scholarly journals Physicians’ Perceptions of a Situation Awareness–Oriented Visualization Technology for Viscoelastic Blood Coagulation Management (Visual Clot): Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Tadzio Raoul Roche ◽  
Sadiq Said ◽  
Julian Rössler ◽  
Malgorzata Gozdzik ◽  
Patrick Meybohm ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Situation Awareness ◽  
Online Survey ◽  
Blood Clot ◽  
Care Providers ◽  
Coagulation Management ◽  
Standard Result ◽  
Field Note ◽  
Visualization Technology

BACKGROUND Viscoelastic tests enable a time-efficient analysis of coagulation properties. An important limitation of viscoelastic tests is the complicated presentation of their results in the form of abstract graphs with a multitude of numbers. We developed Visual Clot to simplify the interpretation of presented clotting information. This visualization technology applies user-centered design principles to create an animated model of a blood clot during the hemostatic cascade. In a previous simulation study, we found Visual Clot to double diagnostic accuracy, reduce time to decision making and perceived workload, and improve care providers’ confidence. OBJECTIVE This study aimed to investigate the opinions of physicians on Visual Clot technology. It further aimed to assess its strengths, limitations, and clinical applicability as a support tool for coagulation management. METHODS This was a researcher-initiated, international, double-center, mixed qualitative-quantitative study that included the anesthesiologists and intensive care physicians who participated in the previous Visual Clot study. After the participants solved six coagulation scenarios using Visual Clot, we questioned them about the perceived pros and cons of this new tool. Employing qualitative research methods, we identified recurring answer patterns, and derived major topics and subthemes through inductive coding. Based on them, we defined six statements. The study participants later rated their agreement to these statements on five-point Likert scales in an online survey, which represented the quantitative part of this study. RESULTS A total of 60 physicians participated in the primary Visual Clot study. Among these, 36 gave an interview and 42 completed the online survey. In total, eight different major topics were derived from the interview field note responses. The three most common topics were “positive design features” (29/36, 81%), “facilitates decision making” (17/36, 47%), and “quantification not made” (17/36, 47%). In the online survey, 93% (39/42) agreed to the statement that Visual Clot is intuitive and easy to learn. Moreover, 90% (38/42) of the participants agreed that they would like the standard result and Visual Clot displayed on the screen side by side. Furthermore, 86% (36/42) indicated that Visual Clot allows them to deal with complex coagulation situations more quickly. CONCLUSIONS A group of anesthesia and intensive care physicians from two university hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision making in situations of active bleeding. From the responses of these possible future users, Visual Clot appears to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test–based coagulation management.

scholarly journals Physicians’ Perceptions of a Situation Awareness–Oriented Visualization Technology for Viscoelastic Blood Coagulation Management (Visual Clot): Mixed Methods Study

10.2196/19036 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e19036
Author(s):  
Tadzio Raoul Roche ◽  
Sadiq Said ◽  
Julian Rössler ◽  
Malgorzata Gozdzik ◽  
Patrick Meybohm ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Situation Awareness ◽  
Online Survey ◽  
Blood Clot ◽  
Care Providers ◽  
Coagulation Management ◽  
Standard Result ◽  
Field Note ◽  
Visualization Technology

