Objective Assessment of Checklist Fidelity Using Digital Audio Recording and a Standardized Scoring System Audit.

OBJECTIVES: The use of the World Health Organization Surgical Safety Checklist (SSC) has been reported to significantly reduce operative morbidity and mortality rates. Recent findings have cast doubt on the efficacy of such checklists in improving patient safety. The effectiveness of surgical safety checklists cannot be fully measured or understood without an accurate assessment of implementation fidelity, most effectively through direct observations of the checklist process. Here, we describe the use of a secure audio recording protocol in conjunction with a novel standardized scoring system to assess checklist compliance rates. METHODS: We used a black box digital audio recording protocol to observe the execution of SSCs in real time. A novel checklist scoring system was used to quantify the implementation fidelity of a modified version of the SSC. Physician and staff perception of patient safety was also surveyed before and after implementation. RESULTS: Audio-recorded audits revealed a precisely executed checklist 73.6% of the time compared with a previously reported compliance rate of 97.6%. Implementation fidelity was highest during preanesthesia and preincision checklist sections, whereas postprocedure checklist compliance and fidelity was consistently the lowest. Positive attitudes on patient safety by surgical staff increased by 11% from baseline. CONCLUSIONS: The use of a secure digital audio recording protocol is a simple yet effective tool for observing checklist performance. Moreover, the implementation of a standardized scoring system allows for the objective evaluation of checklist fidelity. Together, they provide a powerful auditing tool for identifying improvement.

Unbalanced lateral mandibular deviation associated with TMJ sound as a sign in TMJ disc dysfunction diagnosis.

The aim was to study the characteristics of lateral mandibular horizontal deviations during opening-closing movements and their association with TMJ sounds of the clicking type. Subjects were 28 healthy volunteers and 38 patients diagnosed with MRI imaging as having TMJ disc dysfunction, 22 with disc displacement without (DD) and 16 as having disc displacement with reduction (DDR). TMJ sounds were recorded with miniature microphones placed in the ear canals, and jaw movements were documented with a kinesiograph. A sign, unbalanced lateral deviation (ubd) was defined as a rapid, short duration, change in jaw movement direction from, and back to, a smooth deviation path in the horizontal plane. The hypotheses were that degrees of maximal deviations, proportions of unbalanced deviation (ubd) and such deviation associated with TMJ sounds (ubdS), differ between healthy subjects and patients with DD or DDR. Comparisons between groups were made using one-way anova and chi-square analysis, as appropriate. No differences were found between groups regarding degree of lateral deviation per se. The proportions of ubd and ubdS were significantly higher in patients with DDR than in healthy subjects and than in patients with DD (P < 0·001), but no such differences were found between healthy subjects and patients with DD. For prediction of DDR, the sensitivity and specificity of the sign ubdS were found to be 68·8% and 89·3%, respectively. For the sign ubd, they were 100·0% and 64·3%. This indicates that the sign ubdS has diagnostic value in screening for DDR.

Malleability and Machines: Glenn Gould and the Technological Self.

The Pianist Glenn Gould has often been portrayed as a musical idealist who embraced mundane recording media as a way of escaping the anxiety of the concert hall. In pursuing his musical ideals, however, Gould obsessed over material objects-the qualities of a chair, the action of piano keys, the placement of splices in magnetic tape. This paper argues that for him, the detailed properties of machines and electronic media were crucial, not just as tools for pursuing disembodied aesthetic aims, but as instruments and material sites for a moral project. Locating Gould's concerns among the techniques and technologies that inspired him, the concert hall he despised, and the jazz and chance music he tolerated, the paper explores how Gould's famed philosophy of technology was rooted in a "technological self" that tied morality and aesthetics, and intimacy and isolation, to concrete ideals for the kinds of people we ought to be.

Calibration of Clinical Audio Recording and Analysis Systems for Sound Intensity Measurement.

PURPOSE: Sound intensity is an important acoustic feature of voice/speech signals. Yet recordings are performed with different microphone, amplifier, and computer configurations, and it is therefore crucial to calibrate sound intensity measures of clinical audio recording and analysis systems on the basis of output of a sound-level meter. This study was designed to evaluate feasibility, validity, and accuracy of calibration methods, including audiometric speech noise signals and human voice signals under typical speech conditions. METHOD: Calibration consisted of 3 comparisons between data from 29 measurement microphone-and-computer systems and data from the sound-level meter: signal-specific comparison with audiometric speech noise at 5 levels, signal-specific comparison with natural voice at 3 levels, and cross-signal comparison with natural voice at 3 levels. Intensity measures from recording systems were then linearly converted into calibrated data on the basis of these comparisons, and validity and accuracy of calibrated sound intensity were investigated. RESULTS: Very strong correlations and quasisimilarity were found between calibrated data and sound-level meter data across calibration methods and recording systems. CONCLUSIONS: Calibration of clinical sound intensity measures according to this method is feasible, valid, accurate, and representative for a heterogeneous set of microphones and data acquisition systems in real-life circumstances with distinct noise contexts.

