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Puladi B, Coldewey B, Volmerg JS, Grunert K, Berens J, Rashad A, Hölzle F, Röhrig R, Lipprandt M. Improving detection of oral lesions: Eye tracking insights from a randomized controlled trial comparing standardized to conventional approach. Head Neck 2024. [PMID: 38454656 DOI: 10.1002/hed.27687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/23/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Early detection of oral cancer (OC) or its precursors is the most effective measure to improve outcome. The reasons for missing them on conventional oral examination (COE) or possible countermeasures are still unclear. METHODS In this randomized controlled trial, we investigated the effects of standardized oral examination (SOE) compared to COE. 49 dentists, specialists, and dental students wearing an eye tracker had to detect 10 simulated oral lesions drawn into a volunteer's oral cavity. RESULTS SOE had a higher detection rate at 85.4% sensitivity compared to 78.8% in the control (p = 0.017) due to higher completeness (p < 0.001). Detection rate correlated with examination duration (p = 0.002). CONCLUSIONS A standardized approach can improve systematics and thereby detection rates in oral examinations. It should take at least 5 min. Perceptual and cognitive errors and improper technique cause oral lesions to be missed. Its wide implementation could be an additional strategy to enhance early detection of OC.
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Affiliation(s)
- Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia S Volmerg
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kim Grunert
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jeff Berens
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Peters P, Lemos M, Bönsch A, Ooms M, Ulbrich M, Rashad A, Krause F, Lipprandt M, Kuhlen TW, Röhrig R, Hölzle F, Puladi B. Effect of head-mounted displays on students' acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: a randomized controlled trial. Int J Surg 2023; 109:2228-2240. [PMID: 37161620 PMCID: PMC10442110 DOI: 10.1097/js9.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although surgical suturing is one of the most important basic skills, many medical school graduates do not acquire sufficient knowledge of it due to its lack of integration into the curriculum or a shortage of tutors. E-learning approaches attempt to address this issue but still rely on the involvement of tutors. Furthermore, the learning experience and visual-spatial ability appear to play a critical role in surgical skill acquisition. Virtual reality head-mounted displays (HMDs) could address this, but the benefits of immersive and stereoscopic learning of surgical suturing techniques are still unclear. MATERIAL AND METHODS In this multi-arm randomized controlled trial, 150 novices participated. Three teaching modalities were compared: an e-learning course (monoscopic), an HMD-based course (stereoscopic, immersive), both self-directed and a tutor-led course with feedback. Suturing performance was recorded by video camera both before and after course participation (>26 h of video material) and assessed in a blinded fashion using the Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score (GRS). Furthermore, the optical flow of the videos was determined using an algorithm. The number of sutures performed was counted, the visual-spatial ability was measured with the Mental Rotation Test (MRT), and courses were assessed with questionnaires. RESULTS Students' self-assessment in the HMD-based course was comparable to that of the tutor-led course and significantly better than in the e-learning course ( P =0.003). Course suitability was rated best for the tutor-led course ( x̄ =4.8), followed by the HMD-based ( x̄ =3.6) and e-learning ( x̄ =2.5) courses. The median ΔGRS between courses was comparable ( P =0.15) at 12.4 (95% CI 10.0-12.7) for the e-learning course, 14.1 (95% CI 13.0-15.0) for the HMD-based course, and 12.7 (95% CI 10.3-14.2) for the tutor-led course. However, the ΔGRS was significantly correlated with the number of sutures performed during the training session ( P =0.002), but not with visual-spatial ability ( P =0.615). Optical flow ( R2 =0.15, P <0.001) and the number of sutures performed ( R2 =0.73, P <0.001) can be used as additional measures to GRS. CONCLUSION The use of HMDs with stereoscopic and immersive video provides advantages in the learning experience and should be preferred over a traditional web application for e-learning. Contrary to expectations, feedback is not necessary for novices to achieve a sufficient level in suturing; only the number of surgical sutures performed during training is a good determinant of competence improvement. Nevertheless, feedback still enhances the learning experience. Therefore, automated assessment as an alternative feedback approach could further improve self-directed learning modalities. As a next step, the data from this study could be used to develop such automated AI-based assessments.
