The relationship between evaluator and test user

In this paper, we present the results of a pilot study in Denmark of cross cultural effects on Think Aloud usability testing. We provide an overview of previous research on cross cultural usability evaluation with a special focus on the relationship between the evaluator and the test user. This relation was studied in an experiment with usability testing of a localized clipart application in which eight participants from Denmark and India formed pairs of evaluator-test user. The test users were asked to think aloud and the evaluators’ role were to facilitate the test users thinking aloud and hereby identify usability problems with the clipart application. Data on the evaluators’ and test users’ behaviour were recorded and analyzed by coding and summarizing statistics on these behavioural events. The results show that Think Aloud Usability Test of a localized application is most effectively performed, in terms of number of think aloud events and number of usability problems found, when both the evaluators and the test users are local. These results are however limited to the Danish context and need to be investigated in other cultural settings

Self administered medical abortion pills: evaluation of the clinical outcome and complications among women presenting with unsupervised pill intake to a tertiary care hospital in Malwa region of Punjab, India

Background: Unsupervised medical abortion pill intake is becoming a public health hazard. Because of its widespread misuse, we planned to undertake this study to evaluate the clinical presentation and outcome of such patients.Methods: Hundred patients meeting inclusion criteria were included. Clinical presentation, treatment given and, outcome and complications were analyzed.Results: Majority (53%) patients were aged between 30-39 years. Seventy-seven percent were gravida three or more. Only 26% had taken the pill within prescribed gestational age limit for MTP (<seven weeks). Mid-trimester pill intake was encountered in 13 % patients. Pill was consumed without any prior medical consultation by 73% patients. Majority (49%) presented with incomplete abortion requiring surgical evacuation. Anaemia was most common associated co-morbidity in 80% patients and 28% required blood transfusions. Twenty-four percent patients presented with life threatening shock. Sepsis was noted in 3% patients. Emergency laprotomy was required in 11% cases. Continuation of pregnancy was reported in 13% patients. Unintended pregnancy and failure of contraception were main reasons cited for abortion by 38% and 26% women. Non-contraceptive users constituted 48% patients . Over the counter easy availability was the main reason for unsupervised pill intake in 58% cases.Conclusions: Unauthorized over the counter pill availability despite legal ban and ignorance of women have led to increased number of unsafe abortions. Strict legislations need to be imposed. Increasing awareness among women regarding complications of unsupervised pill intake and easy availability of safe contraceptive methods can help control this problem

Essential criteria for quality OPD services as perceived by patients in a tertiary care hospital in Faridabad City

Background: In a health care system, patient’s perception about quality is of utmost importance to understand the relationship between quality of care and utilization of health services. It is also treated as an outcome of health care delivery. The current study was planned to improve the quality of services rendered at tertiary care facilities by utilizing the clients’ perception regarding the services.Methods: The present study was a hospital based, cross sectional type of descriptive study. Data collection was done through exit interviews among randomly selected new OPD attendees in a tertiary care hospital using a pre- structured, pretested Performa as the study tool. Likert’s scale was used for assessment of client perception on quality of health services and overall satisfaction. Data was analyzed using SPSS 17.0.Results: Present study was comprised of 402 subjects including 216 males and 184 females. It was observed that 93.9% subjects perceive quality of services as good and 87.8% clients were satisfied with the services rendered at the hospital. Good doctor behavior (51.7%), medicine availability (38.6%) and cleanliness (35.4%) in the hospital were found to be most important reasons behind the satisfaction of the clients as verbally expressed by them. Among dissatisfied (12.2%) study subjects, poor medicine availability (57.1%) and poor investigation facilities were considered (48.9%) as major reasons behind their dissatisfaction.Conclusions: Majority of our patients were satisfied after availing health services at our hospital. We have identified a few deficient areas in terms of service delivery and the same will be bridged as early as possible in order to achieve universal patient satisfaction

Population Study of Ovarian Cancer Risk Prediction for Targeted Screening and Prevention

