From Sheltered in Place to Thriving in Place: Pandemic Places of Aging.

BACKGROUND AND OBJECTIVES: Response to the coronavirus disease 2019 pandemic required rapid changes to physical, social, and technological environments. There is a need to understand how independent-living older adults are adapting to pandemic-borne transformations of place and how environmental factors may shape experiences of aging well in the context of a public health emergency response. RESEARCH DESIGN AND METHODS: We conducted a photovoice study to examine the characteristics associated with aging in place. Our study investigated how independent-living older adults characterized aging in a "right" place approximately 1 year after the onset of the pandemic. RESULTS: Six themes categorized into 2 groups capture how older adults describe a "right" place to age. The first category, "places as enactors of identity and belonging," describes the significance of places contributing to intimate relationships, social connections, and a sense of personal continuity. The second category, "places as facilitators of activities and values," recognizes environments that promote health, hobbies, goals, and belief systems. Participants reported modifying their daily living environments with increased use of technology and more time outdoors. DISCUSSION AND IMPLICATIONS: Our findings emphasize older adults' active engagement with place and strategies used to maintain healthy aging despite public health restrictions. The results also identify place-based characteristics that may help overcome stressful circumstances from older adults' perspectives. These findings inform pathways to pursue to facilitate resiliency for aging in place.

Aging in Place Through the COVID-19 Pandemic: Perspectives from Aging Service Providers.

Formal and informal networks of resources are critical to supporting the growing number of older adults aging in place (AIP). Data are needed from aging-service providers about assets and barriers that impact their abilities to support AIP during the pandemic, as well as emergent needs resulting from response measures. A series of World Café workshops were conducted with aging-service providers in Salt Lake City, Utah, to understand supportive factors, service gaps, and future needs. Novel domains to support AIP in the context of the pandemic were identified: digital access and literacy, social isolation and mental health, and emergency preparedness. Issues related to access, equity, and affordability were identified as overarching themes across domains. Issues reflect concern over how the pandemic exacerbated socioeconomic and cultural disparities impacting older adults who benefit from aging services. Networks of advocacy and support are needed to bolster resources for older adults, caregivers, and aging-service providers.

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms.

OBJECTIVE: This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs. MATERIALS AND METHODS: A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts. RESULTS: Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001). DISCUSSION AND CONCLUSION: Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.

Development of the Electronic Social Network Assessment Program Using the Center for eHealth and Wellbeing Research Roadmap.

BACKGROUND: The number of Web-based psychological and behavioral interventions is growing. Beyond their theoretical underpinnings, a key factor to the success of these interventions is how they are designed and developed to ensure usability over a new method of delivery. Our team has adapted ecomapping, a tool for visualizing family caregiver social network resources, for the Web. Here, we describe how we designed and developed the electronic Social Network Assessment Program (eSNAP) Web-based tool using a framework of the Center for eHealth and Wellbeing Research (CeHRes) Roadmap for Web-based intervention development. The CeHRes Roadmap is still new in terms of tool development and we showcase an example of its application. OBJECTIVE: The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP's acceptance and usability for users and the feasibility of its implementation. METHODS: We describe the development of the eSNAP app to support family caregivers of neuro-oncology patients. This development is based on the 5 iterative stages of the CeHRes Roadmap: contextual inquiry, value specification, design, operationalization, and summative evaluation. Research activities to support eSNAP development prior to implementation included literature review, focus groups, and iterative rounds of interviews. RESULTS: Key lessons learned in developing the eSNAP app broadly fell under a theme of translating theoretical needs and ideas to the real world. This included how to prioritize needs to be addressed at one time, how the modality of delivery may change design requirements, and how to develop a tool to fit within the context it will be used. CONCLUSIONS: Using the CeHRes Roadmap to develop Web-based interventions such as eSNAP helps to address potential issues by outlining important intervention development milestones. In addition, by encouraging inclusion of users and other stakeholders in the process, Web-based intervention developers using the Roadmap can identify what will work in the real world and increase feasibility and effectiveness.

Design Activity Framework for Visualization Design.

