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Task complexity plays an important role in performance and procedure adherence. While studies have attempted to assess the contribution of different aspects of task complexity and their relationship to workers’ performance and procedure adherence, only a few have focused on application-specific measurement of task complexity. Further, generalizable methods of operationalizing task complexity that are used to both write and evaluate a wide range of routine or non-routine procedures is largely absent. This paper introduces a novel framework to quantify the step-level complexity of written procedures based on attributes such as decision complexity, need for judgment, interdependency of instructions, multiplicity of instructions, and excess information. This framework was incorporated with natural language processing and artificial intelligence to create a tool for procedure writers for identifying complex elements in procedures steps. The proposed technique has been illustrated through examples as well as an application to a tool for procedure writers. This method can be used both to support writers when constructing procedures as well as to examine the complexity of existing procedures. Further, the complexity index is applicable across several high-risk industries in which written procedures are prevalent, improving the linguistic complexity of the procedures and thus reducing the likelihood of human errors with procedures associated with complexity.
Farzan Sasangohar; Nilesh Ade; Noor Quddus; S. Camille Peres; Pranav Kannan. Identifying step-level complexity in procedures: Integration of natural language processing into the Complexity Index for Procedures—Step level (CIPS). International Journal of Industrial Ergonomics 2021, 85, 103184 .
AMA StyleFarzan Sasangohar, Nilesh Ade, Noor Quddus, S. Camille Peres, Pranav Kannan. Identifying step-level complexity in procedures: Integration of natural language processing into the Complexity Index for Procedures—Step level (CIPS). International Journal of Industrial Ergonomics. 2021; 85 ():103184.
Chicago/Turabian StyleFarzan Sasangohar; Nilesh Ade; Noor Quddus; S. Camille Peres; Pranav Kannan. 2021. "Identifying step-level complexity in procedures: Integration of natural language processing into the Complexity Index for Procedures—Step level (CIPS)." International Journal of Industrial Ergonomics 85, no. : 103184.
Objective We collected naturalistic heart rate data from veterans diagnosed with post-traumatic stress disorder (PTSD) to investigate the effects of various factors on heart rate. Background PTSD is prevalent among combat veterans in the United States. While a positive correlation between PTSD and heart rate has been documented, specific heart rate profiles during the onset of PTSD symptoms remain unknown. Method Veterans were recruited during five cycling events in 2017 and 2018 to record resting and activity-related heart rate data using a wrist-worn device. The device also logged self-reported PTSD hyperarousal events. Regression analyses were performed on demographic and behavioral covariates including gender, exercise, antidepressants, smoking habits, sleep habits, average heart rate during reported hyperarousal events, age, glucocorticoids consumption, and alcohol consumption. Heart rate patterns during self-reported PTSD hyperarousal events were analyzed using Auto Regressive Integrated Moving Average (ARIMA). Heart rate data were also compared to an open-access non-PTSD representative case. Results Of 99 veterans with PTSD, 91 participants reported at least one hyperarousal event, with a total of 1023 events; demographic information was complete for 38 participants who formed the subset for regression analyses. The results show that factors including smoking, sleeping, gender, and medication significantly affect resting heart rate. Moreover, unique heart rate patterns associated with PTSD symptoms in terms of stationarity, autocorrelation, and fluctuation characteristics were identified. Conclusion Our findings show distinguishable heart rate patterns and characteristics during PTSD hyperarousal events. Application These findings show promise for future work to detect the onset of PTSD symptoms.
Mahnoosh Sadeghi; Farzan Sasangohar; Anthony D. McDonald; Sudeep Hegde. Understanding Heart Rate Reactions to Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Naturalistic Study. Human Factors: The Journal of the Human Factors and Ergonomics Society 2021, 1 .
AMA StyleMahnoosh Sadeghi, Farzan Sasangohar, Anthony D. McDonald, Sudeep Hegde. Understanding Heart Rate Reactions to Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Naturalistic Study. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2021; ():1.
Chicago/Turabian StyleMahnoosh Sadeghi; Farzan Sasangohar; Anthony D. McDonald; Sudeep Hegde. 2021. "Understanding Heart Rate Reactions to Post-Traumatic Stress Disorder (PTSD) Among Veterans: A Naturalistic Study." Human Factors: The Journal of the Human Factors and Ergonomics Society , no. : 1.
