Syndromic surveillance of population-level COVID-19 burden with cough monitoring in a hospital emergency waiting room.

Syndromic surveillance is an effective tool for enabling the timely detection of infectious disease outbreaks and facilitating the implementation of effective mitigation strategies by public health authorities. While various information sources are currently utilized to collect syndromic signal data for analysis, the aggregated measurement of cough, an important symptom for many illnesses, is not widely employed as a syndromic signal. With recent advancements in ubiquitous sensing technologies, it becomes feasible to continuously measure population-level cough incidence in a contactless, unobtrusive, and automated manner. In this work, we demonstrate the utility of monitoring aggregated cough count as a syndromic indicator to estimate COVID-19 cases. In our study, we deployed a sensor-based platform (Syndromic Logger) in the emergency room of a large hospital. The platform captured syndromic signals from audio, thermal imaging, and radar, while the ground truth data were collected from the hospital's electronic health record. Our analysis revealed a significant correlation between the aggregated cough count and positive COVID-19 cases in the hospital (Pearson correlation of 0.40, p-value < 0.001). Notably, this correlation was higher than that observed with the number of individuals presenting with fever (ρ = 0.22, p = 0.04), a widely used syndromic signal and screening tool for such diseases. Furthermore, we demonstrate how the data obtained from our Syndromic Logger platform could be leveraged to estimate various COVID-19-related statistics using multiple modeling approaches. Aggregated cough counts and other data, such as people density collected from our platform, can be utilized to predict COVID-19 patient visits related metrics in a hospital waiting room, and SHAP and Gini feature importance-based metrics showed cough count as the important feature for these prediction models. Furthermore, we have shown that predictions based on cough counting outperform models based on fever detection (e.g., temperatures over 39°C), which require more intrusive engagement with the population. Our findings highlight that incorporating cough-counting based signals into syndromic surveillance systems can significantly enhance overall resilience against future public health challenges, such as emerging disease outbreaks or pandemics.

Lifting the curtain on the emergency department crisis: a multi-method reception study of Larry Saves the Canadian Healthcare System.

BACKGROUND: Despite growing evidence of the potential of arts-based modalities to translate knowledge and spark discussion on complex issues, applications to health policy are rare. This study explored the potential of a research-based theatrical video to increase public capacity and motivation to engage with the complex issues that make Emergency Department wait times such an intractable problem. METHODS: Larry Saves the Canadian Healthcare System is a digital musical micro-series developed from extensive research examining system-level causes of Emergency crowding and the ineffectiveness of prevailing approaches. We released individual episodes and a revised full-length version on YouTube, using organic promotion strategies and paid advertising. We used YouTube Analytics to track views, engagement and viewer demographics, and content-analyzed viewer comments. We also conducted five university-based screenings; 92 students completed questionnaires, rating Larry on 16 descriptors using a 7-point Likert scale. RESULTS: From June 2022 through May 2023, Larry garnered over 100,000 views (76,752 of the full-length version, 35,535 of episodes), 1329 likes, 2780 shares, and 139 comments. Views and watch time were higher among women and positively associated with age. Among YouTube comments, the predominating themes were praise for the video and criticism of the healthcare system. Many commenters applauded the show's accuracy, humor, and/or resonance with their experience; several shared healthcare horror stories. Students overwhelmingly agreed with all positive and disagreed with all negative descriptors, and nearly unanimously deemed the video informative, thought-provoking, and entertaining. Most also affirmed that it had increased their knowledge, interest, and confidence to participate in discussions about healthcare issues. Neither gender, primary language, nor employment in healthcare predicted ratings, but graduate students and those 25+ years old evaluated the video most positively. DISCUSSION: These findings highlight the promise of research-informed musical satire to inform and invigorate discourse on an urgent health policy problem. Larry has reached tens of thousands of viewers, garnered excellent feedback, and received high student ratings. Further research should directly assess educational and behavioural outcomes and explore what facilitative strategies could maximize this knowledge translation product's potential to foster informed, impactful policy dialogue.

Maintaining a safe environment in emergency department waiting rooms.

