The rehabilitation robot: factors influencing its use, advantages and limitations in clinical rehabilitation.

PURPOSE: Despite the proven effectiveness of rehabilitation robots (RR) in the literature, they are still little used in clinical rehabilitation. The aim of this study was to analyse the factors influencing the use of RR and the perception of therapists who used RR. METHOD: In order to characterize the factors influencing the use of RR by therapists, a semi-structured interview was conducted with 18 therapists. These interviews are based on an interview guide inspired by the Unified Theory of Acceptance and Use of Technology model. The interviews were recorded and then transcribed, summarized and finally synthesized cross-sectionally. In addition and in parallel, the System Usability Scale (SUS) was also proposed to clinicians in order to collect quantitative data. RESULTS: The interviews highlight the facilitators perceived by the therapists, such as the intensity of the movement, the complementarity with conventional rehabilitation. The results also showed the possible barriers perceived, these can be sometimes inconclusive (e.g., bugs). The SUS results show no effect, either on the gender of the users, their therapists, or the duration of use of the tool. CONCLUSION: Better communication on the functionality of the robot and the construction of achievable goals would lead to more results that are conclusive but also better patient care. To date, and despite the evidence for the effectiveness of RRs, therapists believe that there are still many barriers to their use. They agree, however, that if changes are made, RRs will become an integral part of therapy.IMPLICATIONS FOR REHABILITATIONThe study idenfied and highlighted the factors influencing the use of the rehabilitation robot in the clinics through metric and ergonomic evaluations.The study allowed to quantify the level of acceptance of the Lokomat among therapists.This study allowed to identify negative factors that could be resolved through the implementation of a structured and generalized protocol for patients and thus improve their care.

Time pressure and regulations on hospital-in-the-home (HITH) nurses: An on-the-road study.

This study investigated both causal factors and consequences of time pressure in hospital-in-the-home (HITH) nurses. These nurses may experience additional stress from the time pressure they encounter while driving to patients' homes, which may result in greater risk taking while driving. From observation in natural settings, data related to the nurses' driving behaviours and emotions were collected and analysed statistically; semi-directed interviews with the nurses were analysed qualitatively. The results suggest that objective time constraints alone do not necessarily elicit subjective time pressure. The challenges and uncertainty associated with healthcare and the driving period contribute to the emergence of this time pressure, which has a negative impact on both the nurses' driving and their emotions. Finally, the study focuses on anticipated and in situ regulations. These findings provide guidelines for organizational and technical solutions allowing the reduction of time pressure among HITH nurses.

From technological acceptability to appropriation by users: methodological steps for device assessment in road safety.

This article presents the methodology developed within the framework of the research project SARI (Automated Road Surveillance for Driver and Administrator Information). This methodology is based on the logic of action research. The article presents the different stages in the development of technological innovation addressing vehicle control loss when driving on a curve. The results observed in speed reduction illustrate that no matter how optimal an innovation may be technologically speaking, it is only as effective as it is acceptable from a user standpoint. This acceptability can only be obtained if the technology is developed by engineers in liaison with social science specialists.

How do time pressured drivers estimate speed and time?

The purpose of this laboratory study was to investigate the influence of time pressure on the perception of speed and duration in driving situations. Participants provided estimations of speed and performed both productions and reproductions of time durations, based on traffic films. The experimental films were made from a driver's point of view within a moving car, and audio-recorded instructions invited participants to imagine that they were driving while under time pressure or while relaxed. The results obtained using this within-participant design support the hypothesis that time pressure promotes fast driving, and may induce an underestimation of speed and trip-related durations, the latter of which suggests that time pressure modulates time perception. Some of these effects were mediated by the emotional impact of time pressure. Links between time perception and speed were also observed. The discussion makes reference to internal clock models and focuses on the practical consequences of these results.

A comparison of the impact of CPOE implementation and organizational determinants on doctor-nurse communications and cooperation.

