics of anaerobic exercise to improve the dynamic comfort.

Tsai-chun Huang, Bingxue Li

Conference Proceedings

Incorporating Human Factors Methods into Healthcare Process Improvement Work

Utilizing human factors engineering (HFE) methods and a human-centered design (HCD) process can be valuable in improving the functionality and safety of a system, process, or other product. While some HFE methods require advanced training for optimal use, others may be employed more easily or may be adapted for easier use. We identified HFE methods that appear most important for successful system design, found opportunities for deployment in existing redesign efforts, and developed education materials and tools to simplify their use with the intention of facilitating incorporation of these HFE methods into healthcare process improvement work.

Helen Fuller, Kathleen Adams, Tee Achee, Timothy Arnold

Conference Proceedings

Analysis of Procedures and Instruments for the Digitization of the Foot and Ankle Aimed at Orthosis Development

Orthoses are products considered assistive technology for maintaining or expanding the skills of people with physical disabilities (Pwd), promoting greater social integration. All Pwd's who have sequelae of hemiplegia/hemiparesis need to use an orthosis. Generally, such an artifact has characteristics that interfere negatively during its use. The design of products (orthesis and footwear) separately often meets the functional requirements but has limitations regarding the conditions to facilitate usability and offer attractive aesthetic attributes that can promote a pleasant experience for people with disabilities. Such aspects influence the way people move around and interfere negatively in the physical rehabilitation process. Rapid prototyping can contribute to the development of these products in a personalized way and provide better patient satisfaction. For this, it is necessary to develop a digital model with reliable dimensions and formats based on three-dimensional scanning. The objective of this study was to demonstrate the quality of the digital model through image capture by different instruments and image processing procedures to obtain the three-dimensional model. Three-dimensional scanning was performed in a hemiparetic woman, patient at APAE-Jaú. The procedures performed were Kinect device and Skanect software; tomography scanning, and digital photogrammetry technique using a professional camera and the software Agisoft Metashape. All scans were aimed at the development and production of orthoses. It was noted that the most efficient digital model for the development of a customized orthosis was the tomography procedure. The software for developing the three-dimensional model is free, however, data collection to obtain the image (CT scanner) is expensive.

Rosangela Santos, Ademir Marques Jr, João Silva, Flávio Cardoso Ventura, Célio Favoni, Isabel Cristina Buttignon, Rosemeire Dos Santos Almeida, Marcelo Oliveira

Conference Proceedings

Reconceptualising Multiculturalism in an Evolving Landscape of Healthcare Delivery

Multiculturalism in medicine is a dynamic concept that requires ongoing adaptation to evolving global psychosocial, and geopolitical circumstances. Recent global events have had far reaching implications that warrant recognition as an essential component of ongoing medical education and practice. Our previous studies on global trends in healthcare delivery have identified multiculturalism as a key component of medicine that requires reconceptualising to enhance patient care in the evolving landscape of healthcare. The purpose of this paper is to adapt, reframe, and refine multiculturalism in medicine with a focus on medical practice, education, and medical ethics. Core underpinnings of medical ethics such as justice, autonomy, beneficence, and maleficence are present throughout healthcare practices around the globe. How these concepts are translated into everyday practices can vary widely between regions, institutions, and individuals. Medical ethics has traditionally been developed and interpreted through the lens of Western values. A narrowed or outdated perspective on medical ethics results in misunderstood cultural nuances, impaired communication, inequitable healthcare delivery and poor patient outcomes. Contemporary global events, including geopolitical conflicts, pandemics, and unprecedented migration patterns, have challenged existing paradigms of medical ethics and highlighted the necessity to reassess multiculturalism in practice and education. The landscape of modern medicine demands healthcare providers be competent and comfortable in addressing the unique healthcare needs of a globalized patient population. The next generation of medical providers will require the skills, experience, and insights to collaborate across cultural boundaries with comfort and competence in order to deliver sensitive and efficacious patient-centred care. Incorporation of diverse cultural lenses into medical education is necessary to ensure compassionate medical care that is attuned to the nuances and needs of an ever-increasing multicultural patient population. Cultural competence is no longer considered a skill that is acquired, but rather an ongoing process that requires continuous education and adaptation to each clinical encounter. Integrating immersive cultural experiences is an essential step in applying skills to clinical practice. Mentoring and debriefing practices allow learners to reflect on their own values and recognize implicit biases to improve multiculturalism on an ongoing basis. Reconceptualising multiculturalism in medicine is a necessary and timely response to the evolving landscape of global healthcare. By reframing multiculturalism as a fundamental pillar of medical education, new and seasoned healthcare providers will be equipped to navigate the evolving intricacies of cultural diversity. Acknowledging when current practices require revision is the first step to modernizing multicultural medical care. This work will have far-reaching implications on improving health equity, diversity, and inclusion to improve patient outcomes and satisfaction in a growingly interconnected world.

