Determining the impact of usability issues of primary care physicians by expertise when using an electronic health record

Background: EHRs with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error prone use of EHR in medical practice by new resident physicians. The goal of this study is to identify usability-related and performance-related differences that arise between primary care physicians by expertise when using an EHR. Methods: We compared usability measures after three rounds of usability tests Lab-based usability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed nineteen tasks, based on an artificial but typical patient visit note. We used a mixed methods approach including quantitative performance measures (percent task success, time on task, mouse activities), a survey instrument: system usability scale (SUS), qualitative narrative feedback during the debriefing session, subtask analysis, and debriefing session with physicians. Results: Geometric mean values of percent task success rates, time on task, and mouse activities were compared between the two physician groups across three rounds. Our findings show that there were mixed changes in performance measures and expert physicians were more proficient than novice physicians on some performance measures. Thirty-one common and four unique usability issues were identified between the two physician groups across three rounds. Five themes emerged during analysis: six usability issues were related to inconsistencies, nine issues concerning user interface issues, six issues in relation to structured data issues, seven ambiguous terminology issues, and six issues in regards to workarounds. Discussion and Conclusion: This study found differences in novice and expert physicians' performance, demonstrating that physicians' proficiency did increase with EHR experience. Future directions include identifying usability issues faced by physicians when using the EHR through a more granular task analysis to recognize subtle usability issues that would have otherwise been unnoticed. Also, exploring associations between performance measures and usability issues will also be studied. Training physicians to use the EHR may decrease difficulty of completing tasks in the EHR. Improving physician training may reduce the amount of workarounds created that may lead to workflow problems. These results highlight the areas of difficulty resident physicians with different experience levels are currently facing, which may potentially improve the EHR training program and increase physicians' performance when using an EHR

Role of Social Determinants of Health in building an mHealth application

The pandemic has shown that the health of those with the least resources affects the rest of the population. Social determinants of health effect health disparities leading to greater inequities between those with and those without the resources needed to stay healthy. In order to help people, find resources they need to stay healthy, an mHealth application was created. Data was collected through this mobile application to investigate: what are the social determinants of health resources (SDOH) that are needed to address health inequities? Using this data, an mHealth prototype was developed to help understand whether the application can be useful in addressing the health inequities in a local community. Following a design science approach, the analysis suggests that resources for some social determinants of health are more useful than others. The contribution of this paper is in uncovering the SDOH resources that are needed to address the health inequities

Exploring the Readability of Ingredients Lists of Food Labels with Existing Metrics

Healthy diet and dietary behaviors are key components in prevention of chronic disease and management of chronic illness. Nutritional literacy has been associated with dietary behaviors and consumer choice of healthy foods. Nutritional literacy can be measured, for example, by examining consumer food label use, but current research focuses largely on the Nutrition Facts panel of a food product. Ingredients lists are critical for communicating food composition but are relatively unstudied in existing literature. The goal of this work is to measure the readability of ingredients lists on branded food products in the United States using existing metrics. We examined ingredients lists for all 495,646 products listed in the USDA Food Data Central database using four existing readability measures for text written in natural language. Each of these indices approximates the grade level that would be expected to comprehend a text; comparatively, patient consent forms are considered acceptable at an 8th grade reading level or lower. We report a broad variability for in readability using different metrics: ingredients lists recorded at a 9th grade reading level or higher to comprehend are found at rates of 16.5% (Automated Reading Index) to 74.9% (Gunning-Fog Index). Ingredients lists recorded at a 10th grade reading level or higher to comprehend are found at rates of 84.2% (using FRE Index). These results demonstrate the need to further explore how ingredients lists can be measured for readability, both for the purposes of consumer understanding as well as for supporting future nutrition research involving text mining