OBJECTIVE: To compare the impact of CPOE implementation and of the workplace organizational determinants on the doctor-nurse cooperation and communication processes. METHOD: A first study was undertaken in eight different wards aimed to identify the different workplace organizations that support doctor-nurse communications'. A second study compared the impact of these organizations and of a CPOE on medication-related doctor-nurse communications. RESULTS: The doctor-nurse communications could be structured into three typical workplace organizations: the common round, the briefing and the opportunistic exchange organizations. The results (i) confirmed the impact of the organizational determinants on the cooperative activities and (ii) demonstrated the CPOE system has no significant impact within a given workplace organization. CONCLUSION: The success of the implementation of HIT applications relies partly on the identification of the actual (and sometimes hidden) structuring variables of teamwork and ultimately on their control at the time of implementation to ensure the quality and safety of the patient care provided.

The impact of perceptual treatments on driver's behavior: from driving simulator studies to field tests--first results.

Our study focused on the lateral position of drivers in relation to risk on rural crest vertical curves, using a field site proposed by a local operator of the French road network (Conseil Général de Maine-et-Loire, 49). The final goal was to test one road treatment on this field site. The study consisted of three stages. The first, using driving simulators, selected two perceptual treatments (i.e., rumble strips on both sides of the centerline and sealed shoulders) from five that were tested in order to help drivers maintain lateral control when driving on crest vertical curves. The rumble strips were installed first on the field site. The second stage was to develop a diagnostic device specifically in order to evaluate, on the field site, the impact of a perceptual treatment on the driver's performance (i.e., lateral position). This diagnostic device was installed in the field upstream and downstream of the target crest vertical curve. The third stage was to collect the data during two periods, before and after the centerline rumble strips were installed. We then compared the results obtained in the field study with those from the driving simulator studies. The comparison showed that, as in the simulator studies, the centerline rumble strips on the crest vertical curve affected lateral positions, causing the participants to drive closer to the center of the lane. Finally, the results showed the usefulness of driving simulators in the road design process.

Does CPOE actually disrupt physicians-nurses communications?

This study addresses the question of the respective impact of organizational vs. technical environment variables on the collaborative aspects of healthcare work situations. It analyzes the physicians-nurses communications during the medication use process, according to both the organization of their work and their technical environment. Participant observations, interviews and recording of the dialogs were performed in 4 hospitals functioning with either a CPOE or a Paper based system. The study (i) presents the identification and description of the communications' processes involving doctors-nurses face-to-face communications and the supports that mediate medication information and (ii) focuses on the amount of face-to-face communications depending on the organization of work and the technical system used. The analyses demonstrate that the organizational variables have a larger impact than the technical environment on the quality and quantity of the communications and cooperation activities.

The impact of perceptual treatments on lateral control: a study using fixed-base and motion-base driving simulators.

This research was carried out as part of the French national multidisciplinary research project, PREDIT-SARI. Using a driving simulator, it aimed to test the effectiveness of road treatments intended to inform drivers about the risk of losing control on rural roads with "crest vertical curves" (Landis et al., 2004). [Rosey, F., Auberlet, J.M., Bertrand, J., Plainchault, P., 2008. Impact of perceptual treatments on lateral control during driving on crest vertical curves: a driving simulator study. Accid. Anal. Prev. 40, 1515-1523, Scopus.] used a fixed-base driving simulator to test four perceptual treatments intended to help drivers maintain lateral control when driving on crest vertical curves and found that two of them, rumble strips on both sides of the centerline and sealed shoulders, were more effective than the others. This first study prompted us to ask if non-visual sensory cues (e.g., vestibular or proprioceptive perceptions) could influence driver perception and consequently lateral control. We therefore conducted a second study on a motion-base driving simulator, using the same virtual 3D database. The results showed that: (1) drivers drive closer to the center of their lane when there are rumble strips on both sides of the centerline, or when there are sealed shoulders, than they do with the current marking system (i.e., continuous lines), and (2) the impact of the two tested perceptual treatments was replicated on both types of driving simulator.

Organizational vs. technical variables: impact on the collective aspects of healthcare work situations.

This study addresses the question of the respective impact of organizational vs. technical environment variables on the collective aspects of healthcare work situations. It analyzes the physicians-nurses communications during the medication use process, according to both the organization of their work and their technical environment. It demonstrates that the organizational variables have a larger impact than the technical environment on the communications and cooperation activities.