Evaluation of an interactive multi-media device for delivering information on Le Fort I osteotomy.

This study was carried out on volunteers to evaluate a newly developed interactive software package aimed at informing prospective Le Fort I osteotomy patients regarding the surgical technique and possible complications. The aim of the study was to compare two methods of information delivery; a multi-media tablet device delivering both graphic and verbal information, and an audio device delivering essentially the same information in verbal form only. The null hypothesis was that there would be no difference between the efficiencies of the two methods. The subjects' ability to recall the information delivered by both devices was assessed using a questionnaire. The tablet device participants scored an average of 15.48 points, while the audio device participants scored an average of 268 points. The difference was statistically significant (p < 0.001), suggesting that the multi-media tablet device was more effective method.

Preliminary study for the personal handheld device based snoring detection in ordinary sleep situation.

Snoring is one of the representative phenomena of the sleep disorder and detection of snoring is quite important for improving quality of daily human life. The purpose of this research is to define the noises of the ordinary sleep situation and to find its characteristics as a preliminary research of snoring detection. Differently from previous snoring researches, we use a built-in sound recording system of Smartphone for practical use in ordinary sleep condition, and recording was carried out in a general private bedroom. Especially, we designed the experimental protocol, including the various noises could be frequently occurred during sleep such as cough, music, talking, alarm, door open/close, fan, radio and footstep to make closer to the actual sleep circumstance. The sound data set was recorded during actual sleep from 10 normal subjects. Totally 44 snoring data set and 75-noise dataset is acquired and analyzed.

Wireless behind-the-ear EEG recording device with wireless interface to a mobile device (iPhone/iPod touch).

EEG remains the mainstay test for the diagnosis and treatment of patients with epilepsy. Unfortunately, ambulatory EEG systems are far from ideal for patients that have infrequent seizures. The systems only last up to 3 days and if a seizure is not captured during the recordings, the doctor cannot give a definite diagnosis of the patient's condition. The ambulatory systems also suffers from being too bulky and posing some constraints on the patient, such as not being able to shower during the recordings. This paper presents a novel behind-the-ear EEG recording device that uses an iPhone or iPod Touch to continuously upload the patient's data to a secure server. This device not only gives the doctors access to the EEG data in real time but it can be easily removed and re-applied by the patient at any time, thus reducing the interference with quality of life.

Identification of sleep bruxism with an ambulatory wireless recording system.

PURPOSE: To examine whether an ambulatory bruxism recording system, including a biologic monitor, that measures sleep variables and sympatho-vagal balance can specifically identify sleep bruxism (SB) at home. MATERIALS AND METHODS: Twenty-six volunteers, including 16 SB subjects, were recruited. Each participant recorded his or her electromyogram (EMG), sympatho-vagal balance, and sound level for 3 consecutive nights using an audio-video recorder to identify SB. Data of sleep variables were compared among the 3 experimental nights. The episodes were classified into SB episodes with and without grinding and non-SB episodes. EMG patterns, amplitude, sympatho-vagal balance, and sound level of all episodes were analyzed so as to determine the appropriate thresholds to detect SB episodes and grinding sound. Then, all episodes without video-recording data were classified into SB and non-SB episodes by using the appropriate thresholds, and the sensitivity and specificity to detect SB episodes were calculated. RESULTS: With regard to sleep variables, there were no significant differences except for sleep latency between the first and second nights. The appropriate EMG pattern and thresholds of amplitude, sympatho-vagal balance, and sound level were phasic or mixed EMG pattern, 20% of maximum voluntary contraction, mean + 1 SD, and mean + 2 SDs, respectively. The sensitivity and specificity to detect SB episodes were 88.4% and 74.2%, respectively. CONCLUSION: The results suggest that this system enables the detection of SB episodes at home with considerably high accuracy and little interference with sleep.

An electroacoustic recording device for wireless sensing of neural signals.