Background Viscoelastic tests enable a time-efficient analysis of coagulation properties. An important limitation of viscoelastic tests is the complicated presentation of their results in the form of abstract graphs with a multitude of numbers. We developed Visual Clot to simplify the interpretation of presented clotting information. This visualization technology applies user-centered design principles to create an animated model of a blood clot during the hemostatic cascade. In a previous simulation study, we found Visual Clot to double diagnostic accuracy, reduce time to decision making and perceived workload, and improve care providers’ confidence. Objective This study aimed to investigate the opinions of physicians on Visual Clot technology. It further aimed to assess its strengths, limitations, and clinical applicability as a support tool for coagulation management. Methods This was a researcher-initiated, international, double-center, mixed qualitative-quantitative study that included the anesthesiologists and intensive care physicians who participated in the previous Visual Clot study. After the participants solved six coagulation scenarios using Visual Clot, we questioned them about the perceived pros and cons of this new tool. Employing qualitative research methods, we identified recurring answer patterns, and derived major topics and subthemes through inductive coding. Based on them, we defined six statements. The study participants later rated their agreement to these statements on five-point Likert scales in an online survey, which represented the quantitative part of this study. Results A total of 60 physicians participated in the primary Visual Clot study. Among these, 36 gave an interview and 42 completed the online survey. In total, eight different major topics were derived from the interview field note responses. The three most common topics were “positive design features” (29/36, 81%), “facilitates decision making” (17/36, 47%), and “quantification not made” (17/36, 47%). In the online survey, 93% (39/42) agreed to the statement that Visual Clot is intuitive and easy to learn. Moreover, 90% (38/42) of the participants agreed that they would like the standard result and Visual Clot displayed on the screen side by side. Furthermore, 86% (36/42) indicated that Visual Clot allows them to deal with complex coagulation situations more quickly. Conclusions A group of anesthesia and intensive care physicians from two university hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision making in situations of active bleeding. From the responses of these possible future users, Visual Clot appears to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test–based coagulation management.

scholarly journals Effects of an animated blood clot on the decision-making of users inexperienced in viscoelastic testing - Visual Clot technology: a multicenter trial (Preprint)

2021 ◽  
Author(s):  
Sadiq Said ◽  
Tadzio Raoul Roche ◽  
Julia Braun ◽  
Micheal Thomas Ganter ◽  
Patrick Meybohm ◽  
...  
Keyword(s):  
Decision Making ◽  
Situation Awareness ◽  
Blood Clot ◽  
Tertiary Care ◽  
Multicenter Trial ◽  
Diagnostic Confidence ◽  
Coagulation Management ◽  
Therapeutic Decisions ◽  
International Multicenter Study ◽  
User Centered

BACKGROUND Viscoelastic-test-guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3-dimensional blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness-oriented method. OBJECTIVE This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation. METHODS We conducted an investigator-initiated, international, multicenter study between September 16 and October 6, 2020, in five tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed nine different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models, adjusted for possible confounding factors. RESULTS Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR]: 33.66; 95% confidence interval [CI]: 21.13–53.64; P<0.001), perceived more diagnostic confidence (OR: 206.2; 95% CI: 93.5–454.75; P<0.001) and less workload (coefficient -41.63; 95% CI: -43.91 to -39.36; P<0.001) using Visual Clot compared to using standard ROTEM tracings. CONCLUSIONS This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. CLINICALTRIAL Not applicable

scholarly journals Ethical and Social Issues for Health Care Providers in the Intensive Care Unit during the Early Stages of the COVID-19 Pandemic in Japan: a Questionnaire Survey

2021 ◽  
Author(s):  
Yusuke Seino ◽  
Yayoi Aizawa ◽  
Atsushi Kogetsu ◽  
Kazuto Kato
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Medical Care ◽  
Health Care Providers ◽  
Moral Distress ◽  
Social Issues ◽  
Free Text ◽  
Care Providers

AbstractThis questionnaire-based observational study was conducted in July 2020 with the aim of understanding the ethical and social issues faced by health care providers (HCPs) registered with the Japanese Society of Intensive Care Medicine in intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic. There were 200 questionnaire respondents, and we analyzed the responses of 189 members who had been involved in COVID-19 treatment in ICUs. The ethical and social issues that HCPs recognized during the pandemic were difficulties in the decision-making process with patients’ families, limitations of life-sustaining treatment, lack of palliative care, and inadequate mental support for patients’ families and HCPs. Regarding decision-making on issues of clinical ethics during the pandemic, more than half of the respondents thought they had failed to provide sufficient palliative care to patients and responded that they experienced moral distress. The free-text responses on moral distress revealed issues such as unusual treatment and care, restricted visits, challenging situations for HCPs, and psychological burden. Additionally, 38.1% of respondents experienced episodes of social prejudice or discrimination and 4.7% experienced a shortage of medical resources. Our study result shows that the moral distress of HCPs was caused by difficulties in patient-centered decision-making and insufficient medical care to patients and their families. These were caused mainly by a lack of communication due to the stronger implementation of infection control measures. We believe that it is important to address ethical and social issues during a pandemic in order to provide appropriate medical care and prevent burnout among HCPs.