Jay Kalra, Mackenzie Marchant, Zoher Rafid-Hamed, Patrick Seitzinger

Conference Proceedings

Development of a semi-automatic patient lift vehicle for bedridden or wheelchair-bound persons with reduced mobility

Users with motor disabilities who are bedridden or in wheelchairs depend on the assistance of third parties to perform routine mobility movements through transport and/or transfer actions. This generates physical wear and tear on the assistant and the risk of injury or lumbar disease that may even lead him/her to stop assisting the patient. This article presents the development of a low-cost semi-automatic patient lift vehicle for bedridden or wheelchair-bound people with reduced mobility. The equipment was designed and built using specialized manufacturing techniques and mechatronic methodologies to provide operational stability and mechanical control of the equipment's linear travel and lifting movements. The designs of the equipment were obtained using Solidworks®. The semi-automatic patient lift vehicle support structure was manufactured based on dimensions declared on ISO 10535 standard and using readily available materials of proven resistance, considering a mobile structure composed of a wheeled base, a mast and an ergonomic pendant were attached to several stability points. A mechatronic remote-control system was developed using an Arduino® UNO electronic board with its respective programming platform. The remote-control interface was developed using the App Inventor® application and by means of a mobile device the up and down control of the patients in the proposed prototype was achieved. Design and prototype construction allows and adequate lifting and transport of patients with no difference on age, height, weight and gender due to the statistical analysis applied determined that design of semi-automatic patient lift vehicle is adequate to accomplish the purpose of patient lifting indistinctly of weight, height and route type. Nevertheless, improvements must be done as a future work in order to have a better prototype considering the handling of the caregiver person for the operation. The semi-automatic patient lift vehicle was put into operation directly in public social assistance centers (DIF Municipal and Centro de Atención Múltiple VIII) located in Pabellón de Arteaga City, Aguascalientes, Mexico.

Jose Alonso Dena Aguilar, Enrique Javier Martinez Delgado, Victor Manuel Velasco Gallardo, Edgar Zacarias Moreno, Ludovico Hernandez Aguilar, Ruth Elizabeth Martinez Escobedo

Conference Proceedings

Design of a corrective hip orthosis for patients with abnormal flexor pattern after transfemoral amputation

Transfemoral amputation is a surgical procedure performed to remove the lower limb above the knee joint when that part of the body has been severely damaged by trauma, disease, or congenital defect. The result is the loss of important anatomical structures such as the knee, tibia, fibula, ankle, and foot. Currently, the evolution of this medical procedure has highlighted the relevance of muscle stabilization and biomechanical principles. As a part of most relevant goals, after the amputation process, is to preserve the adductor magnus and perform a myodesis (the muscle is secured to the bone by suturing the distal tendon via pre-drilled holes to the bone) with the purpose to have a functional stump. If biomechanical principles are correctly applied in addition with an effective surgical technique, patients could have better prognosis, and more chances to have a prosthetic device. In addition to this, it’s important to mention that the shape of the residual limb is crucial for the prosthetic fitting and rehabilitation process. On the other hand, there is a lack of information about the relevance of the adductor magnus in preserving the anatomical femur axis after the amputation process. Actually, the loss of function of the adductor magnus, and other adductor muscles, leads to an abnormal abduction and flexion of the femoral stump; this condition modifies the posture, specially when patients are in sitting position or try to walk with crutches. In addition to this, their center of gravity is modified, affecting the possible suspension and handling of the prostheses, in case they have one. According to this, it’s important to correct the abnormal abductor and flexor pattern of the femoral stump before fitting a prosthetic device. Hence, this project aims to develop an orthosis that helps patients to keep the lower limb in a more anatomical position, after the amputation and during their rehabilitation treatment. For the development of this device it was necessary to design an anthropometric protocol taking as a reference the case of a patient with an appropriate transfemoral amputation. The design proposal highlights specific anthropometric measurements, such as residual limb length, circumferences, and shape, to ensure an optimal and fit of the orthosis. For the selection of materials, it was important that these were flexible, comfortable and they didn't cause any discomfort after several hours of use. Additionally, through a system of harnesses that were placed to provide traction, the flexor and abductor patterns were modified to keep the amputated stump in a completely vertical axis.