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Affiliation(s)
| | | | - Andrea Bönsch
- Visual Computing Institute, Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery
| | - Max Ulbrich
- Department of Oral and Maxillofacial Surgery
| | | | - Felix Krause
- Department of Operative Dentistry, Periodontology and Preventive Dentistry
| | - Myriam Lipprandt
- Institute of Medical Informatics, University Hospital RWTH Aachen
| | - Torsten W. Kuhlen
- Visual Computing Institute, Faculty of Mathematics, Computer Science and Natural Sciences, RWTH Aachen University, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital RWTH Aachen
| | | | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery
- Institute of Medical Informatics, University Hospital RWTH Aachen
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3
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Lipprandt M, Klausen AD, Röhrig R. Methodology for the Description of Socio-Technical Systems: A Case Study Approach. Stud Health Technol Inform 2023; 302:656-660. [PMID: 37203772 DOI: 10.3233/shti230230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The ethical implications and regulatory requirements of AI applications and decision support systems are generally the subjects of interdisciplinary research. Case studies are a suitable means to prepare AI applications and clinical decision support systems for research. This paper proposes an approach that describes a procedure model and a categorization of the contents of cases for socio-technical systems. The developed methodology was applied to three cases and serve the researchers in the DESIREE research project as a basis for qualitative research and for ethical, social, and regulatory analyses.
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Affiliation(s)
- Myriam Lipprandt
- Institut of Medical Informatics, Medical Faculty of RWTH University Aachen, Aachen, Germany
| | - Andrea D Klausen
- Institut of Medical Informatics, Medical Faculty of RWTH University Aachen, Aachen, Germany
| | - Rainer Röhrig
- Institut of Medical Informatics, Medical Faculty of RWTH University Aachen, Aachen, Germany
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4
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Volmerg JS, Coldewey B, Röhrig R, Lipprandt M. Usability-Tests of Mechanical Ventilators: A Systematic Review. Stud Health Technol Inform 2023; 302:680-681. [PMID: 37203778 DOI: 10.3233/shti230236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The usability of ventilators is critical for patient safety. This systematic review shows the methods used in usability studies on ventilators, if those are similar in methodology. Furthermore, the usability tasks are compared to the requirements for manufactures during approval. Results show that the methodology and procedure of the studies are similar, but only cover part of the primary operating functions from their corresponding ISO Norm. Therefore optimisation of aspects of the study design, e.g., scope of tested scenarios, is possible.
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Affiliation(s)
- Julia S Volmerg
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
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5
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Pérez Garriga A, Wolking S, Fortmann J, Majeed RW, Stockem C, Niekrenz L, Bosselmann C, Weber Y, Röhrig R, Lipprandt M. Modeling Clinical Guidelines for an Epilepsy-CDSS: The EDiTh Project. Stud Health Technol Inform 2023; 302:611-612. [PMID: 37203761 DOI: 10.3233/shti230218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The knowledge transformation process involves the guideline for the diagnosis and therapy of epilepsy to an executable and computable knowledge base that serves as the basis for a decision-support system. We present a transparent knowledge representation model which facilitates technical implementation and verification. Knowledge is represented in a plain table, used in the frontend code of the software where simple reasoning is performed. The simple structure is sufficient and comprehensible also for non-technical persons (i.e., clinicians).
