The Visual Patient Avatar ICU Facilitates Information Transfer of Written Information by Visualization: A Multicenter Comparative Eye-Tracking Study.

Patient monitoring is crucial in critical care medicine. Perceiving and interpreting multiple vital signs requires a high workload that can lead to decreased situation awareness and consequently inattentional blindness, defined as impaired perception of unexpectedly changing data. To facilitate information transfer, we developed and validated the Visual-Patient avatar. Generated by numerical data, the animation displays the status of vital signs and patient installations according to a user-centered design to improve situation awareness. As a surrogate parameter for information transfer in patient monitoring, we recorded visual attention using eye-tracking data. In this computer-based study, we compared the correlation of visually perceived and correctly interpreted vital signs between a Visual-Patient-avatar ICU and conventional patient monitoring. A total of 50 recruited study participants (25 nurses, 25 physicians) from five European study centers completed five randomized scenarios in both modalities. Using a stationary eye tracker as the primary endpoint, we recorded how long different areas of interest of the two monitoring modalities were viewed. In addition, we tested for a possible association between the length of time an area of interest was viewed and the correctness of the corresponding question. With the conventional monitor, participants looked at the installation site the longest (median 2.13-2.51 s). With the Visual-Patient-avatar ICU, gaze distribution was balanced; no area of interest was viewed for particularly long. For both modalities, the longer an area was viewed, the more likely the associated question was answered incorrectly (OR 0.97, 95% CI 0.95-0.99, p = 0.008). The Visual-Patient-avatar ICU facilitates and improves information transfer through its visualizations, especially with written information. The longer an area of interest was viewed, the more likely the associated question was answered incorrectly.

User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study.

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user's situation awareness in intensive care settings. It dynamically displays the patient's current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users' perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation.

User Perceptions of Visual Blood: An International Mixed Methods Study on Novel Blood Gas Analysis Visualization.

Blood gas analysis plays a central role in modern medicine. Advances in technology have expanded the range of available parameters and increased the complexity of their interpretation. By applying user-centered design principles, it is possible to reduce the cognitive load associated with interpreting blood gas analysis. In this international, multicenter study, we explored anesthesiologists' perspectives on Visual Blood, a novel visualization technique for presenting blood gas analysis results. We conducted interviews with participants following two computer-based simulation studies, the first utilizing virtual reality (VR) (50 participants) and the second without VR (70 participants). Employing the template approach, we identified key themes in the interview responses and formulated six statements, which were rated using Likert scales from 1 (strongly disagree) to 5 (strongly agree) in an online questionnaire. The most frequently mentioned theme was the positive usability features of Visual Blood. The online survey revealed that participants found Visual Blood to be an intuitive method for interpreting blood gas analysis (median 4, interquartile range (IQR) 4-4, p < 0.001). Participants noted that minimal training was required to effectively learn how to interpret Visual Blood (median 4, IQR 4-4, p < 0.001). However, adjustments are necessary to reduce visual overload (median 4, IQR 2-4, p < 0.001). Overall, Visual Blood received a favorable response. The strengths and weaknesses derived from these data will help optimize future versions of Visual Blood to improve the presentation of blood gas analysis results.

Avatar-based patient monitoring improves information transfer, diagnostic confidence and reduces perceived workload in intensive care units: computer-based, multicentre comparison study.

Patient monitoring is the foundation of intensive care medicine. High workload and information overload can impair situation awareness of staff, thus leading to loss of important information about patients' conditions. To facilitate mental processing of patient monitoring data, we developed the Visual-Patient-avatar Intensive Care Unit (ICU), a virtual patient model animated from vital signs and patient installation data. It incorporates user-centred design principles to foster situation awareness. This study investigated the avatar's effects on information transfer measured by performance, diagnostic confidence and perceived workload. This computer-based study compared Visual-Patient-avatar ICU and conventional monitor modality for the first time. We recruited 25 nurses and 25 physicians from five centres. The participants completed an equal number of scenarios in both modalities. Information transfer, as the primary outcome, was defined as correctly assessing vital signs and installations. Secondary outcomes included diagnostic confidence and perceived workload. For analysis, we used mixed models and matched odds ratios. Comparing 250 within-subject cases revealed that Visual-Patient-avatar ICU led to a higher rate of correctly assessed vital signs and installations [rate ratio (RR) 1.25; 95% CI 1.19-1.31; P < 0.001], strengthened diagnostic confidence [odds ratio (OR) 3.32; 95% CI 2.15-5.11, P < 0.001] and lowered perceived workload (coefficient - 7.62; 95% CI - 9.17 to - 6.07; P < 0.001) than conventional modality. Using Visual-Patient-avatar ICU, participants retrieved more information with higher diagnostic confidence and lower perceived workload compared to the current industry standard monitor.