Increasing demand, overcrowding and insufficient resources have led to situations where patient care is delivered in emergency department (ED) waiting rooms. For nurses undertaking triage in the ED waiting room, overcrowding is challenging, particularly in terms of assessing patients in a timely fashion, monitoring patients for clinical deterioration and ordering investigations. Additionally, long waiting times and a lack of information can lead to communication breakdowns with patients and, at times, patient confrontations with ED staff. This article explores the effects of the busy environment in ED waiting rooms on patients and staff such as triage nurses and waiting room nurses.

Designing Worthy Waiting Spaces: A Cross-Cultural Study of Waiting Room Features and Their Impact on Women's Affective States.

OBJECTIVE: This study examines the impact of ambulatory waiting room characteristics on patients' emotional states and investigates whether these states are universally experienced or influenced by social and cultural factors among women aged 18-35 from the three largest demographic groups in the United States: Black, Hispanic/Latina, and White. BACKGROUND: Patients typically spend more time waiting for routine medical appointments than receiving care, and evidence suggests that waiting can reinforces power dynamics that benefit privileged groups, leading to different experiences for minority women seeking preventative care. Still, literature addressing the impact of waiting areas is largely limited to universal measures, and little is known about how different ethnic/race groups respond to waiting spaces. METHODS: This inquiry used a questionnaire assessing 15 waiting room characteristics and testing four variables (furniture arrangement, room-scale, color saturation, and quantity of positive distractions) in a 2 × 3 quasiexperiment using a fractional randomized block design with 24 waiting room images. FINDINGS: Responses from 1,114 participants revealed mutual preferences for sociopetal seating, positive distractions, neutral colors, and welcoming and calming environments. Yet, Black participants indicated significantly greater importance in seeing ethnically/racially similar patients and healthcare providers and strategies that promote transparency, including image-based provider directories and views into the clinic. CONCLUSION: By investigating the impact of the waiting room environment on patient affect and comparing perceptions across three demographic groups of women, this study offers insights into potential strategies for improving access to preventative care services by creating more welcoming ambulatory care waiting environments.

Striving Toward Better Eye Health Beyond Our Waiting Rooms: The LXXX Edward Jackson Memorial Lecture.

PURPOSE: Visual impairment (VI) negatively impacts the quality of lives of individuals and the optimal health of populations, creating both human and financial costs. Yet, VI has not risen to a level that is considered a priority in population health. This analysis assesses the evidence currently available for strengthening the value proposition for eye health, particularly the demographic characteristics and patient-centered outcomes found in clinical research. DESIGN: Retrospective cross-sectional analysis. METHOD: Two searches of the AJO database were performed using relevant key words: Search 1 (S1): NEI-sponsored clinical trials (1970-2023); and Search 2 (S2): Quality of life (2018-2023). The Scopus Cite Score was used as a filter for each search, specifically ≥50 for S1 and ≥20 for S2. RESULTS: Of the initial 466 articles found, 100 met the preestablished criteria. Age, sex, and race/ancestry/ethnicity were reported across glaucoma, retina, uveitis, cornea, and pediatrics subspecialties in 56% ± 9.7% of the articles; 37% ± 9.5% listed either age only or age, sex, or gender. The characterizations varied and subcategories were rarely reported. Only 2% of S1 and 25% of S2 noted patient-centered outcomes. CONCLUSIONS: The characterization of study populations in the ophthalmic literature is limited by underreporting of patient-centered outcomes, useful for reaffirming the value of eye and vision health in population health. This analysis highlights the need for paying greater attention to more specific demographic categories and focusing more on patient-centered outcomes in clinical research.

Percepções de mães de crianças com autismo sobre rede apoiadora e estratégias de cuidado consigo / Perceptions of mothers of children withautism about a support network and self-care strategies

Objetivo: Analisar as percepções das mães de crianças com autismo quanto à rede de apoio existente e as estratégias de cuidado para si que poderiam ser oferecidas pelos serviços terapêuticos em sala de espera. Métodos: Estudo qualitativo, exploratório e descritivo, realizado em outubro de 2021, aprovado pelo comitê de ética, parecer 4.767.339. Empregou-se a entrevista semiestruturada com 29 mães de crianças diagnosticadas com Transtorno do Espectro Autista, através da análise temática de conteúdo. Resultados: Perante a necessidade terapêutica dos filhos, cabe às mães toda a logística de acompanhamento da família, em uma representação patriarcal que ainda não rompeu com o romantismo da maternidade. As mães apontam a necessidade de momentos que pudessem proporcionar a realização de atividade física, alongamento, meditação e de cuidados estéticos, pois devido à sobrecarga a qual são submetidas e à carência da rede de apoio a elas ofertadas, os locais terapêuticos poderiam também vir a ser ambientes de autocuidado. Conclusão: Ressalta-se que os serviços precisam reconhecer as marcas do patriarcalismo e, ao mesmo tempo, ofertar acolhimento, escuta e atendimento a outras necessidades que permeiam a maternagem de uma criança com autismo. Descritores: Saúde da mulher; Mães;Transtorno do Espectro Autista; Autocuidado; Salas de espera