Objective This article analyzes the changes in downloads and activity of users of select popular mental health mobile applications (mHealth apps) during coronavirus disease 2019 (COVID-19). Background The outbreak of the COVID-19 crisis has shown a negative impact on public mental health. Mobile health has the potential to help address the psychological needs of existing and new patients during the pandemic and beyond. Method Downloads data of 16 widely used apps were analyzed. The quality of apps was reviewed using the Mobile Application Rating Scale (MARS) framework. Correlation analysis was conducted to investigate the relationship between app quality and app popularity. Results Among the 16 apps, 10 were meditational in nature, 13 showed increased downloads, with 11 apps showing above 10% increase in the downloads after the pandemic started. The popular apps were satisfactory in terms of functionality and esthetics but lacked clinical grounding and evidence base. There exists a gap between app quality and app popularity. Conclusion This study provided evidence for increased downloads of mental mHealth apps (primarily meditation apps) during the COVID-19 pandemic but revealed several gaps and opportunities to address deficiencies in evidence-based design, usability and effective assessment, and integration into current workflows. Application The COVID-19 pandemic is a potential turning point for mHealth applications for mental health care. Whereas the evidence suggests a need for alternative delivery of care, human factors and ergonomics methods should be utilized to ensure these tools are user-centered, easy to use, evidence-based, well-integrated with professional care, and used sustainably.
Xiaomei Wang; Carl Markert; Farzan Sasangohar. Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic. Human Factors: The Journal of the Human Factors and Ergonomics Society 2021, 1 .
AMA StyleXiaomei Wang, Carl Markert, Farzan Sasangohar. Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic. Human Factors: The Journal of the Human Factors and Ergonomics Society. 2021; ():1.
Chicago/Turabian StyleXiaomei Wang; Carl Markert; Farzan Sasangohar. 2021. "Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic." Human Factors: The Journal of the Human Factors and Ergonomics Society , no. : 1.
Background The development, review, and approval process of therapeutic biological products in the United States presents two primary challenges: time and cost. Advancing a biotherapeutic from concept to market may take an average of 12 years, with costs exceeding US $1 billion, and the product may still fail the US Food and Drug Administration (FDA) approval process. Despite the FDA’s practices to expedite the approval of new therapies, seeking FDA approval remains a long, costly, and risky process. Objective The objective of this paper is to explore the factors and gaps related to the FDA review and approval process that contribute to process inefficiencies and complexities as well as proposed methods and solutions to address such gaps. This paper also aims to investigate the available modeling efforts for the FDA approval process of therapeutic biological products. Methods A narrative review of literature was conducted to understand the scope of published knowledge about challenges, opportunities, and specific methods to address the factors and gaps related to the review and approval of new drugs, including therapeutic biological products. Relevant peer-reviewed journal articles, conference proceedings, book chapters, official reports from public policy professional centers, and official reports and guidelines from the FDA were reviewed. Results Of the 23 articles identified in this narrative literature review, none modeled the current FDA review and approval process structure to address issues related to the robustness, reliability, and efficiency of its operations from an external point of view. Although several studies summarize the FDA approval process with clarity, in addition to bringing to light the problems and challenges faced by the regulatory agency, only a few attempts have been made to provide solutions for the problems and challenges identified. In addition, although several reform models have been discussed, these models lack the application of scientific methodologies and modeling techniques in understanding FDA as a complex sociotechnical system. Furthermore, tools and methods to assess the efficacy of the models before implementation are largely absent. Conclusions The findings suggest the efficacy of model-based systems engineering approaches for identifying opportunities for significant improvements to the FDA review and approval process. Using this holistic approach will serve several investigative purposes: identify influential sources of variability that cause major delays, including individual, team, and organizational decision making; identify the human-system bottlenecks; identify areas of opportunity for design-driven improvements; study the effect of induced changes in the system; and assess the robustness of the structure of the FDA approval process in terms of enforcement and information symmetry.
Samuel Bonet Olivencia; Farzan Sasangohar. Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review. JMIR Formative Research 2021, 5, e14563 .
AMA StyleSamuel Bonet Olivencia, Farzan Sasangohar. Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review. JMIR Formative Research. 2021; 5 (3):e14563.
Chicago/Turabian StyleSamuel Bonet Olivencia; Farzan Sasangohar. 2021. "Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review." JMIR Formative Research 5, no. 3: e14563.