Elimination of wires connecting neural recording electrodes to external electronics is highly desired, particularly in survival animal studies, due to neural damage and the device failures caused by these wires. In this study, an electroacoustic device for sensing and wireless transmission of neural signals to an external unit is proposed and results from a prototype are presented. In this method, the neural signals modulate the acoustic pulse amplitudes generated by a small piezoelectric element that is implanted at the recording site. The acoustics waves are detected wirelessly outside the nervous system by another piezoelectric transducer and the neural signals are extracted by amplitude demodulation. To test the prototype, a sinusoidal signal with 100µVpp amplitude was applied in phosphate buffered saline to simulated neural signals and the external transducer was placed 10mm away from the recording element. The results show that a sinusoidal signal of the given amplitude could be wirelessly sensed and reconstructed with a signal-to-noise ratio of 14dB.

Speaking fundamental frequency and phonation time during work and leisure time in vocally healthy preschool teachers measured with a voice accumulator.

OBJECTIVE: More knowledge is needed about preschool teachers' voice use to identify voice behaviours related to work demands that increase the risk for vocal dysfunction. The purpose of this study was to: (1) determine if speaking fundamental frequency (F0) and phonation time differ between work and leisure time and (2) describe variation in F0 and phonation time across the workday in preschool teachers with healthy voices. METHODS: A portable voice accumulator was used to collect data on F0 and phonation time. Twelve vocally healthy female preschool teachers participated in recordings during both work and leisure time for 2 successive days. Their mean age was 35 years (range 21-53 years). RESULTS: Mean F0 was high during the working day (266 Hz) and decreased significantly after work (p < 0.0001). F0 was high also during leisure time (246 Hz) as compared to reference F0 values for Swedish females based on laboratory recordings. Phonation time at work varied widely among the participants, with an average of 12.0%, and decreased significantly to 5.5% during leisure time (p < 0.0001). Most participants had few opportunities for voice rest during work. CONCLUSION: Swedish preschool teachers use high levels of F0 and phonation time during work compared to leisure time indicating high vocal load caused by work. To clarify the role of daily voice use in the causation of vocal dysfunction in this profession, recordings over several days are needed. In addition to F0 and phonation time, recordings of voice sound pressure level and background noise level seem important.

Note-, phrase- and song-specific acoustic variables contributing to the individuality of male duet song in the Bornean southern gibbon (Hylobates albibarbis).

In this study, we examine acoustic individuality in male duet songs of wild, non-habituated Bornean southern gibbons (Hylobates albibarbis) and identify contributing acoustic variables. We recorded 174 male duet songs from nine groups in a rainforest in Central Kalimantan, Indonesia. Each male portion of the duet was analysed for 14 acoustic variables at three levels of variation, including six note-specific variables (start frequency, end frequency, minimum frequency, maximum frequency, average frequency and duration), four phrase-specific variables (minimum frequency, maximum frequency, duration and number of syllables) and four song-specific variables (minimum frequency, maximum frequency, duration and number of syllables). Principal component analysis was performed to summarise each of these sets of variables into a total of six principal components (PCs). Strong acoustic individuality was found in all PCs and at all three levels: note, phrase and song (all p < 0.001). Furthermore, a particularly high magnitude of individuality was found in PC 1 of the song-specific analysis, defined by the acoustic variables of duration and number of syllables. Due to the high levels of individuality, we suggest that these acoustic variables may be used by Bornean southern gibbons for individual discrimination. As well as furthering our biological understanding of male gibbon song with regards to individuality and associated conspecific recognition, these findings also have the potential to help improve population survey methods, such as the acoustic sampling method using listening points, by offering a more accurate method of individual recognition.

Effectiveness and safety of remote monitoring of patients with an implantable loop recorder.

INTRODUCTION AND OBJECTIVES: Implantable loop recorders have proven efficacy in the study of patients with syncope and palpitations. Remote monitoring of patients with pacemakers and implantable cardioverter-defibrillators has been shown to be safe and effective. The purpose of this study was to analyze the safety and effectiveness of remote monitoring in patients with an implantable loop recorder. METHODS: Retrospective observational study in which 109 patients with an implantable loop recorder were analyzed and 2 population groups were compared: 1 receiving conventional follow-up consisting of 3-monthly office visits (41 patients) and 1 with remote monitoring via monthly telephone transmissions and yearly visits (68 patients). The mean follow-up was 64 weeks (range, 0.57-164.57 weeks). The study analyzed diagnosis of a significant event, defined as any event that led to a therapeutic approach and explained the symptoms leading to the implant, as well as the mean time from implant to diagnosis and the specific treatment. RESULTS: A significant event was diagnosed in 82.6% of patients; of these, 54.4% had a normal electrocardiogram; 26.7%, asystole; 15.6%, tachycardia, and 3.3%, bradycardia. The mean time from implant to diagnosis was 260 days (range, 5-947 days) in conventional follow-up, compared with 56 days (range, 0-650 days) in patients with remote monitoring (P<.01), which led to targeted treatment in this group 187 days earlier, on average, with no secondary complications. CONCLUSIONS: Remote monitoring of patients with an implantable loop recorder can significantly shorten the time to diagnosis and targeted treatment, without adversely affecting patient safety.