An important aspect in visualization design is the connection between what a designer does and the decisions the designer makes. Existing design process models, however, do not explicitly link back to models for visualization design decisions. We bridge this gap by introducing the design activity framework, a process model that explicitly connects to the nested model, a well-known visualization design decision model. The framework includes four overlapping activities that characterize the design process, with each activity explicating outcomes related to the nested model. Additionally, we describe and characterize a list of exemplar methods and how they overlap among these activities. The design activity framework is the result of reflective discussions from a collaboration on a visualization redesign project, the details of which we describe to ground the framework in a real-world design process. Lastly, from this redesign project we provide several research outcomes in the domain of cybersecurity, including an extended data abstraction and rich opportunities for future visualization research.

Graphical user interface simplifies infusion pump programming and enhances the ability to detect pump-related faults.

BACKGROUND: Drug administration errors are frequent and are often associated with the misuse of IV infusion pumps. One source of these errors may be the infusion pump's user interface. METHODS: We used failure modes-and-effects analyses to identify programming errors and to guide the design of a new syringe pump user interface. We designed the new user interface to clearly show the pump's operating state simultaneously in more than 1 monitoring location. We evaluated anesthesia residents in laboratory and simulated environments on programming accuracy and error detection between the new user interface and the user interface of a commercially available infusion pump. RESULTS: With the new user interface, we observed the number of programming errors reduced by 81%, the number of keystrokes per task reduced from 9.2 ± 5.0 to 7.5 ± 5.5 (mean ± SD), the time required per task reduced from 18.1 ± 14.1 seconds to 10.9 ± 9.5 seconds and significantly less perceived workload. Residents detected 38 of 70 (54%) of the events with the new user interface and 37 of 70 (53%) with the existing user interface, despite no experience with the new user interface and extensive experience with the existing interface. CONCLUSIONS: The number of programming errors and workload were reduced partly because it took less time and fewer keystrokes to program the pump when using the new user interface. Despite minimal training, residents quickly identified preexisting infusion pump problems with the new user interface. Intuitive and easy-to-program infusion pump interfaces may reduce drug administration errors and infusion pump-related adverse events.

A simulation-based evaluation of a graphic cardiovascular display.

INTRODUCTION: A graphic presentation of complex information can facilitate early detection and management of adverse events. Prior work found that graphical presentation of selected cardiovascular variables led to earlier detection of a simulated ischemic event. Based on these findings, a second evaluation explored the utility of a graphical cardiovascular display (GCD) in a variety of simulated adverse cardiopulmonary events for two different display configurations. In this evaluation, we revised the GCD to present hemodynamic variables with or without a pulmonary artery catheter. Our hypotheses were that the revised GCD would improve detection of adverse cardiopulmonary events and add no additional perceived workload. METHODS: Sixteen anesthesiologists and anesthesia residents were enrolled in a simulation-based evaluation of the GCD. Participants were randomly split into two groups balanced for expertise and asked to manage six simulated adverse cardiopulmonary events. The GCD was present in half of the simulations, balanced across scenarios and groups. Participants' verbalizations and actions during each scenario were recorded and transcribed. Transcripts of treatment interventions were subsequently rated by two blinded expert anesthesiologists. Perceived workload, time to detection, and proper treatment of the adverse event were compared between groups. RESULTS: Experts ranked anesthesiologists using the GCD as being more effective overall and individually in three of six scenarios. Use of the GCD was demonstrated to influence the time to detection and the time to treatment of some critical events. There were no workload differences between display groups. DISCUSSION: Treatment intervention by participants using the GCD was rated superior by two blinded experts. The presence of the GCD resulted in a modest improvement in the time to detect myocardial ischemia and increased pulmonary capillary wedge pressure. The GCD may be a useful adjunct to monitor patients during adverse cardiopulmonary events.

Development and evaluation of a just-in-time support system.

OBJECTIVE: To lay the foundation for a framework of just-in-time support (JITS) for novices dealing with urgent, unfamiliar tasks, and to evaluate a JITS system. BACKGROUND: More than 350,000 people die annually of cardiac arrest in the United States. In response, automated defibrillators are advocated that, unfortunately, do not provide important respiratory support. This paper presents elements of a framework for a JITS system that instructs a lay responder to follow a treatment protocol for integrating respiratory support with the use of an automatic external defibrillator. METHOD: We simulated a medical emergency using a high-fidelity patient simulator and asked participants to care for the patient. RESULTS: When using a paper-based NASA treatment protocol, participants made more errors and took longer to stabilize the injured person than when using the JITS system. CONCLUSION: These findings demonstrate the benefit of a JITS system to instruct novices in unfamiliar tasks. APPLICATION: The JITS system has the potential to improve the treatment outcome of victims of cardiac arrest. The JITS framework can be applied to many situations in which novices deal with urgent tasks without expertise available.