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Affiliation(s)
- Ariadna Pérez Garriga
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stefan Wolking
- Department of Epileptology and Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jonas Fortmann
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Raphael W Majeed
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Christian Stockem
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lukas Niekrenz
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Christian Bosselmann
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Yvonne Weber
- Department of Epileptology and Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Coldewey B, Marie Klöckener A, Göbel C, Röhrig R, Lipprandt M. Usability Engineering of Dynamic Biosignal Displays Using Ventilation Data. Stud Health Technol Inform 2023; 302:626-630. [PMID: 37203766 DOI: 10.3233/shti230224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The aim of this work is to develop and evaluate a multi-stage procedure model for the identification of use problems and optimization of usability using biosignal data. The concept is divided into 5 steps: 1. static analysis of data to identify use problems; 2. conducting interviews within the context of use and requirements analysis to investigate problems in more detail; 3. developing new interface concepts to implement the requirements and a prototype of an interface including dynamic visualization of data; 4. formative evaluation using an unmoderated remote usability test; 5. usability test with realistic scenarios and influencing factors in the simulation room. The concept was evaluated in the ventilation setting as an example. The procedure allowed the identification of use problems in the ventilation of patients as well as the development of suitable concepts and their evaluation to counteract use problems. To relieve users, ongoing analyses of biosignals with respect to the use problem are to be carried out. To overcome technical barriers, further development is needed in this area.
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Affiliation(s)
- Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Anne Marie Klöckener
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Christof Göbel
- Löwenstein Medical Technology GmbH + Co. KG, Hamburg, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
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7
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Lipprandt M, Liedtke W, Langanke M, Klausen A, Baumgarten N, Röhrig R. Causes of adverse events in home mechanical ventilation: a nursing perspective. BMC Nurs 2022; 21:264. [PMID: 36167541 PMCID: PMC9513291 DOI: 10.1186/s12912-022-01038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 09/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adverse events (AE) are ubiquitous in home mechanical ventilation (HMV) and can jeopardise patient safety. One particular source of error is human interaction with life-sustaining medical devices, such as the ventilator. The objective is to understand these errors and to be able to take appropriate action. With a systematic analysis of the hazards associated with HMV and their causes, measures can be taken to prevent damage to patient health. Methods A systematic adverse events analysis process was conducted to identify the causes of AE in intensive home care. The analysis process consisted of three steps. 1) An input phase consisting of an expert interview and a questionnaire. 2) Analysis and categorisation of the data into a root-cause diagram to help identify the causes of AE. 3) Derivation of risk mitigation measures to help avoid AE. Results The nursing staff reported that patient transportation, suction and tracheostomy decannulation were the main factors that cause AE. They would welcome support measures such as checklists for care activities and a reminder function, for e.g. tube changes. Risk mitigation measures are given for many of the causes listed in the root-cause diagram. These include measures such as device and care competence, as well as improvements to be made by the equipment providers and manufacturers. The first step in addressing AE is transparency and an open approach to errors and near misses. A systematic error analysis can prevent patient harm through a preventive approach. Conclusion Risks in HMV were identified based on a qualitative approach. The collected data was systematically mapped onto a root-cause diagram. Using the root-cause diagram, some of the causes were analysed for risk mitigation. For manufacturers, caregivers and care services requirements for intervention offers the possibility to create a checklist for particularly risky care activities.
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Affiliation(s)
- Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Wenke Liedtke
- Protestant University of Applied Sciences, Bochum, Germany
| | | | - Andrea Klausen
- Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Nicole Baumgarten
- University of Sheffield, School of Languages and Cultures, Sheffield, UK
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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8
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Kremer L, Lipprandt M, Röhrig R, Breil B. Examining Mental Workload Relating to Digital Health Technologies in Health Care: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e40946. [DOI: 10.2196/40946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
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Coldewey B, Röhrig R, Lipprandt M. Online Usability Tool - First Experiences from Testing a Ventilator Interface. Stud Health Technol Inform 2022; 294:807-808. [PMID: 35612210 DOI: 10.3233/shti220590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Usability tests of medical devices are mainly conducted on-site, but remote tests can also be suitable for quick feedback. Using the online survey tool SoSci Survey and videos of a ventilator interface prototype, a usability test environment was developed which allows participation independent of time and place.