scholarly journals A Nationwide Cross-Sectional Online Survey on the Treatment of COVID-19-ARDS: High Variance in Standard of Care in German ICUs

2021 ◽  
Vol 10 (15) ◽  
pp. 3363
Author(s):  
Steffen Dickel ◽  
Clemens Grimm ◽  
Maria Popp ◽  
Claudia Struwe ◽  
Alexandra Sachkova ◽  
...  
Keyword(s):  
Intensive Care ◽  
Online Survey ◽  
Scientific Literature ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Future Research ◽  
High Peep ◽  
Care Providers ◽  
Cross Sectional ◽  
German Icus

Introduction: Coronavirus disease (COVID-19) has recently dominated scientific literature. Incomplete understanding and a lack of data concerning the pathophysiology, epidemiology, and optimal treatment of the disease has resulted in conflicting recommendations. Adherence to existing guidelines and actual treatment strategies have thus far not been studied systematically. We hypothesized that capturing the variance in care would lead to the discovery of aspects that need further research and—in case of proven benefits of interventions not being performed—better communication to care providers. Methods: This article is based on a quantitative and qualitative cross-sectional mixed-methods online survey among intensive-care physicians in Germany during the COVID-19 pandemic by the CEOsys (COVID-19 Evidence Ecosystem) network, endorsed by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) conducted from December 3 to 31 December 2020. Results: We identified several areas of care with an especially high variance in treatment among hospitals in Germany. Crucially, 51.5% of the participating ICUs (n = 205) reported using intubation as a last resort for respiratory failure in COVID-19 patients, while 21.8% used intubation early after admission. Furthermore, 11.5% considered extracorporeal membrane oxygenation (ECMO) in awake patients. Finally, 72.3% of respondents used the ARDS-network-table to titrate positive end-expiratory-pressure (PEEP) levels, with 36.9% choosing the low-PEEP table and 41.8% the high-PEEP table. Conclusions: We found that significant differences exist between reported treatment strategies and that adherence to published guidelines is variable. We describe necessary steps for future research based on our results highlighting significant clinical variability in care.

Utilization of echocardiography in Intensive Care Units: results of an online survey in Germany

2019 ◽  
Vol 85 (3) ◽  
Author(s):  
Felix Balzer ◽  
Ralf F. Trauzeddel ◽  
Martin Ertmer ◽  
Joachim Erb ◽  
Matthias Heringlake ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Online Survey

Would you Make the Right Decision? – Decision Making Biases in Economy - Related Dilemmas

2018 ◽  
Vol 9 (1) ◽  
pp. 59-66
Author(s):  
Zsuzsanna Gödör ◽  
Georgina Szabó
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Framing Effect ◽  
Economic Knowledge ◽  
Bank Account ◽  
Financial Decisions ◽  
Hungarian Population ◽  
The Moment ◽  
The Right ◽  
Decision Making Biases

Abstract As they say, money can’t buy happiness. However, the lack of it can make people’s lives much harder. From the moment we open our first bank account, we have to make lots of financial decisions in our life. Should I save some money or should I spend it? Is it a good idea to ask for a loan? How to invest my money? When we make such decisions, unfortunately we sometimes make mistakes, too. In this study, we selected seven common decision making biases - anchoring and adjustment, overconfidence, high optimism, the law of small numbers, framing effect, disposition effect and gambler’s fallacy – and tested them on the Hungarian population via an online survey. In the focus of our study was the question whether the presence of economic knowledge helps people make better decisions? The decision making biases found in literature mostly appeared in the sample as well. It proves that people do apply them when making decisions and in certain cases this could result in serious and costly errors. That’s why it would be absolutely important for people to learn about them, thus increasing their awareness and attention when making decisions. Furthermore, in our research we did find some connection between decisions and the knowledge of economics, people with some knowledge of economics opted for the better solution in bigger proportion

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