Objective:To analyze the perceptions of mothers of children with autism regarding the existing support network and self-care strategies that might be offered by therapeutic services in waiting rooms.Methods:A qualitative, exploratory and descriptive study carried out in October 2021, duly approved by the ethics committee under opinion No.4,767,339. Semi-structured interviews were conducted with 29 mothers of children diagnosed with Autistic Spectrum Disorder, through thematic content analysis. Results:Given the therapeutic needs of their children, it is up to the mothers to take care of all the monitoring logistics of the family, in a patriarchal representation that has not yet broken away from the romanticism of motherhood. The mothers point out the need for moments that may provide physical activity, stretching, meditation and aestheticcare since, due to the overload to which they are subjected and the absence of support network offered to them, therapeutic places might also come to be self-care environments. Conclusion:It is emphasized that the services need to recognize the distinctive signs of patriarchy and, at the same time, offer welcoming, listening and assistance to other needs that permeate the aspects of being the mother of a child with autism.Descriptors:Women's health; Mothers; Autism Spectrum Disorder; Self-care; Waitingrooms.

The Nurse in the Waiting Room: In Grief and Abandoned.

Finding no guidance or support at a vulnerable moment.

Do health service waiting areas contribute to the health literacy of consumers? A scoping review.

Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.

Health service waiting areas are commonly used to provide health resources (such as health information, resources and supports) for consumers. Health resources which are appropriate and accessible for consumers can improve health literacy by increasing health knowledge, supporting good decision-making or changing behaviours which may result in better health. Although it is common to offer health resources in health service waiting areas, the evidence supporting this practice is unclear. This scoping review of the literature focussed on the use of health service waiting areas as a place to contribute to the health literacy of adult consumers attending outpatient or primary care health appointments. A total of 116 unique articles were included which addressed this issue. Majority of articles were set in primary and community care waiting areas (49%). A range of health topics and resource types were available but these were not always used by consumers. Overall, interventions in waiting areas targeting health literacy-related outcomes resulted in positive outcomes, although the benefit declined after 3­6 months. Research on using waiting areas for health-literacy purposes is increasing worldwide. Future research is needed to identify how to optimize the effectiveness of interventions in waiting areas to benefit consumers.

O processo ensino-aprendizagem na construção e aplicação de ação educativa em sala de espera: relato de experiência / El proceso de enseñanza-aprendizaje en la construcción y aplicación de la acción educativa en la sala de espera: informe de experiencia / The teaching-learning process in the construction and application of educational action in the waiting room: experience report

Objetivo: Relatar o processo de ensino aprendizagem na construção e aplicação de ações educativas na sala de espera de uma unidade básica de saúde. Método: Relato de experiência executado pelo método Blended Learning, com abordagem pelo construtivismo e analisada por meio da Teoria da Atividade. Foi executada entre julho e setembro de 2021 pela Universidade Federal do Pará. Participaram discentes do terceiro semestre de graduação em enfermagem, docente e discente de pós-graduação de Enfermagem. Resultados: Apresenta-se estruturado em 3 etapas: Revisão da Literatura, Desenvolvimento e construção das tecnologias educacionais e Aplicação no serviço de saúde. Identificou-se como potenciais estratégias as atividades em grupo, com metodologias ativas, lúdicas, mediadas por interações e para reconstrução do conhecimento. O planejamento seguiu os fatores-chave: conteúdo, processo e forma. Considerações Finais: A experiência apontou que ações em sala de espera podem ser mediadas por metodologias ativas a partir de interações tecnológicas e dos pontos-chave do ensino-aprendizagem.