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Affiliation(s)
- Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
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Puladi B, Ooms M, Bellgardt M, Cesov M, Lipprandt M, Raith S, Peters F, Möhlhenrich SC, Prescher A, Hölzle F, Kuhlen TW, Modabber A. Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study. JMIR Serious Games 2022; 10:e34781. [PMID: 35468090 PMCID: PMC9086879 DOI: 10.2196/34781] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/04/2022] [Accepted: 03/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Although nearly one-third of the world’s disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD–guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD–guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies.
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Affiliation(s)
- Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.,Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Bellgardt
- Visual Computing Institute, RWTH Aachen University, Aachen, Germany
| | - Mark Cesov
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.,Visual Computing Institute, RWTH Aachen University, Aachen, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan Raith
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephan Christian Möhlhenrich
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.,Department of Orthodontics, Private University of Witten/Herdecke, Witten, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Coldewey B, Diruf A, Röhrig R, Lipprandt M. Causes of use errors in ventilation devices - Systematic review. Appl Ergon 2022; 98:103544. [PMID: 34461508 DOI: 10.1016/j.apergo.2021.103544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 07/15/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
A systematic review according to the PRISMA reporting standard was performed to identify causes of use errors in mechanical ventilators described in the literature. The PubMed search resulted in the inclusion of 16 papers. The errors described were systematically analyzed with regard to their causes and categorized in an adapted cause-and-effect diagram. The causes of use errors were related to specific usability issues and to the general condition that medical staff often work with different ventilators. When many devices are used, the different user interfaces are a source of use errors, since, for example, the same ventilation modes have different names. In order to avoid the identified causes for use errors in the future, this work offers manufacturers of ventilation devices design recommendations and the possibility to include the results in their risk management. In addition, standardizing user interface content across all ventilators, as in ISO 19223, can help reduce use errors.
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Affiliation(s)
- Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany.
| | - Annette Diruf
- Division for Medical Informatics, Faculty VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; Division for Medical Informatics, Faculty VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; Division for Medical Informatics, Faculty VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany
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12
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Kremer L, Lipprandt M, Röhrig R, Breil B. Examining the Mental Workload Associated With Digital Health Technologies in Health Care: Protocol for a Systematic Review Focusing on Assessment Methods. JMIR Res Protoc 2021; 10:e29126. [PMID: 34342590 PMCID: PMC8371485 DOI: 10.2196/29126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/23/2021] [Accepted: 06/14/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The workload in health care is high; physicians and nurses report high stress levels due to a demanding environment where they often have to perform multiple tasks simultaneously. As a result, mental health issues among health care professionals (HCPs) are on the rise and the prevalence of errors in their daily tasks could increase. Processes of demographic change are partly responsible for even higher stress levels among HCPs. The digitization of patient care is intended to counteract these processes. However, it remains unclear whether these health information systems (HIS) and digital health technologies (DHT) support the HCPs and relieve stress, or if they represent a further burden. The mental construct that describes this burden of technologies is mental workload (MWL). Work in the clinic can be viewed as working in safety-critical environments. Particularly in this sensitive setting, the measurement methods of MWL are relevant, mainly due to their strongly differing levels of intrusiveness and sensitivity. The method of eye tracking could be a useful way to measure MWL directly in the field. OBJECTIVE The systematic review aims to address the following questions: (1) In which manner do DHT contribute to the overall MWL of HCPs? (2) Can we observe a direct or indirect effect of DHT on MWL? (3) Which aspects or factors of DHT contribute to an increase in MWL? (4) Which methods/assessments are applied to measure MWL related to HIS/DHT? (5) What role does eye tracking/pupillometry play in the context of measuring MWL? (6) Which outcomes are being assessed via eye tracking? METHODS Following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement, we will conduct a systematic review. Based on the research questions, we define keywords that we then combine in search terms. The review follows the following steps: literature search, article selection, data extraction, risk of bias assessment, data analysis, and data synthesis. RESULTS We expect results as well as a finalization of the review in the summer of 2021. CONCLUSIONS This review will evaluate the impact of DHT on the MWL of HCPs. In addition, assessment methods of MWL in the context of digital technologies will be systematically analyzed. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29126.