Background The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. Objective We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. Methods Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository—the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. Results The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. Conclusions A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support.
Farhaan Vahidy; Stephen L Jones; Mauricio E Tano; Juan Carlos Nicolas; Osman A Khan; Jennifer R Meeks; Alan P Pan; Terri Menser; Farzan Sasangohar; George Naufal; Dirk Sostman; Khurram Nasir; Bita A Kash. Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR). JMIR Medical Informatics 2021, 9, e26773 .
AMA StyleFarhaan Vahidy, Stephen L Jones, Mauricio E Tano, Juan Carlos Nicolas, Osman A Khan, Jennifer R Meeks, Alan P Pan, Terri Menser, Farzan Sasangohar, George Naufal, Dirk Sostman, Khurram Nasir, Bita A Kash. Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR). JMIR Medical Informatics. 2021; 9 (2):e26773.
Chicago/Turabian StyleFarhaan Vahidy; Stephen L Jones; Mauricio E Tano; Juan Carlos Nicolas; Osman A Khan; Jennifer R Meeks; Alan P Pan; Terri Menser; Farzan Sasangohar; George Naufal; Dirk Sostman; Khurram Nasir; Bita A Kash. 2021. "Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR)." JMIR Medical Informatics 9, no. 2: e26773.
Background Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. Objective This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). Methods A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. Results Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. Conclusions Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching.
Carl Markert; Farzan Sasangohar; Bobak J Mortazavi; Sherecce Fields. The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review. JMIR Human Factors 2021, 8, e23796 .
AMA StyleCarl Markert, Farzan Sasangohar, Bobak J Mortazavi, Sherecce Fields. The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review. JMIR Human Factors. 2021; 8 (1):e23796.
Chicago/Turabian StyleCarl Markert; Farzan Sasangohar; Bobak J Mortazavi; Sherecce Fields. 2021. "The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review." JMIR Human Factors 8, no. 1: e23796.
BACKGROUND The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. OBJECTIVE We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. METHODS Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository—the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. RESULTS The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. CONCLUSIONS A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support.
Farhaan Vahidy; Stephen L Jones; Mauricio E Tano; Juan Carlos Nicolas; Osman A Khan; Jennifer R Meeks; Alan P Pan; Terri Menser; Farzan Sasangohar; George Naufal; Dirk Sostman; Khurram Nasir; Bita A Kash. Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) (Preprint). 2020, 1 .
AMA StyleFarhaan Vahidy, Stephen L Jones, Mauricio E Tano, Juan Carlos Nicolas, Osman A Khan, Jennifer R Meeks, Alan P Pan, Terri Menser, Farzan Sasangohar, George Naufal, Dirk Sostman, Khurram Nasir, Bita A Kash. Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) (Preprint). . 2020; ():1.
Chicago/Turabian StyleFarhaan Vahidy; Stephen L Jones; Mauricio E Tano; Juan Carlos Nicolas; Osman A Khan; Jennifer R Meeks; Alan P Pan; Terri Menser; Farzan Sasangohar; George Naufal; Dirk Sostman; Khurram Nasir; Bita A Kash. 2020. "Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) (Preprint)." , no. : 1.
Fatigue is defined as “a loss of force-generating capacity” in a muscle that can intensify tremor. Tremor quantification can facilitate early detection of fatigue onset so that preventative or corrective controls can be taken to minimize work-related injuries and improve the performance of tasks that require high-levels of accuracy. We focused on developing a system that recognizes and classifies voluntary effort and detects phases of fatigue. The experiment was designed to extract and evaluate hand-tremor data during the performance of both rest and effort tasks. The data were collected from the wrist and finger of the participant’s dominant hand. To investigate tremor, time, frequency domain features were extracted from the accelerometer signal for segments of 45 and 90 samples/window. Analysis using advanced signal processing and machine-learning techniques such as decision tree, k-nearest neighbor, support vector machine, and ensemble classifiers were applied to discover models to classify rest and effort tasks and the phases of fatigue. Evaluation of the classifier’s performance was assessed based on various metrics using 5-fold cross-validation. The recognition of rest and effort tasks using an ensemble classifier based on the random subspace and window length of 45 samples was deemed to be the most accurate (96.1%). The highest accuracy (~98%) that distinguished between early and late fatigue phases was achieved using the same classifier and window length.
