Impact of window views on recovery-an example of post-cesarean section women

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

The Influence of Exposure to Nature on Inpatient Hospital Stays: A Scoping Review

AIM

To summarize the existing literature surrounding the influence of natural elements on course in hospital and to introduce clinicians to the concept of biophilic design and the potential for incorporation of nature into the hospital environment as a component of a therapeutic hospitalization.

BACKGROUND

For decades, architects and designers have espoused the benefits of incorporating natural elements into the healthcare environment for therapeutic purposes. The benefits of this "biophilic" design philosophy has been investigated predominantly in long-term care or rehabilitation settings; however, some of the most appealing opportunities lie in the acute care setting.

METHODS

This scoping review surveyed the literature surrounding the influence of exposure to nature on course in acute hospitalizations. After screening 12,979 citations, 41 articles were included. Exposures were divided into seven categories, the most common of which were the presence of a window/natural light, a natural scene through a window, and nature soundscapes. These articles were reviewed in a narrative fashion and thematic analysis was conducted.

RESULTS

Studies were extremely heterogeneous in their design, research questions, and reported outcomes. Types of exposure to nature studied were exposure to a real natural scene through a window, presence of a window/nature light, nature in the healthcare environment, art depicting nature, direct contact with nature, nature soundscapes, and nature experienced through virtual reality (VR).

CONCLUSIONS

Exposure to nature during an acute hospital admission appears to have a real but small therapeutic effect, predominantly on psychological metrics like anxiety/depression, pain, and patient satisfaction. Greater beneficial effects are seen with greater durations of exposure to nature and greater degrees of immersion into nature (e.g., creating multisensory experiences using emerging technology like VR).

Effects of a False Window on the Change of Cognitive Function in Patients Admitted to a Neurological Ward

False windows can display a variety of outdoor scenery in rooms without real windows. We aimed to assess the effects of three different hospital beds on the change in the frontal assessment battery scores in patients aged ≥ 20-year-old admitted in our neurological ward. We included 24 patients on the window side, 12 patients on the aisle side with a false window, and 12 patients on the aisle side without a false window. There were no statistical differences in the change of cognitive function among the three hospital beds. Only the length of hospital stay was a significant associated factor.

The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

Application of the Childbirth Supporter Study to Advance the Birth Unit Design Spatial Evaluation Tool

OBJECTIVE

Translational research to advance design criteria and apply the Childbirth Supporter Study (CSS) findings to practice.

BACKGROUND

The physical design of birth environments has not undergone substantial improvements in layout or ambiance since the initial move to hospitals. Cooperative, continuously present childbirth supporters are beneficial and are an expectation for most modern birth practices, yet the built environment does not offer support for the supporter.

METHODS

To advance design criteria, we use a comparative case study approach to create translational findings. Specifically, CSS findings were used as indicators to advance the Birth Unit Design Spatial Evaluation Tool (BUDSET) design characteristics in pursuit of better support for childbirth supporters in the built hospital birth environment.

RESULTS

This comparative case study provides eight new BUDSET design domain suggestions to benefit the supporter-woman dyad, and subsequently the baby and care providers.

CONCLUSIONS

Research-informed design imperatives are needed to guide the inclusion of childbirth supporters as both a supporter and as an individual in the birth space. Increased understanding of relationships between specific design features and childbirth supporters' experiences and reactions are provided. Suggestions to enhance the applicability of the BUDSET for birth unit design facility development are made, specifically ones that will better accommodate childbirth supporters.

Residential Greenness and Long-term Mortality Among Patients Who Underwent Coronary Artery Bypass Graft Surgery

BACKGROUND

Studies have reported inverse associations between exposure to residential greenness and mortality. Greenness has also been associated with better surgical recovery. However, studies have had small sample sizes and have been restricted to clinical settings. We investigated the association between exposure to residential greenness and all-cause mortality among a cohort of cardiac patients who underwent coronary artery bypass graft (CABG) surgery.

METHODS

We studied this cohort of 3,128 CABG patients between 2004 and 2009 at seven cardiothoracic departments in Israel and followed patients until death or 1st May 2021. We collected covariate information at the time of surgery and calculated the patient-level average normalized difference vegetation index (NDVI) over the entire follow-up in a 300 m buffer from the home address. We used Cox proportional hazards regression models to estimate associations between greenness and death, adjusting for age, sex, origin, socioeconomic status, type of hospital admission, peripherality, air pollution, and distance from the sea.

RESULTS

Mean age at surgery was 63.8 ± 10.6 for men and 69.5 ± 10.0 for women. During an average of 12.1 years of follow-up (37,912 person-years), 1,442 (46%) patients died. A fully adjusted Cox proportional hazards model estimated a 7% lower risk of mortality (HR: 0.93, 95% CI = [0.85, 1.00]) per 1 interquartile range width increase (0.04) in NDVI. Results were robust to the use of different buffer sizes (100 m-1,250 m from the home) and to the use of average NDVI exposure during the first versus the last 2 years of follow-up.

CONCLUSIONS

Residential greenness was associated with lower risk of mortality in CABG patients.