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Affiliation(s)
- Lisanne Kremer
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Bernhard Breil
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
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13
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Coldewey B, Diruf A, Röhrig R, Lipprandt M. Usability Issues with Mechanical Ventilation Devices. Stud Health Technol Inform 2020; 270:1419-1420. [PMID: 32570688 DOI: 10.3233/shti200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The user interface of a mechanical ventilator is safety critical, as use errors can lead to patient harm. A systematic review was conducted to identify published usability issues and contributing factors that can lead to use errors. The findings were grouped in an Ishikawa diagram. Many of the problems mentioned based on inconsistent labeling and manufacturer-specific naming of ventilation modes. In the studies, usability was often measured quantitatively and did not allow any conclusions to be drawn about concrete problems.
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Affiliation(s)
- Beatrice Coldewey
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Annette Diruf
- Division for Medical Informatics, Carl von Ossietzky University of Oldenburg, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
| | - Myriam Lipprandt
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Germany
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Becker K, Lipprandt M, Röhrig R, Neumuth T. Digital health – Software as a medical device in focus of the medical device regulation (MDR). it - Information Technology 2019. [DOI: 10.1515/itit-2019-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The Medical Device Directive (MDD) will be replaced on 26.05.2020 by the new Medical Device Regulation (MDR). The European Parliament wants to create a transparent, solid, predictable and sustainable legal framework. One of the major upcoming changes effects the perspective on software as a medical device. This paper describes the fundamental relationships between the policy framework and the challenges faced by manufacturers and operators of medical devices, in particular medical software and artificial intelligence (AI) systems, who need to verify compliance. To address this topic, we review and discuss the main implications of medical device regulations on software as a medical device and digital health applications along the MDR structure. Furthermore, we address practical limitations of the implementation, such as the availability of notified bodies and costs of the approval procedure.
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Affiliation(s)
- Kurt Becker
- 178432 APOLLON Hochschule der Gesundheitswirtschaft , Bremen , Germany
| | - Myriam Lipprandt
- University-Hospital RWTH Aachen , Institut for Medical Informatics , Aachen , Germany
| | - Rainer Röhrig
- University-Hospital RWTH Aachen , Institut for Medical Informatics , Aachen , Germany
| | - Thomas Neumuth
- Universität Leipzig , Innovation Center Computer Assisted Surgery (ICCAS) , Leipzig , Germany
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15
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Klausen A, Röhrig R, Lipprandt M. Feasibility of Three Head Mounted Eye-Tracker in Anesthesia: A Feasibility Study. Stud Health Technol Inform 2019; 264:1238-1242. [PMID: 31438123 DOI: 10.3233/shti190424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many studies use eye-tracker to analyse the socio-technical system, also in medical research. Only a few articles describe the use of eye-tracker to examine human-computer interaction in a critical care environment, especially in the field of anaesthesia or surgery. Therefore, we have tested in a feasibility study head-mounted eye-tracker of three different manufactures in a simulated anesthesia surrounding with mankind patient simulators. The research question was to analyse whether the field scene camera of the eye-tracker can be used in the light conditions and changes in brightness of the operating room. In addition, it was tested whether the eye-tracker was still calibrated and held on the subject's head during the resuscitation movement. All eye-trackers tested had a good adaptation on changing light or changing distances.