Objective: To report the teaching-learning process in the construction and application of educational action in the waiting room of abasic health unit. Method: Experience report performed by the Blended Learning method, with approach by constructivism and analyzed through activity theory. It was executed between July and September 2021 by the Federal University of Pará. Participants were students of the third semester, professor and graduate student of Nursing. Results: It is structured in 3 Phases: Literature Review, Development and construction of educational technologies and Application in the health service. Group activities were identified as potential strategies, with active methodologies, playful, mediated by interactions and for knowledge reconstruction. Planning followed the key factors: content, process and form. Final Considerations: The experience pointed out that actions in the waiting room can be mediated by active methodologies based on technological interactions and the key points of teaching-learning.

Objetivo: Relatar el proceso de enseñanza-aprendizaje en la construcción y aplicación de la acción educativa en la sala de espera de una unidad básica de salud. Método: Informe de experiencia realizado por el método Blended Learning, con enfoque por constructivismo y analizado a través de la teoría de la actividad. Fue ejecutado entre julio y septiembre de 2021 por la Universidad Federal de Pará. Participaron estudiantes del tercer semestre, profesor y estudiante graduado de Enfermería. Resultados: Se estructura en 3 Fases: Revisión de la Literatura, Desarrollo y construcción de tecnologías educativas y Aplicación en el servicio de salud. Las actividades grupales fueron identificadas como estrategias potenciales, con metodologías activas, lúdicas, mediadas por interacciones y para la reconstrucción del conocimiento. La planificación siguió los factores clave: contenido, proceso y forma. Consideraciones finales: La experiencia señaló que las acciones en la sala de espera pueden ser mediadas por metodologías activas basadas en interacciones tecnológicas y los puntos clave de enseñanza-aprendizaje.

Assessing Spatial User Experience for Design Guidelines: A Comparative Study of Outpatient Waiting Rooms With Conventional Versus Modern Features.

OBJECTIVES: Identify waiting room design features that are most appreciated by outpatients and their companions in conventional and modern waiting rooms. Evaluate if end users evaluate the environment differently from experts and in what aspects. Provide evidence-based design guidelines that orient designers and healthcare managers. BACKGROUND: Built environments are relevant in patients' evaluation of overall healthcare service. For outpatients, waiting frequently consumes the largest amount of time; thus, waiting room interior design has great potential to enhance their experience. METHODS: This study compares perceptions of two types of waiting rooms-conventional and modern-based on the spatial user experience (SUE) model. In the first stage of the study, we compared user evaluations of conventional waiting rooms (n = 137) and modern waiting rooms (n = 426) with respect to the eight SUE model dimensions using multigroup structural equation modeling. In the second stage, an expert ergonomist and two professional interior designers assessed both types of waiting rooms. RESULTS: Results showed that modern waiting rooms were perceived to be significantly better in all SUE dimensions. We also found experts' evaluations were overall consistent with users' perceptions. Discrepancies were only found in temperature perception, signage evaluation, and spatial appreciation. CONCLUSIONS: Participants valued modern style waiting room features such as good quality signage, use of armchairs and sofas, a controlled environment, and decoration. We suggest involving end users in the design process to respond to their needs and promote a positive experience. Finally, we provide easy-to-adopt design guidelines to improve patients' waiting room experience.

Optimizing Outpatient Oral Contrast Use in Abdominal CT-A Radiology Pandemic Response Initiative to Reduce Patient Time in the Waiting Room and Reduce Costs, While Improving Patient Experience.