Visual Blood, Visualisation of Blood Gas Analysis in Virtual Reality, Leads to More Correct Diagnoses: A Computer-Based, Multicentre, Simulation Study.

Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95% CI, 0.92-1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95% CI, 1.42-3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95% CI, 0.58-1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95% CI, -0.09-4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters' perception. However, the study also highlighted the limitations of today's virtual reality headsets and Visual Blood.

Improved Task Performance, Low Workload, and User-Centered Design in Medical Diagnostic Equipment Enhance Decision Confidence of Anesthesia Providers: A Meta-Analysis and a Multicenter Online Survey.

Decision confidence­the subjective belief to have made the right decision­is central in planning actions in a complex environment such as the medical field. It is unclear by which factors it is influenced. We analyzed a pooled data set of eight studies and performed a multicenter online survey assessing anesthesiologists' opinions on decision confidence. By applying mixed models and using multiple imputation to determine the effect of missing values from the dataset on the results, we investigated how task performance, perceived workload, the utilization of user-centered medical diagnostic devices, job, work experience, and gender affected decision confidence. The odds of being confident increased with better task performance (OR: 1.27, 95% CI: 0.94 to 1.7; p = 0.12; after multiple imputation OR: 3.19, 95% CI: 2.29 to 4.45; p < 0.001) and when user-centered medical devices were used (OR: 5.01, 95% CI: 3.67 to 6.85; p < 0.001; after multiple imputation OR: 3.58, 95% CI: 2.65 to 4.85; p < 0.001). The odds of being confident decreased with higher perceived workload (OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001; after multiple imputation, OR: 0.94, 95% CI: 0.93 to 0.95; p < 0.001). Other factors, such as gender, job, or professional experience, did not affect decision confidence. Most anesthesiologists who participated in the online survey agreed that task performance (25 of 30; 83%), perceived workload (24 of 30; 80%), work experience (28 of 30; 93%), and job (21 of 30; 70%) influence decision confidence. Improved task performance, lower perceived workload, and user-centered design in medical equipment enhanced the decision confidence of anesthesia providers.

Improving Visual-Patient-Avatar Design Prior to Its Clinical Release: A Mixed Qualitative and Quantitative Study.

Visual-Patient-avatar, an avatar-based visualisation of patient monitoring, is a newly developed technology aiming to promote situation awareness through user-centred design. Before the technology's introduction into clinical practice, the initial design used to validate the concept had to undergo thorough examination and adjustments where necessary. This mixed qualitative and quantitative study, consisting of three different study parts, aimed to create a design with high user acceptance regarding perceived professionalism and potential for identification while maintaining its original functionality. The first qualitative part was based on structured interviews and explored anaesthesia personnel's first impressions regarding the original design. Recurrent topics were identified using inductive coding, participants' interpretations of the vital sign visualisations analysed and design modifications derived. The second study part consisted of a redesign process, in which the visualisations were adapted according to the results of the first part. In a third, quantitative study part, participants rated Likert scales about Visual-Patient-avatar's appearance and interpreted displayed vital signs in a computer-based survey. The first, qualitative study part included 51 structured interviews. Twenty-eight of 51 (55%) participants mentioned the appearance of Visual-Patient-avatar. In 23 of 51 (45%) interviews, 26 statements about the general impression were identified with a balanced count of positive (14 of 26) and negative (12 of 26) comments. The analysis of vital sign visualisations showed deficits in several vital sign visualisations, especially central venous pressure. These findings were incorporated into part two, the redesign of Visual-Patient-avatar. In the subsequent quantitative analysis of study for part three, 20 of 30 (67%) new participants agreed that the avatar looks professional enough for medical use. Finally, the participants identified 73% (435 of 600 cases) of all vital sign visualisations intuitively correctly without prior instruction. This study succeeded in improving the original design with good user acceptance and a reasonable degree of intuitiveness of the new, revised design. Furthermore, the study identified aspects relevant for the release of Visual-Patient-avatar, such as the requirement for providing at least some training, despite the design's intuitiveness. The results of this study will guide further research and improvement of the technology. The study provides a link between Visual-Patient-avatar as a scientific concept and as an actual product from a cognitive engineering point of view, and may serve as an example of methods to study the designs of technologies in similar contexts.

User Perceptions of Different Vital Signs Monitor Modalities During High-Fidelity Simulation: Semiquantitative Analysis.