Lilia Aljihmani; Oussama Kerdjidj; Yibo Zhu; Ranjana K. Mehta; Madhav Erraguntla; Farzan Sasangohar; Khalid Qaraqe. Classification of Fatigue Phases in Healthy and Diabetic Adults Using Wearable Sensor. Sensors 2020, 20, 6897 .
AMA StyleLilia Aljihmani, Oussama Kerdjidj, Yibo Zhu, Ranjana K. Mehta, Madhav Erraguntla, Farzan Sasangohar, Khalid Qaraqe. Classification of Fatigue Phases in Healthy and Diabetic Adults Using Wearable Sensor. Sensors. 2020; 20 (23):6897.
Chicago/Turabian StyleLilia Aljihmani; Oussama Kerdjidj; Yibo Zhu; Ranjana K. Mehta; Madhav Erraguntla; Farzan Sasangohar; Khalid Qaraqe. 2020. "Classification of Fatigue Phases in Healthy and Diabetic Adults Using Wearable Sensor." Sensors 20, no. 23: 6897.
Understanding the effects of travel on the health of travelers could have profound effects on the tourism industry and behaviors of tourists. While psychometric analyses have suggested travel has the ability to relieve stress and improve one’s overall well-being, scant research has utilized physiological data to examine the effects of travel on health. The current study, guided by the cognitive activation theory of stress (CATS), compared self-reported diaries and physiological data (using heart rate monitors) to examine the effects cruising has on both perceived and actual stress. Results empirically validate the use of CATS as a theoretical framework for understanding travelers’ perceived and actual stress. Findings also inform specific guidance to both cruise management, on how to engineer cruise experiences based on stress, and individuals, on how to experience positive stress while traveling.
James F. Petrick; Carl Markert; Farzan Sasangohar. Stress for Success: Potential Benefits of Perceived and Actual Stress While Cruising. Journal of Travel Research 2020, 1 .
AMA StyleJames F. Petrick, Carl Markert, Farzan Sasangohar. Stress for Success: Potential Benefits of Perceived and Actual Stress While Cruising. Journal of Travel Research. 2020; ():1.
Chicago/Turabian StyleJames F. Petrick; Carl Markert; Farzan Sasangohar. 2020. "Stress for Success: Potential Benefits of Perceived and Actual Stress While Cruising." Journal of Travel Research , no. : 1.
Samuel Bonet Olivencia; Sudeep Hegde; Farzan Sasangohar. A multi-level stakeholder-centered approach to investigate unnecessary readmissions in emergency departments. IISE Transactions on Healthcare Systems Engineering 2020, 11, 24 -37.
AMA StyleSamuel Bonet Olivencia, Sudeep Hegde, Farzan Sasangohar. A multi-level stakeholder-centered approach to investigate unnecessary readmissions in emergency departments. IISE Transactions on Healthcare Systems Engineering. 2020; 11 (1):24-37.
Chicago/Turabian StyleSamuel Bonet Olivencia; Sudeep Hegde; Farzan Sasangohar. 2020. "A multi-level stakeholder-centered approach to investigate unnecessary readmissions in emergency departments." IISE Transactions on Healthcare Systems Engineering 11, no. 1: 24-37.
Background When the COVID-19 pandemic restricted visitation between intensive care unit patients and their families, the virtual intensive care unit (vICU) in our large tertiary hospital was adapted to facilitate virtual family visitation. The objective of this paper is to document findings from interviews conducted with family members on three categories: (1) feelings experienced during the visit, (2) barriers, challenges or concerns faced using this service, and (3) opportunities for improvements. Methods Family members were interviewed postvisit via phone. For category 1 (feelings), automated analysis in Python using the Valence Aware Dictionary for sentiment Reasoner package produced weighted valence (extent of positive, negative or neutral emotive connotations) of the interviewees’ word choices. Outputs were compared with a manual coder’s valence ratings to assess reliability. Two raters conducted inductive thematic analysis on the notes from these interviews to analyse categories 2 (barriers) and 3 (opportunities). Results Valence-based and manual sentiment analysis of 230 comments received on feelings showed over 86% positive sentiments (88.2% and 86.8%, respectively) with some neutral (7.3% and 6.8%) and negative (4.5% and 6.4%) sentiments. The qualitative analysis of data from 57 participants who commented on barriers showed four primary concerns: inability to communicate due to patient status (44% of respondents); technical difficulties (35%); lack of touch and physical presence (11%); and frequency and clarity of communications with the care team (11%). Suggested improvements from 59 participants included: on demand access (51%); improved communication with the care team (17%); improved scheduling processes (10%); and improved system feedback and technical capabilities (17%). Conclusions Use of vICU for remote family visitations evoked happiness, joy, gratitude and relief and a sense of closure for those who lost loved ones. Identified areas for concern and improvement should be addressed in future implementations of telecritical care for this purpose.