Astroculture – Figurations of Cosmology in Media and Arts

Astroculture is a testament to the literary imagination and theoretical innovation of the late Sonja A.J. Neef, who devised the term as an expanding horizon of collaborative research – into the powerful gravitational force exerted on culture by astronomical phenomena and imagery. It is also the name of a conference on the topic inspired by Neef and held at the Center for Advanced Studies Morphomata at the University of Cologne in November, 2011. Indeed, Astroculture is a perfect instance of a morphome, the overall target of the Cologne College’s ongoing symposia: a persistent trope or topos of cultural fascination and transcription appearing across a gamut of civilizations and historical periods. Commentary in this volume ranges from Claudius Ptolemy’s mapping of the universe and the emergence of a pluralistic cosmology in seventeenth-century Europe to the spread of planetariums, the Whole Earth Catalog, and the contemporary artwork of Ingo Günter. With interventions by David Aubin, Lucía Ayala, Monika Bernold, Dietrich Boschung, Bruce Clarke, Gerd Graßhoff, Hans-Christian von Hermann, Martina Leeker, Patricia Pisters, and Henry Sussman

Urban American Indian Community Health Beliefs Associated with Addressing Cancer in the Northern Plains Region

American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha’s urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community’s perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region

European recommendations integrating genetic testing into multidisciplinary management of sudden cardiac death.

Sudden cardiac death (SCD) accounts for 10-20% of total mortality, i.e., one in five individuals will eventually die suddenly. Given the substantial genetic component of SCD in younger cases, postmortem genetic testing may be particularly useful in elucidating etiological factors in the cause of death in this subset. The identification of genes responsible for inherited cardiac diseases have led to the organization of cardiogenetic consultations in many countries worldwide. Expert recommendations are available, emphasizing the importance of genetic testing and appropriate information provision of affected individuals, as well as their relatives. However, the context of postmortem genetic testing raises some particular ethical, legal, and practical (including economic or financial) challenges. The Public and Professional Policy Committee of the European Society of Human Genetics (ESHG), together with international experts, developed recommendations on management of SCD after a workshop sponsored by the Brocher Foundation and ESHG in November 2016. These recommendations have been endorsed by the ESHG Board, the European Council of Legal Medicine, the European Society of Cardiology working group on myocardial and pericardial diseases, the ERN GUARD-HEART, and the Association for European Cardiovascular Pathology. They emphasize the importance of increasing the proportion of both medical and medicolegal autopsies and educating the professionals. Multidisciplinary collaboration is of utmost importance. Public funding should be allocated to reach these goals and allow public health evaluation

Quantifying and addressing the prevalence and bias of study designs in the environmental and social sciences

Building trust in science and evidence-based decision-making depends heavily on the credibility of studies and their findings. Researchers employ many different study designs that vary in their risk of bias to evaluate the true effect of interventions or impacts. Here, we empirically quantify, on a large scale, the prevalence of different study designs and the magnitude of bias in their estimates. Randomised designs and controlled observational designs with pre-intervention sampling were used by just 23% of intervention studies in biodiversity conservation, and 36% of intervention studies in social science. We demonstrate, through pairwise within-study comparisons across 49 environmental datasets, that these types of designs usually give less biased estimates than simpler observational designs. We propose a model-based approach to combine study estimates that may suffer from different levels of study design bias, discuss the implications for evidence synthesis, and how to facilitate the use of more credible study designs.Fil: Christie, Alec P.. University of Cambridge; Reino UnidoFil: Abecasis, David. Universidad de Algarve. Centro de Ciencias del Mar; PortugalFil: Adjeroud, Mehdi. Université de Perpignan; Francia. Institut de Recherche Pour Le Developpement; FranciaFil: Alonso, Juan Carlos. Consejo Superior de Investigaciones Científicas. Museo Nacional de Ciencias Naturales; EspañaFil: Amano, Tatsuya. University of Queensland; AustraliaFil: Anton, Alvaro. Universidad del País Vasco. Facultad de Educación de Bilbao; EspañaFil: Baldigo, Barry P.. United States Geological Survey; Estados UnidosFil: Barrientos, Rafael. Universidad Complutense de Madrid; EspañaFil: Bicknell, Jake E.. University of Kent; Reino UnidoFil: Buhl, Deborah A.. United States Geological Survey; Estados UnidosFil: Cebrian, Just. Mississippi State University; Estados UnidosFil: Ceia, Ricardo S.. Universidad de Coimbra; PortugalFil: Cibils Martina, Luciana. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Ciencias Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; ArgentinaFil: Clarke, Sarah. Marine Institute; IrlandaFil: Claudet, Joachim. Universite de Paris; Francia. Centre National de la Recherche Scientifique; FranciaFil: Craig, Michael D.. University of Western Australia; Australia. Murdoch University; AustraliaFil: Davoult, Dominique. Sorbonne University; FranciaFil: De Backer, Annelies. Flanders Research Institute for Agriculture, Fisheries and Food; BélgicaFil: Donovan, Mary K.. University of California; Estados Unidos. University of Hawaii at Manoa; Estados UnidosFil: Eddy, Tyler D.. University of South Carolina; Estados Unidos. Memorial University of Newfoundland; Canadá. Victoria University of Wellington; Nueva ZelandaFil: França, Filipe M.. Lancaster University; Reino UnidoFil: Gardner, Jonathan P. A.. Victoria University of Wellington; Nueva ZelandaFil: Harris, Bradley P.. Alaska Pacific University; Estados UnidosFil: Huusko, Ari. Natural Resources Institute Finland; FinlandiaFil: Jones, Ian L.. Memorial University of Newfoundland; CanadáFil: Kelaher, Brendan P.. Southern Cross University; AustraliaFil: Kotiaho, Janne S.. Universidad de Jyvaskyla; FinlandiaFil: López Baucells, Adrià. Universidad de Lisboa; Portugal. Smithsonian Tropical Research Institute; Panamá. Universidad Nacional de Colombia. Instituto de Investigaciones Amazonicas; Colombia. Museo de Ciencias Naturales de Granollers; EspañaFil: Major, Heather L.. University of New Brunswick; CanadáFil: Mäki Petäys, Aki. Voimalohi Oy; Finlandia. University of Oulu; Finlandi