BACKGROUND: Patient safety during anesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar, an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centered design principles. After a high-fidelity simulation study, we analyzed the participants' perceptions of 3 different monitor modalities, including this newly introduced technique. OBJECTIVE: The aim of this study was to collect and evaluate participants' opinions and experiences regarding 3 different monitor modalities, which are Visual-Patient-avatar, Split Screen (avatar and Conventional monitor alongside each other), and Conventional monitor after using them during simulated critical anesthetic events. METHODS: This study was a researcher-initiated, single-center, semiquantitative study. We asked 92 care providers right after finishing 3 simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. We processed the field notes obtained and derived the main categories and corresponding subthemes following qualitative research methods. RESULTS: We gained a total of 307 statements. Through a context-based analysis, we identified the 3 main categories of "Visual-Patient-avatar," "Split Screen," and "Conventional monitor" and divided them into 11 positive and negative subthemes. We achieved substantial interrater reliability in assigning the statements to 1 of the topics. Most of the statements concerned the design and usability features of the avatar or the Split Screen mode. CONCLUSIONS: This study semiquantitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed the strengths and limitations of the avatar only and Split Screen modality. In addition to valuable suggestions for improving the design, the requirement for training prior to clinical implementation was emphasized. The responses to the Split Screen suggest that this symbiotic modality generates better situation awareness in combination with numerical data and accurate curves. As a subsequent development step, a real-life introduction study is planned, where we will test the avatar in Split Screen mode under actual clinical conditions.

Physicians' perceptions of two ways of algorithm presentation: graphic versus text-based approach.

Acute bleeding during surgery or after trauma harms patients, and challenges involved physicians. Protocols and cognitive aids can help in such situations. This dual-centre study investigated physicians' opinions regarding two ways to present cognitive aids, graphic 'Haemostasis Traffic Light' and text-based, using the example of a coagulation management algorithm to identify the strengths and limitations of both presentation modalities. Using qualitative research methods, we identified recurring answer patterns and derived major topics and subthemes through inductive coding. Eighty-four physicians participated. We assigned each half randomly to one of the cognitive aids (graphic/text-based) and determined 447 usable statements. We qualitatively deduced the importance of having a cognitive aid for physicians. Furthermore, it is noticeable that the graphic group made more positive comments (154 of 242 (64%) statements), while the text-based participants made more negative annotations (126 of 205 (61%) statements), suggesting a generally stronger approval of this cognitive aid. Practitioner summary: This qualitative study provides an overview of physicians` positive and negative perceptions regarding two presentation ways for a coagulation management algorithm. Participants perceived the graphic method created according to user-centred design principles more positively. The analysis reveals components that an ideal algorithm should have to help streamline the decision-making process.

Glial cell line-derived neurotrophic factor promotes barrier maturation and wound healing in intestinal epithelial cells in vitro.

Recent data suggest that neurotrophic factors from the enteric nervous system are involved in intestinal epithelial barrier regulation. In this context the glial cell line-derived neurotrophic factor (GDNF) was shown to affect gut barrier properties in vivo directly or indirectly by largely undefined processes in a model of inflammatory bowel disease (IBD). We further investigated the potential role and mechanisms of GDNF in the regulation of intestinal barrier functions. Immunostaining of human gut specimen showed positive GDNF staining in enteric neuronal plexus and in enterocytes. In Western blots of the intestinal epithelial cell lines Caco2 and HT29B6, significant amounts of GDNF were detected, suggesting that enterocytes represent an additional source of GDNF. Application of recombinant GDNF on Caco2 and HT29B6 cells for 24 h resulted in significant epithelial barrier stabilization in monolayers with immature barrier functions. Wound-healing assays showed a significantly faster closure of the wounded areas after GDNF application. GDNF augmented cAMP levels and led to significant inactivation of p38 MAPK in immature cells. Activation of p38 MAPK signaling by SB-202190 mimicked GDNF-induced barrier maturation, whereas the p38 MAPK activator anisomycin blocked GDNF-induced effects. Increasing cAMP levels had adverse effects on barrier maturation, as revealed by permeability measurements. However, increased cAMP augmented the proliferation rate in Caco2 cells, and GDNF-induced proliferation of epithelial cells was abrogated by the PKA inhibitor H89. Our data show that enterocytes represent an additional source of GDNF synthesis. GDNF contributes to wound healing in a cAMP/PKA-dependent manner and promotes barrier maturation in immature enterocytes cells by inactivation of p38 MAPK signaling.