Informal notes to support the asynchronous collaborative activities.

BACKGROUND: Health care professionals' collaboration is highly important for the medical practice. Efficient exchange of information improves good cooperation, but remains complex, due to the diversity of the medical activities. Currently, the health record is mainly used to manage structured medical information. On the one hand, such structure supports treatment that requires the documented information. On the other hand, however, the structure also imposes constraints on narrative and conversational practices of health care professionals. They use other collaboration means through phone, mail, annotations and free texts for informal strategies of communication. We focussed on informal written documents. Two different studies provided us some materials: home care charts in the context of home care and annotations in the context of the hospital health records. PURPOSES: We wanted to design a model of the Communication Notes to computerize the written notes so as to improve the communication and the coordination of the practitioners. METHODS: We compared the results of the two studies about the various writing strategies used by the health care professionals to keep traces of their exchanges and of their acts. The first study deals with the information mentioned by the nurses in a chart during home care situations. We analysed the distribution of cooperation activities in action and in planning. The second study deals with the annotations which are written by all the practitioners to complete the documents of the health record in a paediatric ward. We analysed how annotations take part in their collaborations. RESULTS: We found some invariable items in these two situations and we proposed a model for these Communication Notes which can be used to describe and to index them according to different points of view. Some indications on the way such descriptions are used in current computerized systems are also reported. The originality of this model comes from the way it takes into account a collaborative perspective which is not often used in the electronic medical settings. CONCLUSIONS: With our model of Communication Notes, we now dispose of a promising setting for managing all the informal and unforeseeable information produced by the health care professionals during care.

Cognitive analysis of physicians and nurses cooperation in the medication ordering and administration process.

The objective of this study was to analyse physician-nurse cooperation in the medication ordering and administration process from a cognitive point of view. In this paper, we compared two work organizations characterized by: (1) a synchronous cooperation engendered by common doctor-nurse medical rounds and (2) an asynchronous situation characterized by split physician's and nurse's rounds. Both organizations worked with paper-based documentation systems. We relied on a cooperation cognitive architecture model and used specific methods from cognitive ergonomics to analyse physicians' and nurses' activity, communications and cooperation. The analysis of doctor-nurse dialogues during the medical rounds demonstrated that in the synchronous situation, the nurses actively participated in the medication ordering process. Such dialogues supported the elaboration of shared knowledge in the form of a common frame of reference (COFOR) which both actors rely on to control the entire medication process, and more precisely the coordination of their actions. Document analysis showed that the orders were far from exhaustively documented. However, self-confrontation interviews with the nurses demonstrated that, except for a small number of ill-documented orders, they were able to accurately retrieve the physician's complete intended orders. In this work organization, the nurse was able to control the medication administration process at a high level, because she understood the highest level of strategic control of the medication ordering carried out by the physician. In the asynchronous situation, the results were reversed. The nurses no longer participated in the decision making phase of the medication process. Doctor-nurse communications were rare, and their shared knowledge about the patient was weakened. Although written orders proved to be better documented, the nurses suffered from a lack of knowledge on the patient's medical case and the particular context of the medical decision making when confronted with incomplete or ambiguous orders. In this work organization, the nurse would find herself restrained to low level process control and confined in a reactive, instead of anticipative, management mode. This latter work organization is very similar to the CPOE situation we observed in previous studies, where the coordination of physicians' and nurses' actions was delegated to the system. We suggest that it is essential to take these organizational and cognitive aspects into account when (re-)designing CPOE applications.

A study of the communication notes for two asynchronous collaborative activities.

INTRODUCTION: To build relevant tools for Health Care Professionals, we must study and understand their practices. This paper discusses the way they leave traces in the Patient Record to help asynchronous collaboration, elaborating new documents or adding annotations. METHODS: We compared the results of two studies about the various writing strategies used by the Health Care Professionals to capture knowledge in the Patient Records. The first study deals with the information written by the nurses in a textbook during homecare situations. The second one deals with the annotations left by all the practitioners to complete the documents of the patient record in a hospital ward. RESULTS: We have found some invariants in these two situations. An interpretation model based on four levels: Communication Context, Communication Object, Value of Communication and Value of Cooperation, is proposed in order to describe and to index the characteristics of the Communication Notes.