A systematic literature review: building window's influence on indoor circadian health

Light has been shown to have a non-visual impact on the biological aspects of human health, particularly on circadian rhythms. Building windows are a potential means of regulating daylight conditions for circadian health and well-being. As a result of advancements in window and glazing technologies and variations in outdoor solar/sky conditions, understanding daylight's spectral characteristics, which pass through building window systems, is complex. Therefore, a systematic review and summary of the knowledge and evidence available regarding windows' impact on human circadian health is necessary. This study provides an overview of research in this domain, compares approaches and evaluation metrics, and underscores the importance of window parameters' influence on circadian health. Published studies available on various online databases since 2012 were evaluated. The findings of this study define a holistic approach to the melanopic performance of windows and provide an overview of current knowledge regarding the effect of windows on circadian health. Additionally, this work identifies future research directions based on the studies reviewed. This research contributes to the growing body of knowledge on the impact of windows on circadian health, which has implications for the design and construction of buildings in ways that support indoor human health and well-being from the circadian light adequacy perspective.

Exploring the relationship between home environmental characteristics and restorative effect through neural activities

As society and the economy have advanced, the focus of architectural and interior environment design has shifted from practicality to eliciting emotional responses, such as stimulating environments and innovative inclusive designs. Of particular interest is the home environment, as it is best suited for achieving restorative effects, leading to a debate between interior qualities and restorative impact. This study explored the relationships between home characteristics, restorative potential, and neural activities using the Neu-VR. The results of the regression analysis revealed statistically significant relationships between interior properties and restorative potential. We examined each potential characteristic of the home environment that could have a restorative impact and elucidated the environmental characteristics that should be emphasized in residential interior design. These findings contribute evidence-based knowledge for designing therapeutic indoor environments. And combining different restorative potential environments with neural activity, discussed new neuro activities which may predict restorativeness, decoded the new indicators of neuro activity for environmental design.

The Variable Impact of Clinical Risk-Adjustment Models to Evaluate Hospital Design

OBJECTIVES

To identify the impact of clinical risk adjustment models for evaluating pain medication consumption differences between private rooms and a multibed ward.

BACKGROUND

Views of nature are reported to reduce anxiety and pain for patients. This often leads to prioritizing large windows with views for patient rooms; however, it is not clear how other factors influencing pain (e.g., patient demographics) may confound evaluations of room design.

METHODS

We identified 1,284 patients at the University of Michigan undergoing thyroidectomy where patients recovered in one of the two locations: a private room with a view to nature or a multibed ward with no windows. We used pain medication data from the electronic medical record and risk adjustment models to evaluate pain medication consumption between the room types.

RESULTS

Private room patients did not use more pain medications when measured using unadjusted morphine milligram equivalents (18.3 vs. 15.3 mg, p = .06). Risk adjusting for age, gender, comorbidities, opioid history, and procedure subtype resulted in private room patients demonstrating higher consumption of morphine milliequivalents (17.5 vs. 15.5 mg, p < .01). In contrast, risk adjusting for age, gender, opioid history, and selected comorbidities estimated higher pain medication consumption for multibed ward patients relative to private rooms (16.27 vs. 15.51 mg, p < .05).

CONCLUSION

Estimated differences of pain medication consumption for patients in differently designed rooms varied depending on the risk adjustment model. These findings underscore the importance of understanding appropriate clinical measurement and risk adjustment strategies to accurately estimate the impact of design, before applying research into practice.

Quantifying of Vision through Polymer Dispersed Liquid Crystal Double-Glazed Window

The visual linking of a building’s occupants with the outside views is a basic property of windows. However, vision through windows is not yet a metricized factor. The previous research employs a human survey methods to assess the vision through conventional windows. The recently fabricated smart films add a changeable visual transparency feature to the windows. The varied operating transparency challenges the evaluation of vision. Therefore, surveying human preferences is no longer a feasible approach for smart windows. This paper proposes an image-processing-based approach to quantify the vision quality through smart windows. The proposed method was experimentally applied to a polymer dispersed liquid crystal (PDLC) double-glazed window. The system instantaneously determines the available contrast band of the scenes seen through the window. The system adjusts the excitation of the PDLC film to maintain a desired vision level within the determined vision band. A preferred vision ratio (PVR) is proposed to meet the requirements of occupant comfort. The impact of the PVR on vision quality, solar heat gain, and daylight performance was investigated experimentally. The results show that the system can determine the available vision comfort band during daytime considering different occupant requirements.

On the relation between a green and bright window view and length of hospital stay in affective disorders

Background

The salutary effect of window views on greenery for inpatients in hospitals on length of stay and recovery rate has been repeatedly shown, however, not for psychiatric inpatients. The study assessed the association between a window view on green trees or man-made objects and brightness of the room on length of stay in a sample of psychiatric inpatients from one clinic.

Methods

Data records of 244 psychiatric inpatients (mean age in years 41.8; SD = 11.8; 59.8% female, length of stay varying between 7 and 100 days) that were admitted between May 2013 and October 2018 with affective disorders were examined. Window view was assessed with images taken from each room and classified into showing man-made objects or green trees. The percentage of green within each image was also calculated as greenness of the view. Brightness was assessed with a luxmeter.

Results

Although no effect was found for the dichotomous measures (man-made objects vs. green trees), a suppression effect emerged for percentage of green and brightness. The results indicate that both greenness of the window view as well as brightness significantly reduce length of stay in psychiatric inpatients with affective disorders.

Conclusions

The suppression effect likely results from the characteristics of the windows; the greenest rooms also being the darkest. Due to the infrastructure of the ward, greenness and brightness came at the expense of each other. The results generally support the importance of a view into greenery and natural sunlight for recovery.