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Affiliation(s)
- Andreas Klausen
- Department for Anesthesiology, Intensive Care-, Emergency Medicine, Pain Therapy, Klinikum Oldenburg, Oldenburg, Germany
| | - Rainer Röhrig
- Department of Medical Informatics, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Myriam Lipprandt
- Department of Medical Informatics, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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16
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Pauls A, Gacek S, Lipprandt M, Koppelin F. [Experiences with health technologies to support physical activity in people over the age of 65: A qualitative survey of the requirements for the development of preventive technologies for a heterogeneous target group]. Z Evid Fortbild Qual Gesundhwes 2019; 144-145:62-71. [PMID: 31235346 DOI: 10.1016/j.zefq.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND For elderly people, physical activity (PA) is an important prerequisite for a healthy and self-determined life and provides preventive protection against many chronic diseases. Since a high proportion of this group does not exercise sufficiently in everyday life, new preventive strategies have been developed. In recent years, health technologies have also become increasingly important and offer a potential for primary prevention to promote PA. The aim of this study was to analyze experience with and acceptance of the use of technologies to support PA and to monitor health parameters in people over the age of 65. In addition to identifying concerns, uncertainties and subjective ideas about technologies, requirements for preventive technology should be derived. METHOD Guided (semi-structured) interviews were conducted. Interviewing topics included "PA" and "technology". Recruitment took place through a public call and the distribution of flyers. The evaluation was carried out by content analysis with inductive and deductive category formation. In addition, an interdisciplinary requirements analysis was performed on the basis of the transcripts in order to derive needs and requirements for preventive technologies. RESULTS The interviews were conducted with 33 persons (19 female). The average age was 75 years. Nine participants with a migration background originated from four countries. All participants were active in everyday life. The barriers identified included a lack of motivation and weather conditions. Many participants used health technologies in their everyday lives and were quite open to these developments. However, concern was expressed regarding topics such as data protection and security. CONCLUSION Experience and acceptance in dealing with future preventive technologies as well as concerns, ideas and requirements could be inferred from discussions with the heterogeneous target group. General strategies (e.g. notices, press) as well as specific strategies (e.g. multipliers) and sufficient time are important to ensure a target group-specific access to different groups of people.
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Affiliation(s)
- Alexander Pauls
- Jade Hochschule Wilhelmshaven/Oldenburg/Elsfleth, Fachbereich Bauwesen Geoinformation Gesundheitstechnologie, Abteilung Technik und Gesundheit für Menschen, Oldenburg, Germany.
| | - Stefanie Gacek
- ise Individuelle Software und Elektronik GmbH, Oldenburg, Germany
| | - Myriam Lipprandt
- Carl von Ossietzky Universität, Fakultät VI Medizin und Gesundheitswissenschaften, Department für Versorgungsforschung, Abteilung Medizinische Informatik, Oldenburg, Germany
| | - Frauke Koppelin
- Jade Hochschule Wilhelmshaven/Oldenburg/Elsfleth, Fachbereich Bauwesen Geoinformation Gesundheitstechnologie, Abteilung Technik und Gesundheit für Menschen, Oldenburg, Germany
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17
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Zeleke AA, Worku AG, Demissie A, Otto-Sobotka F, Wilken M, Lipprandt M, Tilahun B, Röhrig R. Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation. JMIR Mhealth Uhealth 2019; 7:e10995. [PMID: 30741642 PMCID: PMC6388101 DOI: 10.2196/10995] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. OBJECTIVE This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. METHODS A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit-based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. RESULTS From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. CONCLUSIONS EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site.
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Affiliation(s)
- Atinkut Alamirrew Zeleke
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.,Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu Worku
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Adina Demissie
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Fabian Otto-Sobotka
- Division of Epidemiology and Biometry, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Marc Wilken
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Myriam Lipprandt
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Rainer Röhrig
- Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Pauls A, Gacek S, Lipprandt M, Koppelin F. Zugang zu älteren Menschen mit Migrationshintergrund – Ergebnisse aus der BELLA-Studie (Besser Leben durch lebenslange Aktivität). Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Pauls
- Jade Hochschule, Technik und Gesundheit für Menschen, Oldenburg
| | - S Gacek
- Jade Hochschule, Technik und Gesundheit für Menschen, Oldenburg
- Carl von Ossietzky Universität Oldenburg, Fakultät VI – Medizin und Gesundheitswissenschaften, Department für Versorgungsforschung, Oldenburg
| | - M Lipprandt
- Jade Hochschule, Technik und Gesundheit für Menschen, Oldenburg
- Carl von Ossietzky Universität Oldenburg, Fakultät VI – Medizin und Gesundheitswissenschaften, Department für Versorgungsforschung, Oldenburg
| | - F Koppelin
- Jade Hochschule, Technik und Gesundheit für Menschen, Oldenburg
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Röhrig R, Hoffmann F, Lipprandt M. Patientensicherheit ist in einem soziotechnischem System eine gemeinsame Aufgabe. Z Evid Fortbild Qual Gesundhwes 2017; 125:1-2. [PMID: 28755828 DOI: 10.1016/j.zefq.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Rainer Röhrig
- Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, 26111 Oldenburg.