[Development of an experimental methodology: hypotheses and variables]. / Mise en place d'une méthodologie expérimentale: hypotheses et variables.

In this methodological paper, we present the elaboration of the experimental design, central stage of the research cycle. First, we focus on the hypothesis elaboration from the research question. Then, we detail the hypothesis operationalisation by the means of the choice of variables. Finally, the experimental controls and the factorial designs are presented.

Impact of CPOE on doctor-nurse cooperation for the medication ordering and administration process.

The objective of this study was to analyze the impact of medication ordering and administration functions of CPOE on doctor-nurse communications and cooperation. We performed an extensive analysis of the work situations in several departments of three different hospitals. One of the hospitals is still using paper-based orders, the second one is currently implementing a patient care information system (PCIS), but the analysis was carried out with paper-based orders. The third hospital has a PCIS installed with available medication ordering functions. We used standard methods from cognitive psychology to analyze physicians, and nurses' activity, communications and cooperation. This approach was combined with a usability analysis of both work systems, paper and computer-based. The paper-based situation is characterized by a synchronous cooperation with a distributed decision-making where physicians and nurses rely mostly on verbal communications to coordinate their actions; paper order sheets are weakly structured and poorly support the documentation task. In the computer situation, physicians and nurses work in an asynchronous mode, and leave to the system the coordination of their actions. Orders are exhaustively documented but some data may be misinterpreted. Some of these problems are due to usability flaws of the Human Computer Interface. We conclude with recommendations for usability improvement of CPOE systems, combined with recommendations for the organization of doctor-nurse communication when implementing such systems.

A distributed coordination platform for home care: analysis, framework and prototype.

Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users.

User-centred, multidimensional assessment method of Clinical Information Systems: a case-study in anaesthesiology.

This paper describes a multi-dimensional assessment method to support the choice and acquisition process for Clinical Information Systems. The method addresses three different dimensions: (1) Quality management, which evaluates the fulfillment of Users Requirements, and the Users' satisfaction with the existing functions; (2) Usability assessment, which includes a Usability inspection, and a Usability test; (3) Performance evaluation, which assesses the exhaustiveness and quality of documentation. The method is illustrated using the case study of a Clinical Information System (CIS) acquisition for anaesthesiology. It proved efficient and promising as a support for the decision process, for enhancing users' involvement in the project, and for initiating the necessary re-engineering of the Human Computer Interface.

A usability study of CPOE's medication administration functions: impact on physician-nurse cooperation.

Implementation of CPOE systems in Healthcare Institutions has proven efficient in reducing medication errors but it also induces hidden side-effects on Doctor-Nurse cooperation. We propose a usability engineering approach to this problem. An extensive activity analysis of the medication ordering and administration process was performed in several departments of 3 different hospitals. Two of these hospitals are still using paper-based orders, while the 3rd one is in the roll-out phase of medication functions of its CPOE system. We performed a usability assessment of this CPOE system. The usability assessment uncovered usability problems for the entry of medication administration time scheduling by the physician and revealed that the information can be ambiguous for the nurse. The comparison of cooperation models in both situation shows that users tend to adopt a distributed decision making paradigm in the paper-based situation, while the CPOE system supports a centralized decision making process. This analysis can support recommendation for the re-engineering of the Human-Computer Interface.

Multidimensional evaluation of a Clinical Information System for anaesthesiology: quality management, usability, and performances.

This paper describes a multi-dimensional assessment methodology to support the choice and selection process of Clinical Information Systems. The methodology includes 4 evaluation components: Fulfilment of Users Requirements, Usability Inspection, Usability Testing and Performance Evaluation. The methodology is illustrated with the case study of a selection of a CIS for anaesthesiology. It proved to be very efficient and powerful to support the selection process, to enhance users' involvement in the project, and to initiate the necessary re-engineering of the HCI.