Ergonomic automated anesthesia recordkeeper using a mobile touch screen with voice navigtion

Speech recognition for the anaesthesia record during crisis scenarios

INTRODUCTION

This article describes the evaluation of a prototype speech-input interface to an anaesthesia patient record, conducted in a full-scale anaesthesia simulator involving six doctor-nurse anaesthetist teams.

OBJECTIVE

The aims of the experiment were, first, to assess the potential advantages and disadvantages of a vocal interface compared to the traditional touch-screen and keyboard interface to an electronic anaesthesia record during crisis situations; second, to assess the usability in a realistic work environment of some speech input strategies (hands-free vocal interface activated by a keyword; combination of command and free text modes); finally, to quantify some of the gains that could be provided by the speech input modality.

METHODS

Six anaesthesia teams composed of one doctor and one nurse were each confronted with two crisis scenarios in a full-scale anaesthesia simulator. Each team would fill in the anaesthesia record, in one session using only the traditional touch-screen and keyboard interface while in the other session they could also use the speech input interface. Audio-video recordings of the sessions were subsequently analysed and additional subjective data were gathered from a questionnaire. Analysis of data was made by a method inspired by queuing theory in order to compare the delays associated to the two interfaces and to quantify the workload inherent to the memorization of items to be entered into the anaesthesia record.

RESULTS

The experiment showed on the one hand that the traditional touch-screen and keyboard interface imposes a steadily increasing mental workload in terms of items to keep in memory until there is time to update the anaesthesia record, and on the other hand that the speech input interface will allow anaesthetists to enter medications and observations almost simultaneously when they are given or made. The tested speech input strategies were successful, even with the ambient noise. Speaking to the system while working appeared feasible, although improvements in speech recognition rates are needed.

CONCLUSION

A vocal interface leads to shorter time between the events to be registered and the actual registration in the electronic anaesthesia record; therefore, this type of interface would likely lead to greater accuracy of items recorded and a reduction of mental workload associated with memorization of events to be registered, especially during time constrained situations. At the same time, current speech recognition technology and speech interfaces require user training and user dedication if a speech interface is to be used successfully.

Suppression of adiponectin gene expression by histone deacetylase inhibitor valproic acid

Valproic acid (VPA) has been used for the treatment of epilepsy and bipolar disorders for more than 30 yr. Obesity and insulin resistance are common side effects of VPA treatment. Adiponectin is an adipocyte-derived protein that plays an important role in controlling insulin sensitivity and glucose homeostasis. In this report, we examined the effects of VPA on adiponectin gene expression in C57BL/6J mice and in differentiated 3T3-L1 adipocytes. VPA treatment significantly decreased adiponectin protein and mRNA levels in both mice and 3T3-L1 adipocytes. The adipocyte study showed that VPA inhibited adiponectin gene expression in a dose- and time-dependent manner. Repression of adiponectin expression by VPA occurred at the transcription level and correlated with inhibition of histone deacetylase activity. Therapeutic concentrations of VPA increased overall histone acetylation and increased adiponectin promoter-driven luciferase expression in fibroblasts, but decreased adiponectin promoter activity in differentiated 3T3-L1 adipocytes. VPA treatment decreased adipogenic transcription factor CCAAT/enhancer binding protein-alpha (C/EBPalpha) levels and binding of C/EBPalpha to the adiponectin promoter without altering the levels of peroxisome proliferator-activated receptor-gamma and steroid regulatory element binding protein-1. Furthermore, VPA did not suppress adiponectin gene expression in C/EBPalpha gene-deficient adipocytes that stably expressed exogenous peroxisome proliferator-activated receptor-gamma2. Together, these results demonstrate that histone deacetylase inhibitor VPA suppresses adiponectin gene expression in mature adipocytes. The study also provides evidence that diminished C/EBPalpha protein level and decreased binding at the adiponectin promoter mediate the inhibitory effects of VPA on adiponectin gene transcription.

A case study in designing speech interaction with a patient monitor

OBJECTIVE

New developments in speech interaction technology warrant the assumption that some of the interaction problems at anesthesia workplaces can be solved using speech interaction. One application might be the documentation of the anesthetic procedure.

METHOD

To investigate this hypothesis, a speech input system was developed for a commercially available patient monitor (Datex-Ohmeda AS/3 Anesthesia Monitor with Record-Keeper), which in addition to standard functions also facilitates the generation of the anesthesia record. The speech input system was based on the IBM ViaVoice speech recognition technology (version Millennium Pro). The speech input device was preliminarily tested by 5 anesthetists wearing surgical masks under laboratory conditions and through retrospectively documenting 4 to 5 anesthetic procedures (each 12 to 17 documentation entries) in a calm situation. The speech interactive documentation procedure was compared with the conventional keyboard documentation procedure.

RESULTS

The test persons achieved an overall word recognition rate between 72% and 92.4%. Between 76.5% and 97.7% of the single word commands could be completed without any corrections. The same qualifier held for 58.5% to 86.3% of the two- and three-word commands. Despite high speech recognition error rates, almost all documentation entries (236 of 238) could be finished using speech interaction. Comparing both documentation techniques, speech interaction was said to be more intuitive and caused less frustration than the keyboard documentation procedure. However, speech interactive documentation was rated less controllable because of the high speech recognition error rates and bccause the auditive feedback dialogues took too long.

CONCLUSIONS

Modern speech recognition tools are still not advanced enough to facilitate the design of applications with an almost natural speech interface and widespread user acceptance. Nevertheless, many tasks in anesthesia have the necessary characteristics to be optimally supported by speech interaction. In contrast to earlier approaches to speech-interactive anesthesia workplaces, successful application today depends on the question of design rather than solely on that of technology. Many of the constraints and drawbacks of current technology can be overcome through appropriate design measures. The goals must focus first on identifying task areas in intensive care where speech-interaction can yield real benefit in terms of work efficiency, and second on developing and evaluating an ergonomic design of speech interaction. The intended users seem to look forward to the incorporation of speech interaction at the workplace.