| | - Falk Hoffmann
- Abteilung ambulante Versorgung und Pharmakoepidemiologie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg.
| | - Myriam Lipprandt
- Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, 26111 Oldenburg.
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Sax U, Lipprandt M, Röhrig R. The Rising Frequency of IT Blackouts Indicates the Increasing Relevance of IT Emergency Concepts to Ensure Patient Safety. Yearb Med Inform 2016:130-137. [PMID: 27830241 DOI: 10.15265/iy-2016-038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION As many medical workflows depend vastly on IT support, great demands are placed on the availability and accuracy of the applications involved. The cases of IT failure through ransomware at the beginning of 2016 are impressive examples of the dependence of clinical processes on IT. Although IT risk management attempts to reduce the risk of IT blackouts, the probability of partial/total data loss, or even worse, data falsification, is not zero. The objective of this paper is to present the state of the art with respect to strategies, processes, and governance to deal with the failure of IT systems. METHODS This article is conducted as a narrative review. RESULTS Worst case scenarios are needed, dealing with methods as to how to survive the downtime of clinical systems, for example through alternative workflows. These workflows have to be trained regularly. We categorize the most important types of IT system failure, assess the usefulness of classic counter measures, and state that most risk management approaches fall short on exactly this matter. CONCLUSION To ensure that continuous, evidence-based improvements to the recommendations for IT emergency concepts are made, it is essential that IT blackouts and IT disasters are reported, analyzed, and critically discussed. This requires changing from a culture of shame and blame to one of error and safety in healthcare IT. This change is finding its way into other disciplines in medicine. In addition, systematically planned and analyzed simulations of IT disaster may assist in IT emergency concept development.
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Affiliation(s)
| | | | - R Röhrig
- Prof. Dr. Rainer Röhrig, Carl von Ossietzky University, Department of Medical Informatics, 26111 Oldenburg, Germany, E-mail:
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Klausen A, Röhrig R, Lipprandt M. Feasibility of Eyetracking in Critical Care Environments - A Systematic Review. Stud Health Technol Inform 2016; 228:604-608. [PMID: 27577455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Achieving a good understanding of the socio-technical system in critical or emergency situations is important for patient safety. Research in human-computer interaction in the field of anesthesia or surgery has the potential to improve usability of the user interfaces and enhance patient safety. Therefore eye-tracking is a technology for analyzing gaze patterns. It can also measure what is being perceived by the physician during medical procedures. The aim of this review is the applicability of eye-tracker in the domain of simulated or real environments of anesthesia, surgery or intensive care. We carried out a literature research in PubMed. Two independent researchers screened the titles and abstracts. The remaining 8 full-papers were analyzed based on the applicability of eye-trackers. The articles contain topics like training of surgeons, novice vs. experts or the cognitive workload. None of the publications address our goal. The applicability or limitations of the eye-tracker technology were stated incidentally.
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Affiliation(s)
- Andreas Klausen
- Department of Medical Informatics, Carl von Ossietzky University, Oldenburg
| | - Rainer Röhrig
- Department of Medical Informatics, Carl von Ossietzky University, Oldenburg
| | - Myriam Lipprandt
- Department of Medical Informatics, Carl von Ossietzky University, Oldenburg
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Helmer A, Lipprandt M, Frenken T, Eichelberg M, Hein A. 3DLC: A Comprehensive Model for Personal Health Records Supporting New Types of Medical Applications. Journal of Healthcare Engineering 2011. [DOI: 10.1260/2040-2295.2.3.321] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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