Purpose: The aim was to reduce outpatient wait time and improve patient experience by optimising oral contrast use. Methods: Our multidisciplinary stakeholder collaboration implemented two simultaneous interventions: (1) Creation of 'oral contrast policy', limiting recommended indications. (2) Creation of a new shorter oral contrast regime (30 vs 60 min). We conducted a retrospective service evaluation of oral contrast use in outpatient (OP) abdominal CT at baseline and post-intervention. Patient wait times were measured and per-patient cost-savings were reported. An image quality review was performed by 2 blinded abdominal radiologists. Patient experience was evaluated with a standard voluntary survey. Statistical analysis was performed comparing baseline and evaluation outcomes using Chi-square or Fisher Exact test for categorical variables and Student's t-test or ANOVA for continuous data. Results: Over 1-month periods, OP CT scans were assessed in baseline (pre-pandemic) n = 575, baseline (pandemic) n = 495 and post-intervention n = 545 groups. Oral contrast use reduced from 420/575, 73.0% at baseline to 178/545, 32.7% post intervention. The turn-around time reduced by 15.8 minutes per patient from 70.3 to 54.5 minutes, P < .001 (Interventions 1 and 2). The diagnostic quality did not differ between the oral contrast regimes (Intervention 2, P = 1.0, P = .08). No repeat CTs were needed due to lack of oral contrast (Intervention 1) or poor opacification (Intervention 2). There was oral contrast cost reductions of 69.1-78.4% (P < .001). Patients reported their overall experience was improved post-intervention (Interventions 1 and 2). Conclusions: Optimising the CT oral contrast service through judicious use and a shorter regime, reduced patient wait times, improved patient experience and preserved diagnostic quality.

Does Perceived Control Matter in the Outpatient Waiting Room?

OBJECTIVE: The study examined perceived control in the context of the outpatient waiting room to further understand the extent to which patients want to exercise control in that environment. Background: In Ulrich's theory of supportive design, research shows more evidence for positive distraction and social support than for perceived control; its role in outpatient settings has not been examined. METHOD: This between-subjects experimental design, in which participants read a written scenario varying the number of patients waiting (1 or 5) and the control available (no information provided, personal controls, and room controls), examined the effect of those variables on stress, satisfaction with the environment, extent of perceived control, and participants' schema of who should control the environment of the waiting room. RESULTS: Having individual controls available in the waiting room favorably impacted the perception of the environment but did not significantly impact stress. The data show that people likely have a schema of appropriate behavior in a doctor's waiting room, which does not encourage manipulation of environmental elements. CONCLUSIONS: In the doctor's office waiting room, having individual controls, such as on-off knobs on table lamps next to each chair, can improve evaluation of the environment and increase people's perception of control.

Primary Care Patients' and Staff's Perceptions of Self-Rooming as Alternative to Waiting Rooms.

PURPOSE: Most patients are escorted to exam rooms (escorted rooming) although patients directing themselves to their exam room (self-rooming) saves patient and staff time while increasing patient satisfaction. This study assesses patient and staff perceptions after pragmatic implementation of self-rooming. METHODS: In October-December 2020, we surveyed patients and staff in 25 primary care clinics after our institution expanded self-rooming from 4 specially built clinics during the COVID-19 pandemic. Semi-structured surveys asked about rooming process used, rooming process preferred, and perceptions of self-rooming compared with escorted rooming. RESULTS: Most patients (n = 1,561) preferred self-rooming (86%), especially among patients aged <65 years and in family medicine clinics. Few patients felt less welcomed (10.6%), less cared about (6.8%), more isolated (15.6%), more lost/confused (7.6%), or more frustrated (3.2%) with self-rooming compared with escorted rooming. Early-adopter clinics that implemented self-rooming ≤2016 had even lower rates of patients feeling more isolated, lost/confused, or frustrated with self-rooming compared with escorted rooming.Over one-half of staff (n = 241; 180 clinical, 61 nonclinical) preferred self-rooming (59%) and thought most patients liked self-rooming (65.8%), especially among clinical staff and in early adopter clinics (≤2016). Few staff reported worse waiting times for patients (12.4%), medical assistants (MAs) (15.9%), and clinicians (16.4%) or worse crowding in waiting areas (1.7%) and hallways (10.1%). Unlike patient-reported confusion (7.6%), most staff thought self-rooming led to more patient confusion (63.8%), except in early-adopter clinics (44.4%). CONCLUSIONS: Self-rooming is a patient-centered innovation that is also acceptable to staff. We demonstrated that pragmatic implementation is feasible across primary care without expensive technology or specially designed buildings.

Mixed method evaluation of a clinic waiting room-based health education program in the Dominican Republic.

Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room-based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees' change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room-based education talks improve knowledge and provide suggestions for similar interventions.

Tele-Untethered: Telemedicine Without Waiting Rooms.