Drug delivery as control task: improving performance in a common anesthetic task.

OBJECTIVE: To conceptualize delivery of anesthesia as a control task, similar to control tasks in nonmedical domains, and to evaluate how presentation of new information and feedback affects task performance. BACKGROUND: In anesthesia, integrated monitors that show intravenous drug and effect-site concentrations in a patient currently do not exist. However, using real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical performance. Pharmacological models are available to estimate past, present, and future drug concentrations in the brain and to predict the drug's physiological effects. A display that integrates pharmacological models and visualizes drug concentrations was developed and tested to see if this drug display significantly improved clinical performance. METHOD: Thirty-three anesthesiologists with different levels of expertise administered anesthesia to simulated patients in a high-fidelity patient simulator. The experimental group used a drug display that visualized drug concentrations in real time, whereas the control group administered drugs without this information. RESULTS: Anesthesiologists using the drug display achieved better hemodynamic control of the simulated patient than did the control group. Similarly, the drug display enabled anesthesiologists to wake up and reanimate the patient faster. CONCLUSION: Visual feedback of drug concentrations leads to superior performance in the delivery of anesthesia. Drug delivery can be conceptualized within a control theoretical framework. Finally, the drug display has significant clinical potential to increase patient safety. APPLICATION: Clinical performance in delivering anesthesia depends on feedback. By providing this feedback, the drug display supports clinicians' ability to more precisely and safely administer anesthesia.

Evaluation of graphic cardiovascular display in a high-fidelity simulator.

UNLABELLED: "Human error" in anesthesia can be attributed to misleading information from patient monitors or to the physician's failure to recognize a pattern. A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. We designed a graphic display to show hemodynamic variables. Twenty anesthesiologists were asked to assume care of a simulated patient. Half the participants used the graphic cardiovascular display; the other half used a Datex As/3 monitor. One scenario was a total hip replacement with a transfusion reaction to mismatched blood. The second scenario was a radical prostatectomy with 1.5 L of blood loss and myocardial ischemia. Subjects who used the graphic display detected myocardial ischemia 2 min sooner than those who did not use the display. Treatment was initiated sooner (2.5 versus 4.9 min). There were no significant differences between groups in the hip replacement scenario. Systolic blood pressure deviated less from baseline, central venous pressure was closer to its baseline, and arterial oxygen saturation was higher at the end of the case when the graphic display was used. The study lends some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians' ability to detect, diagnose, manage, and treat critical cardiovascular events in a simulated environment. IMPLICATIONS: A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. A user-centered design process led to a novel object-oriented graphic display of hemodynamic variables containing emergent features and functional relationships. In a simulated environment, this display appeared to support clinicians' ability to diagnose, manage, and treat a critical cardiovascular event in a simulated environment. We designed a graphic display to show hemodynamic variables. The study provides some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians' ability to detect, diagnosis, mange, and treat critical cardiovascular events in a simulated environment.

Development and evaluation of a graphical anesthesia drug display.

BACKGROUND: Usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making. Pharmacokinetic models are available to estimate past, present, and future drug effect-site concentrations, and pharmacodynamic models are available to predict the drug's associated physiologic effects. METHODS: An interdisciplinary research team (bioengineering, architecture, anesthesiology, computer engineering, and cognitive psychology) developed a graphic display that presents the real-time effect-site concentrations, normalized to the drugs' EC(95), of intravenous drugs. Graphical metaphors were created to show the drugs' pharmacodynamics. To evaluate the effect of the display on the management of total intravenous anesthesia, 15 anesthesiologists participated in a computer-based simulation study. The participants cared for patients during two experimental conditions: with and without the drug display. RESULTS: With the drug display, clinicians administered more bolus doses of remifentanil during anesthesia maintenance. There was a significantly lower variation in the predicted effect-site concentrations for remifentanil and propofol, and effect-site concentrations were maintained closer to the drugs' EC(95). There was no significant difference in the simulated patient heart rate and blood pressure with respect to experimental condition. The perceived performance for the participants was increased with the drug display, whereas mental demand, effort, and frustration level were reduced. In a post-simulation questionnaire, participants rated the display to be a useful addition to anesthesia monitoring. CONCLUSIONS: The drug display altered simulated clinical practice. These results, which will inform the next iteration of designs and evaluations, suggest promise for this approach to drug data visualization.