[Introduction of a simple audio recording system to the operating room--experience at a small local hospital].

We developed a simple audio recording system using a small personal computer and free audio recording software that makes voice recordings for use in emergencies, particularly for emergency caesarean sections. The system makes a continuous audio recording while the patient receives medical treatment. The recording provides an accurate record of the anesthesia used during treatment. This audio recording system is useful as an auxiliary means of record keeping during medical emergencies.

Naturalistic observation of health-relevant social processes: the electronically activated recorder methodology in psychosomatics.

This article introduces a novel observational ambulatory monitoring method called the electronically activated recorder (EAR). The EAR is a digital audio recorder that runs on a handheld computer and periodically and unobtrusively records snippets of ambient sounds from participants' momentary environments. In tracking moment-to-moment ambient sounds, it yields acoustic logs of people's days as they naturally unfold. In sampling only a fraction of the time, it protects participants' privacy and makes large observational studies feasible. As a naturalistic observation method, it provides an observer's account of daily life and is optimized for the objective assessment of audible aspects of social environments, behaviors, and interactions (e.g., habitual preferences for social settings, idiosyncratic interaction styles, subtle emotional expressions). This article discusses the EAR method conceptually and methodologically, reviews prior research with it, and identifies three concrete ways in which it can enrich psychosomatic research. Specifically, it can (a) calibrate psychosocial effects on health against frequencies of real-world behavior; (b) provide ecological observational measures of health-related social processes that are independent of self-report; and (c) help with the assessment of subtle and habitual social behaviors that evade self-report but have important health implications. An important avenue for future research lies in merging traditional self-report-based ambulatory monitoring methods with observational approaches such as the EAR to allow for the simultaneous yet methodologically independent assessment of inner, experiential aspects (e.g., loneliness) and outer, observable aspects (e.g., social isolation) of real-world social processes to reveal their unique effects on health.

New device for collecting intra-oral findings of unknown body.

In dental identification, the collection of intra-oral images is extremely important. We propose the Dental Watch(®) as a new device for collecting intra-oral findings in situations where sufficient jaw-opening or adequate lighting cannot be obtained in such cases of dead bodies within a day after death or burned bodies encountered in mass disaster. This device is an improved home video camera for taking intra-oral images. It is lightweight and cordless, allowing it to be operated with one hand, and an audio function allows comments to be made and recorded on obtaining findings at the same time as images are taken. In addition, this device allows images of the entire oral cavity to be taken comparatively easily, even when only a minimal degree of jaw movement is available. This device is extremely useful in situations where a single dentist inspector must obtain findings and make an accurate and detailed Dental Chart.

Instrumental assessment of velopharyngeal closure for speech.

The presence of a palatal cleft at birth should not prevent good speech production in most children provided they have (1) appropriate surgical intervention to close the palate at or around the child's first birthday, (2) careful monitoring of speech development throughout childhood, (3) speech therapy when needed, and (4) secondary surgical or speech-prosthetic intervention when needed. When managed carefully by an experienced, well-prepared multidisciplinary team that applies the criteria listed above, ~70% of children with nonsyndromic palatal clefts will have no significant difficulties with speech intelligibility or speech quality due to velopharyngeal insufficiency by the time they enter elementary school. Speech assessment is the first step toward comprehensive team management of children with cleft palate. The purpose of this chapter is to describe the use of instrumentation in the evaluation of speech of children with palatal clefts, within the context of a multidisciplinary team. The focus of this article is on instruments that are used to supplement the perceptual assessment to document current speech status and plan management strategies.

Study protocol: addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: a knowledge translation implementation study.

BACKGROUND: The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. METHODS: Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. DISCUSSION: Consultation recording has been used in oncology, family medicine, and other medicine specialties, and despite affirming evidence and probable applications to a large number of diseases and a variety of clinical contexts, clinical adoption of this intervention has been slow. The proposed study findings will advance our conceptual knowledge of the ways to enhance uptake of consultation recordings in oncology.