BACKGROUND AND OBJECTIVES: Telemedicine bridges the gap between care needs and provider availability. The value of telemedicine can be eclipsed by long wait times, especially if patients are stuck in virtual waiting rooms. UCSD Tele-Untethered allows patients to join visits without waiting in virtual waiting rooms. Tele-Untethered uses a text-to-video link to improve clinic flow, decrease virtual waiting room reliance, improve throughput, and potentially improve satisfaction. METHODS: This institutional review board (IRB)-approved quality improvement pilot (IRB #210364QI) included patients seen in a single vascular neurology clinic, within the pilot period, if they had a smartphone/cell phone, and agreed to participate in a flexible approach to telehealth visits. Standard work was disseminated (patient instructions, scripting, and workflows). Patients provided a cell phone number to receive a text link when the provider was ready to see them. Metrics included demographics, volumes, visit rates, percentage seen early/late, time savings, and satisfaction surveys. RESULTS: Over 2.5 months, 22 patients were scheduled. Of those arriving, 76% were "Tele-Untethered" and 24% were "Standard Telemedicine." Text-for-video link was used for 94% of Tele-Untethered. Fifty-five percent were seen early. There was a 55-minute-per-session time savings. CONCLUSION: This UCSD Tele-Untethered pilot benefitted patients by allowing scheduling flexibility while not being tied to a "virtual waiting room." It benefited providers as it allowed them to see patients in order/not tied to exact times, improved throughput, and saved time. Even modest time savings for busy providers, coupled with Lean workflows, can provide critical value. High Tele-Untethered uptake and use of verbal check-in highlight that patients expect flexibility and ease of use. As our initial UCSD Tele-Untethered successes included patient flexibility and time savings for patients and providers, it can serve as a model as enterprises strive for optimal care and improved satisfaction. Expansion to other clinic settings is underway with a mantra of "UCSD Tele-Untethered: Your provider can see you now."

Engagement and fidelity of a cardiovascular disease prevention-focused digital health intervention in cardiology outpatient waiting rooms: a mixed-methods study.

INTRODUCTION: We delivered a video-based, cardiovascular disease prevention focused intervention in cardiology waiting rooms that increased motivation to improve cardiovascular risk behaviours and satisfaction with clinic services. To better understand the potential generalisability and scalability of such waiting room interventions, this study evaluated the fidelity of intervention delivery and barriers and enablers to implementation. METHODS: Mixed-methods process evaluation conducted among intervention participants in a randomised clinical trial. Data sources included (1) Participant screening logs, (2) Intervention delivery platform data and (3) Semi structured interviews performed with participants. Qualitative data were described using inductive thematic analysis. RESULTS: The tablet-based intervention was delivered to 220 patients (112 (50.9%) male, mean age 54.2 (SD 15.4) years). Of 765 videos opened, 636 (83.1%) were watched to completion. Most videos opened were rated (738/765, 96.5%) and video ratings were predominantly positive (661/738, (89.6%) satisfied or highly satisfied). Younger and more educated participants were more likely to rate videos highly (relative risk (RR) 1.73 (95% CI 1.28 to 2.32) and RR 1.26 (95% CI 1.07 to 1.49)) but less likely to watch videos to completion (younger: RR 0.27 (95% CI 0.17 to 0.43), more educated: RR 0.90 (95% CI 0.85 to 0.96)). Of 39 invited, 21 (53.8%) participated in semistructured interviews. Thematic analysis of responses suggested reported behaviour change post intervention may be due to increased awareness of cardiovascular risk, reduced anxiety and intrinsic motivation from delivery within a cardiology waiting room. Lack of reinforcement and limited personalisation were barriers. CONCLUSION: The current analysis demonstrates that engagement with a digitally delivered clinic waiting room educational intervention was high, providing explanation for its efficacy in improving motivation to change cardiovascular risk behaviours. The high fidelity of delivery demonstrates potential for scaling of such interventions across waiting rooms. Recall bias and low response rate may bias self-reported engagement measures. TRIAL REGISTRATION NUMBER: ANZCTR12618001725257.

Impact of the presence of a humanoid robot in the anesthesia visit waiting room on patient's satisfaction: the PEPPER before-after study.