Farzan Sasangohar; Atiya Dhala; Feibi Zheng; Nima Ahmadi; Bita Kash; Faisal Masud. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Quality & Safety 2020, 30, 715 -721.
AMA StyleFarzan Sasangohar, Atiya Dhala, Feibi Zheng, Nima Ahmadi, Bita Kash, Faisal Masud. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Quality & Safety. 2020; 30 (9):715-721.
Chicago/Turabian StyleFarzan Sasangohar; Atiya Dhala; Feibi Zheng; Nima Ahmadi; Bita Kash; Faisal Masud. 2020. "Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis." BMJ Quality & Safety 30, no. 9: 715-721.
As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
Farzan Sasangohar; Major R Bradshaw; Marianne Millen Carlson; James N Flack; James C Fowler; Diana Freeland; John Head; Kate Marder; William Orme; Benjamin Weinstein; Jacob M Kolman; Bita Kash; Alok Madan. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. Journal of Medical Internet Research 2020, 22, e22523 .
AMA StyleFarzan Sasangohar, Major R Bradshaw, Marianne Millen Carlson, James N Flack, James C Fowler, Diana Freeland, John Head, Kate Marder, William Orme, Benjamin Weinstein, Jacob M Kolman, Bita Kash, Alok Madan. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. Journal of Medical Internet Research. 2020; 22 (10):e22523.
Chicago/Turabian StyleFarzan Sasangohar; Major R Bradshaw; Marianne Millen Carlson; James N Flack; James C Fowler; Diana Freeland; John Head; Kate Marder; William Orme; Benjamin Weinstein; Jacob M Kolman; Bita Kash; Alok Madan. 2020. "Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective." Journal of Medical Internet Research 22, no. 10: e22523.
Background Evidence suggests that the COVID-19 pandemic has generally increased levels of stress and depression among the public. However, the impact on college students in the United States has not been well-documented. Objective This paper surveys the mental health status and severity of depression and anxiety of college students in a large university system in the United States during the COVID-19 pandemic. Methods An online survey was conducted among undergraduate and graduate students recruited from Texas A&M University via email. The survey consisted of two standardized scales—the Patient Health Questionnaire-9 and the General Anxiety Disorder-7—for depression and anxiety, and additional multiple-choice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19. Results Among the 2031 participants, 48.14% (n=960) showed a moderate-to-severe level of depression, 38.48% (n=775) showed a moderate-to-severe level of anxiety, and 18.04% (n=366) had suicidal thoughts. A majority of participants (n=1443, 71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (n=882, 43.25%) indicated that they were able to cope adequately with the stress related to the current situation. Conclusions The proportion of respondents showing depression, anxiety, and/or suicidal thoughts is alarming. Respondents reported academic-, health-, and lifestyle-related concerns caused by the pandemic. Given the unexpected length and severity of the outbreak, these concerns need to be further understood and addressed.
Xiaomei Wang; Sudeep Hegde; Changwon Son; Bruce Keller; Alec Smith; Farzan Sasangohar. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. Journal of Medical Internet Research 2020, 22, e22817 .
AMA StyleXiaomei Wang, Sudeep Hegde, Changwon Son, Bruce Keller, Alec Smith, Farzan Sasangohar. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. Journal of Medical Internet Research. 2020; 22 (9):e22817.
Chicago/Turabian StyleXiaomei Wang; Sudeep Hegde; Changwon Son; Bruce Keller; Alec Smith; Farzan Sasangohar. 2020. "Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study." Journal of Medical Internet Research 22, no. 9: e22817.
Background Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. Objective Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students. Methods We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods. Results Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms. Conclusions Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students.
Changwon Son; Sudeep Hegde; Alec Smith; Xiaomei Wang; Farzan Sasangohar. Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. Journal of Medical Internet Research 2020, 22, e21279 .