Marian Joselyn Ramírez Román, Judith Guadalupe Zepeda Flores, Martin Romero, Pablo Arturo Ramos Sandoval, Blanca Mora, Sergio Alberto Valenzuela Gomez

Conference Proceedings

Design of a semi-automatic passive knee mobilizer for lower limb rehabilitation

Physical rehabilitation is a vital component for the recovery of patients with knee injuries or after a surgical procedure. Part of the rehabilitation treatment includes manual therapy and the use of assistive devices, all these elements play a crucial role in the functional prognosis of the patient. In the context of knee rehabilitation, physical therapists need to find more effective methods and treatments to optimize the final result in terms of function and quality of life in patients with an injury. Hence, in addition to conventional therapies techniques, the introduction of other devices has become an effective strategy to enhance therapeutic outcomes.In this regard, knee mobilizers are devices specifically designed to facilitate and control joint movement during the rehabilitation process. These devices play an important role in providing support and stability, thus contributing to a more effective recovery.There are an important variety of mobilizers with different characteristics each. However, this kind of assistive machines are too expensive for patients and rehabilitation clinics, with poor availability for some parts of the Metropolitan Area of Guadalajara and, sometimes, it’s difficult to adapt their features for patients with different anthropometric characteristics and treatment goals. This lack of adaptability and availability represent an opportunity to develop an assistive device that covers the needs mentioned above. Hence, this project aims to design a passive knee mobilizer to enhance the results of rehabilitation in patients with lower limb disabilities and post-operative procedures. The initiative addresses a fundamental challenge, which is the lack of independence and mobility among this population. The design criteria for this device included anthropometric measurements, interviews with physiotherapists and patients and a systematic literature review. During the design process it was important to select the proper materials, some of the characteristics taken into consideration were these: durability, maintenance, comfort, and cost.Some of the design implementations of this product included an adjustable limb holder to adapt the arm height for pediatric and adult users, a special seat that allows patients to shift their position to ensure the rehabilitation of both knees. Finally, the adaptation of a linear actuator for passive therapy. This machine is remotely controlled so that the physiotherapist can adjust it according to the patient's needs. Finally, it’s important to mention that the design of this product was based on local regulations and international standards. For example, ISO 13485, which outlines Quality Management Systems for Medical Devices and Mexican Official Normatives.

Alicia Lizbeth Paredes Cuan, Brandon Alexis Vázquez Ruiz, Sergio Alberto Valenzuela Gomez, Grecia Miroslava Martínez González, Marisol Tadeo Gaspar

Conference Proceedings

Development of an electric wheelchair for the mobility of people with chronic reduced mobility

Having a patient who is unable to move on his own generates stress on his family, since this type of disease has repercussions on the economic and emotional stability of both the patient and the people who assist him. The present work is a proposed solution for the development of low-cost national technology with high social impact, which was initially designed for the care of a 6-year-old patient with Arthrogryposis Multiplex Congenita, resident of the Pabellón de Arteaga, Aguascalientes, Mexico. The patient has suffered from this disease since birth, which prevents him from performing daily activities and, above all, from moving around on his own. Therefore, an electric wheelchair was designed and built to lighten or reduce the work of carrying and transporting the patient and to reduce or avoid possible injuries to the patient, as well as to the people assisting him. Designs of the device were elaborated in Solidworks® according to the dimensions of the ISO 2570-255 standard. The control system was designed as open loop control and programmed in Phyton language. The chassis and support structure were constructed from readily available materials of proven strength and is equipped with a swivel caster base. For the semi-automation and control system, a mechatronic system was built based on an Arduino® Nano data acquisition board connected to various electronic or electric-electronic modular elements. Design and construction of product allows an adequate transport and displacement of people of any age, weight and gender due to statistical analysis developed and applied determined that having several person conditions o characteristics made not significant difference. Additionally, majority perception of people that operated the chair indicated that it was comfortable, that they felt safe using it and also it was easy to operate the EWC. Nevertheless, as a future work, improvements must be done to have a better safety system and stop control system. Once the development of the electric wheelchair was completed, it was donated to the disabled child for routine use and operation, contributing to improve his quality of life.

Jose Alonso Dena Aguilar, Enrique Javier Martinez Delgado, Victor Manuel Velasco Gallardo, Edgar Zacarias Moreno, Ludovico Hernandez Aguilar, Luis Enrique Hernandez De La Rosa

Conference Proceedings