Unselected population-based personalised ovarian cancer (OC) risk assessment combining genetic/epidemiology/hormonal data has not previously been undertaken. We aimed to perform a feasibility study of OC risk stratification of general population women using a personalised OC risk tool followed by risk management. Volunteers were recruited through London primary care networks. Inclusion criteria: women ≥18 years. Exclusion criteria: prior ovarian/tubal/peritoneal cancer, previous genetic testing for OC genes. Participants accessed an online/web-based decision aid along with optional telephone helpline use. Consenting individuals completed risk assessment and underwent genetic testing (BRCA1/BRCA2/RAD51C/RAD51D/BRIP1, OC susceptibility single-nucleotide polymorphisms). A validated OC risk prediction algorithm provided a personalised OC risk estimate using genetic/lifestyle/hormonal OC risk factors. Population genetic testing (PGT)/OC risk stratification uptake/acceptability, satisfaction, decision aid/telephone helpline use, psychological health and quality of life were assessed using validated/customised questionnaires over six months. Linear-mixed models/contrast tests analysed impact on study outcomes. Main outcomes: feasibility/acceptability, uptake, decision aid/telephone helpline use, satisfaction/regret, and impact on psychological health/quality of life. In total, 123 volunteers (mean age = 48.5 (SD = 15.4) years) used the decision aid, 105 (85%) consented. None fulfilled NHS genetic testing clinical criteria. OC risk stratification revealed 1/103 at ≥10% (high), 0/103 at ≥5%−10% (intermediate), and 100/103 at 5% (low) lifetime OC risk. Decision aid satisfaction was 92.2%. The telephone helpline use rate was 13% and the questionnaire response rate at six months was 75%. Contrast tests indicated that overall depression (p = 0.30), anxiety (p = 0.10), quality-of-life (p = 0.99), and distress (p = 0.25) levels did not jointly change, while OC worry (p = 0.021) and general cancer risk perception (p = 0.015) decreased over six months. In total, 85.5−98.7% were satisfied with their decision. Findings suggest population-based personalised OC risk stratification is feasible and acceptable, has high satisfaction, reduces cancer worry/risk perception, and does not negatively impact psychological health/quality of life

Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study.

BACKGROUND: Acceptance of the role of the fallopian tube in 'ovarian' carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360). METHODS: In-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12. RESULTS: Informational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied. CONCLUSION: Multiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach

In vitro and in vivo delivery of a sustained release nanocarrier-based formulation of an MRTF/SRF inhibitor in conjunctival fibrosis

Abstract Background Sustained drug delivery is a large unmet clinical need in glaucoma. Here, we incorporated a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor, CCG-222740, into slow release large unilamellar vesicles derived from the liposomes DOTMA (1,2-di-O-octadecenyl-3-trimethylammonium propane) and DOPC (1,2-dioleoyl-sn-glycero-3-phosphocholine), and tested their effects in vitro and in vivo. Results The vesicles were spherical particles of around 130 nm and were strongly cationic. A large amount of inhibitor could be incorporated into the vesicles. We showed that the nanocarrier CCG-222740 formulation gradually released the inhibitor over 14 days using high performance liquid chromatography. Nanocarrier CCG-222740 significantly decreased ACTA2 gene expression and was not cytotoxic in human conjunctival fibroblasts. In vivo, nanocarrier CCG-222740 doubled the bleb survival from 11.0 ± 0.6 days to 22.0 ± 1.3 days (p = 0.001), decreased conjunctival scarring and did not have any local or systemic adverse effects in a rabbit model of glaucoma filtration surgery. Conclusions Our study demonstrates proof-of-concept that a nanocarrier-based formulation efficiently achieves a sustained release of a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor and prevents conjunctival fibrosis in an established rabbit model of glaucoma filtration surgery.https://deepblue.lib.umich.edu/bitstream/2027.42/146540/1/12951_2018_Article_425.pd

Cross cultural usability testing

In this paper, we present the results of a pilot study in Denmark of cross cultural effects on Think Aloud usability testing. We provide an overview of previous research on cross cultural usability evaluation with a special focus on the relationship between the evaluator and the test user. This relation was studied in an experiment with usability testing of a localized clipart application in which eight participants from Denmark and India formed pairs of evaluator-test user. The test users were asked to think aloud and the evaluators’ role were to facilitate the test users thinking aloud and hereby identify usability problems with the clipart application. Data on the evaluators’ and test users’ behaviour were recorded and analyzed by coding and summarizing statistics on these behavioural events. The results show that Think Aloud Usability Test of a localized application is most effectively performed, in terms of number of think aloud events and number of usability problems found, when both the evaluators and the test users are local. These results are however limited to the Danish context and need to be investigated in other cultural settings.Cross Cultural Usability Testing; International Usability Testing

The primary psychiatric conditions: Clinical characteristics

Primary psychiatric conditions are those conditions, wherein the cutaneous manifestations are secondary to functional psychopathology in the brain. These comprise of psychiatric disorders with dermatologic manifestations and include conditions such as dermatitis artefacta, delusions of parasitosis, obsessive–compulsive disorders, body-focused repetitive behavior disorders, or somatoform disorders. Herein, we describe the clinical features and diagnostic methods of the individual primary psychiatric conditions, most of which have definitive diagnostic criteria in Diagnostic and Statistical Manual of Mental Disorders, and discuss the differential diagnoses encountered in clinical practice, in brief