AMA StyleChangwon Son, Sudeep Hegde, Alec Smith, Xiaomei Wang, Farzan Sasangohar. Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. Journal of Medical Internet Research. 2020; 22 (9):e21279.
Chicago/Turabian StyleChangwon Son; Sudeep Hegde; Alec Smith; Xiaomei Wang; Farzan Sasangohar. 2020. "Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study." Journal of Medical Internet Research 22, no. 9: e21279.
Background The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients.
Atiya Dhala; Farzan Sasangohar; Bita Kash; Nima Ahmadi; Faisal Masud. Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study. Journal of Medical Internet Research 2020, 22, e20143 .
AMA StyleAtiya Dhala, Farzan Sasangohar, Bita Kash, Nima Ahmadi, Faisal Masud. Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study. Journal of Medical Internet Research. 2020; 22 (9):e20143.
Chicago/Turabian StyleAtiya Dhala; Farzan Sasangohar; Bita Kash; Nima Ahmadi; Faisal Masud. 2020. "Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study." Journal of Medical Internet Research 22, no. 9: e20143.
BACKGROUND Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. OBJECTIVE This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). METHODS A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. RESULTS Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. CONCLUSIONS Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching.
Carl Markert; Farzan Sasangohar; Bobak J Mortazavi; Sherecce Fields. The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review (Preprint). 2020, 1 .
AMA StyleCarl Markert, Farzan Sasangohar, Bobak J Mortazavi, Sherecce Fields. The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review (Preprint). . 2020; ():1.
Chicago/Turabian StyleCarl Markert; Farzan Sasangohar; Bobak J Mortazavi; Sherecce Fields. 2020. "The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review (Preprint)." , no. : 1.
Issues related to procedural systems have been found to contribute to incidents in many high-risk industries such as petrochemical, oil and gas, etc. While previous research has focused on understanding issues with procedural systems from the perspective of the workers (who are the end-users of procedures), most of this research suffers from samples that only include companies with programs focused on improving safety by improving procedures. These companies may have inherent differences in their safety practices and thus the experiences of these workers may not completely represent all workers’ experiences in this domain. The purpose of this study is to gain insights into the thoughts and perceptions from a representative and broad sample of workers concerning procedure use and purpose. To improve the generalizability of previous findings, interviews were conducted with workers from a broad range of high-risk process industries to investigate issues related to procedure adherence that may be present in companies not currently implementing. Findings from a qualitative data analysis provide support for the generalizability of issues previously discovered, such as: more experience workers being more likely to deviate; procedure quality being inconsistent; and the procedure revision process being problematic. However additional prominent issues were found as well. Most importantly, this study found that adherence to procedures is often motivated by potential liability issues instead of genuine concerns for safety in organizations and many deviations from procedures were due to pressure from immediate supervisors. These findings suggest a relationship between the effectiveness/quality of procedural systems and the safety climate of the organization or work unit.
S. Camille Peres; Alec Smith; Farzan Sasangohar. Worker-centered investigation of issues with procedural systems: Findings from interviews with a representative sample of workers in high-risk process industries. Journal of Loss Prevention in the Process Industries 2020, 67, 104264 .
AMA StyleS. Camille Peres, Alec Smith, Farzan Sasangohar. Worker-centered investigation of issues with procedural systems: Findings from interviews with a representative sample of workers in high-risk process industries. Journal of Loss Prevention in the Process Industries. 2020; 67 ():104264.
Chicago/Turabian StyleS. Camille Peres; Alec Smith; Farzan Sasangohar. 2020. "Worker-centered investigation of issues with procedural systems: Findings from interviews with a representative sample of workers in high-risk process industries." Journal of Loss Prevention in the Process Industries 67, no. : 104264.
BACKGROUND Evidence suggests that the COVID-19 pandemic has generally increased levels of stress and depression among the public. However, the impact on college students in the United States has not been well-documented. OBJECTIVE This paper surveys the mental health status and severity of depression and anxiety of college students in a large university system in the United States during the COVID-19 pandemic. METHODS An online survey was conducted among undergraduate and graduate students recruited from Texas A&M University via email. The survey consisted of two standardized scales—the Patient Health Questionnaire-9 and the General Anxiety Disorder-7—for depression and anxiety, and additional multiple-choice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19. RESULTS Among the 2031 participants, 48.14% (n=960) showed a moderate-to-severe level of depression, 38.48% (n=775) showed a moderate-to-severe level of anxiety, and 18.04% (n=366) had suicidal thoughts. A majority of participants (n=1443, 71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (n=882, 43.25%) indicated that they were able to cope adequately with the stress related to the current situation. CONCLUSIONS The proportion of respondents showing depression, anxiety, and/or suicidal thoughts is alarming. Respondents reported academic-, health-, and lifestyle-related concerns caused by the pandemic. Given the unexpected length and severity of the outbreak, these concerns need to be further understood and addressed.