Delayed Appearance of High Altitude Retinal Hemorrhages

When closely examined, a very large amount of climbers exhibit retinal hemorrhages during exposure to high altitudes. The incidence of retinal hemorrhages may be greater than previously appreciated as a definite time lag was observed between highest altitude reached and development of retinal bleeding. Retinal hemorrhages should not be considered warning signs of impending severe altitude illness due to their delayed appearance

A 2 × 2 factorial, randomised, open-label trial to determine the clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care over 52 weeks in adults with bronchiectasis:a protocol for the CLEAR clinical trial

Background: Current guidelines for the management of bronchiectasis (BE) highlight the lack of evidence to recommend mucoactive agents, such as hypertonic saline (HTS) and carbocisteine, to aid sputum removal as part of standard care. We hypothesise that mucoactive agents (HTS or carbocisteine, or a combination) are effective in reducing exacerbations over a 52-week period, compared to usual care. Methods: This is a 52-week, 2 × 2 factorial, randomized, open-label trial to determine the clinical effectiveness and cost effectiveness of HTS 6% and carbocisteine for airway clearance versus usual care-the Clinical and cost-effectiveness of hypertonic saline (HTS 6%) and carbocisteine for airway clearance versus usual care (CLEAR) trial. Patients will be randomised to (1) standard care and twice-daily nebulised HTS (6%), (2) standard care and carbocisteine (750 mg three times per day until visit 3, reducing to 750 mg twice per day), (3) standard care and combination of twice-daily nebulised HTS and carbocisteine, or (4) standard care. The primary outcome is the mean number of exacerbations over 52 weeks. Key inclusion criteria are as follows: Adults with a diagnosis of BE on computed tomography, BE as the primary respiratory diagnosis, and two or more pulmonary exacerbations in the last year requiring antibiotics and production of daily sputum. Discussion: This trial's pragmatic research design avoids the significant costs associated with double-blind trials whilst optimising rigour in other areas of trial delivery. The CLEAR trial will provide evidence as to whether HTS, carbocisteine or both are effective and cost effective for patients with BE. Trial registration: EudraCT number: 2017-000664-14 (first entered in the database on 20 October 2017). ISRCTN.com, ISRCTN89040295. Registered on 6 July/2018. Funder: National Institute for Health Research, Health Technology Assessment Programme (15/100/01). Sponsor: Belfast Health and Social Care Trust. Ethics Reference Number: 17/NE/0339. Protocol version: V3.0 Final_14052018

The profile of executive function in OCD hoarders and hoarding disorder

Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5