BACKGROUND: The quality of information during a medical visit, such as a preoperative anesthesia visit, impacts patient's satisfaction. New digital supports, including humanoid robots, have been recently proposed to provide medical information to patients. We aimed to assess whether the presence of a PEPPER humanoid robot, programmed to deliver information about anesthesia and surgery and placed in the waiting room for a preoperative anesthesia visit, can improve patient overall satisfaction. METHODS: We conducted a prospective, observational, before-after study. French-speaking adult patient global satisfaction (rated from 0 to 10) was measured after a scheduled preoperative anesthesia visit (for orthopedic, abdominal, urologic surgeries or for endoscopy), by direct interview with a research person, before modification of usual practices (information leaflets and brochure were given to the patients prior to the visit), and after the implementation in the waiting room of a PEPPER humanoid robot programmed to deliver information about anesthesia and surgery through short videos, designed by a group of healthcare workers and patients. RESULTS: Two hundred ninety-six patients (237 [80%] ASA I-II) were included, 179 before and 117 after periods. Patient global satisfaction was not different (8.9±1.6 vs. 9.0±1.4/10, for before and after periods, P=0.53). However, the satisfaction on the information about risks was significantly improved in the after period (8.5±2.3 vs. 9.1±1.4/10, P=0.017). CONCLUSIONS: The presence of a humanoid PEPPER robot in the waiting room did not improve patient's global satisfaction about anesthesia visit.

Música como promotora da saúde na sala de espera de cirurgia: percepções de acompanhantes / Music as a health promoter in the surgery waiting room: companions' perceptions / La música como promotora de salud en la sala de espera de cirugía: percepciones de los acompañantes

Objetivo: compreender as percepções dos acompanhantes que aguardam notícias de seus entes queridos que estão em cirurgia, sobre a utilização da música como estratégia para promover saúde no hospital. Método: estudo descritivo, exploratório, qualitativo, fundamentado nos pressupostos teóricos da Promoção da Saúde, com a participação de 15 acompanhantes que aguardavam notícias de seus entes queridos em uma sala de espera no ambiente hospital. Realizaram-se entrevistas semiestruturadas e os dados foram organizados e analisados conforme análise de conteúdo. Resultados: os participantes destacaram algumas possibilidades para promover saúde na sala de espera de cirurgia do hospital, como a música, a qual proporciona distração da realidade preocupante, felicidade, vida, alegria, esperança, sensações boas, ânimo e tranquilidade. Considerações finais: a música destaca-se como tecnologia para promover saúde, despertando sentimentos positivos durante as intervenções musicais no hospital. Portanto, faz-se necessário ampliar a discussão e utilização da música como estratégia para promover saúde no âmbito hospitalar

Objective: to understand the perceptions of companions awaiting news from their loved ones who are undergoing surgery, about the use of music as a strategy to promote health in the hospital. Method: a descriptive, exploratory, qualitative study, based on the theoretical assumptions of Health Promotion, with the participation of 15 companions who were waiting for news from their loved ones in a waiting room in the hospital environment. Semi-structured interviews were carried out and the data were organized and analyzed according to content analysis. Results: the participants highlighted some possibilities to promote health in the hospital surgery waiting room, such as music, which provides distraction from the worrying reality, happiness, life, joy, hope, good feelings, cheer and tranquility. Final considerations: music stands out as a technology to promote health, arousing positive feelings during musical interventions in the hospital. Therefore, it is necessary to expand the discussion and use of music as a strategy to promote health in the hospital environment

Objetivo: comprender las percepciones de acompañantes en espera de noticias de sus seres queridos que están siendo operados, sobre el uso de la música como estrategia de promoción de la salud en el hospital. Método: estudio descriptivo, exploratorio, cualitativo, basado en los presupuestos teóricos de la Promoción de la Salud, con la participación de 15 acompañantes que esperaban noticias de sus seres queridos en una sala de espera del ambiente hospitalario. Se realizaron entrevistas semiestructuradas y los datos fueron organizados y analizados según el análisis de contenido. Resultados: los participantes destacaron algunas posibilidades para promover la salud en la sala de espera de cirugía hospitalaria, como la música, que proporciona distracción de la realidad preocupante, alegría, vida, alegría, esperanza, buenos sentimientos, alegría y tranquilidad. Consideraciones finales: la música se destaca como tecnología para promover la salud, despertando sentimientos positivos durante las intervenciones musicales en el hospital. Por lo tanto, es necesario ampliar la discusión y el uso de la música como estrategia de promoción de la salud en el ámbito hospitalario