Xiaomei Wang; Sudeep Hegde; Changwon Son; Bruce Keller; Alec Smith; Farzan Sasangohar. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study (Preprint). 2020, 1 .
AMA StyleXiaomei Wang, Sudeep Hegde, Changwon Son, Bruce Keller, Alec Smith, Farzan Sasangohar. Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study (Preprint). . 2020; ():1.
Chicago/Turabian StyleXiaomei Wang; Sudeep Hegde; Changwon Son; Bruce Keller; Alec Smith; Farzan Sasangohar. 2020. "Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study (Preprint)." , no. : 1.
Background Posttraumatic stress disorder (PTSD) is a prevalent psychiatric condition that is associated with symptoms such as hyperarousal and overreactions. Treatments for PTSD are limited to medications and in-session therapies. Assessing the way the heart responds to PTSD has shown promise in detecting and understanding the onset of symptoms. Objective This study aimed to extract statistical and mathematical approaches that researchers can use to analyze heart rate (HR) data to understand PTSD. Methods A scoping literature review was conducted to extract HR models. A total of 5 databases including Medical Literature Analysis and Retrieval System Online (Medline) OVID, Medline EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Excerpta Medica Database (Embase) Ovid, and Google Scholar were searched. Non–English language studies, as well as studies that did not analyze human data, were excluded. A total of 54 studies that met the inclusion criteria were included in this review. Results We identified 4 categories of models: descriptive time-independent output, descriptive and time-dependent output, predictive and time-independent output, and predictive and time-dependent output. Descriptive and time-independent output models include analysis of variance and first-order exponential; the descriptive time-dependent output model includes a classical time series analysis and mixed regression. Predictive time-independent output models include machine learning methods and analysis of the HR-based fluctuation-dissipation method. Finally, predictive time-dependent output models include the time-variant method and nonlinear dynamic modeling. Conclusions All of the identified modeling categories have relevance in PTSD, although the modeling selection is dependent on the specific goals of the study. Descriptive models are well-founded for the inference of PTSD. However, there is a need for additional studies in this area that explore a broader set of predictive models and other factors (eg, activity level) that have not been analyzed with descriptive models.
Mahnoosh Sadeghi; Farzan Sasangohar; Anthony D McDonald. Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework. JMIR Mental Health 2020, 7, e16654 .
AMA StyleMahnoosh Sadeghi, Farzan Sasangohar, Anthony D McDonald. Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework. JMIR Mental Health. 2020; 7 (7):e16654.
Chicago/Turabian StyleMahnoosh Sadeghi; Farzan Sasangohar; Anthony D McDonald. 2020. "Toward a Taxonomy for Analyzing the Heart Rate as a Physiological Indicator of Posttraumatic Stress Disorder: Systematic Review and Development of a Framework." JMIR Mental Health 7, no. 7: e16654.
UNSTRUCTURED As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
Farzan Sasangohar; Major R Bradshaw; Marianne Millen Carlson; James N Flack; James C Fowler; Diana Freeland; John Head; Kate Marder; William Orme; Benjamin Weinstein; Jacob M Kolman; Bita Kash; Alok Madan. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective (Preprint). 2020, 1 .
AMA StyleFarzan Sasangohar, Major R Bradshaw, Marianne Millen Carlson, James N Flack, James C Fowler, Diana Freeland, John Head, Kate Marder, William Orme, Benjamin Weinstein, Jacob M Kolman, Bita Kash, Alok Madan. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective (Preprint). . 2020; ():1.
Chicago/Turabian StyleFarzan Sasangohar; Major R Bradshaw; Marianne Millen Carlson; James N Flack; James C Fowler; Diana Freeland; John Head; Kate Marder; William Orme; Benjamin Weinstein; Jacob M Kolman; Bita Kash; Alok Madan. 2020. "Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective (Preprint)." , no. : 1.