Supporting public availability and accessibility with Elvin: experiences and reflections.

We provide a retrospective account of how a generic event notification service called Elvin and a suite of simple client applications: CoffeeBiff, Tickertape and Tickerchat, came to be used within our organisation to support awareness and interaction. After overviewing Elvin and its clients, we outline various experiences from data collated across two studies where Elvin and its clients have been used to augment the workaday world to support interaction, to make digital actions visible, to make physical actions available beyond the location of action, and to support content and socially based information filtering. We suggest there are both functional and technical reasons for why Elvin works for enabling awareness and interaction. Functionally, it provides a way to produce, gather and redistribute information from everyday activities (via Elvin) and to give that information a perceptible form (via the various clients) that can be publicly available and accessible as a resource for awareness. The integration of lightweight chat facilities with these information sources enables awareness to easily flow into interaction, starting to re-connect bodies to actions, and starting to approximate the easy flow of interaction that happens when we are co-located. Technically, the conceptual simplicity of the Elvin notification, the wide availability of its APIs, and the generic functionality of its clients, especially Tickertape, have made the use of the service appealing to developers and users for a wide range of uses

Secondary use of data recorded in primary care: insights from human computer interaction field studies

Introduction: Electronic health records from primary care, are now aggregated in a number of large datasets from primary care settings, containing both coded data and free-text. Secondary users can easily undertake analyses using coded data. However although the balance of information between these codes and free text is variable, they rarely use the information contained in doctors’ free-text notes - because of their ‘messy’ nature and the costs of ensuring anonymity. Our epidemiological studies within the Patient Records Enhancement Project has demonstrated that free text contains important information, that is often ignored. Method: Human computer interaction (HCI) studies, using qualitative approaches, can help us understand the reasons for variability in the balance of coded and free text data. We undertook field studies in six GP surgeries which included observations of record use across the surgery, video analysis of real patient consultations and interviews with a range of surgery staff. We also undertook ‘simulated’ consultations, with two medical actors playing the part of the patient, allowing us to standarise the patient across doctors and software systems. Results: Preliminary results suggest several reasons for variation in data recording. Doctors create notes in order to best manage patients with little consideration for use by others, and reported limited awareness of secondary uses of the information. Doctors often record and “read” a picture painted by the overall record of a consultation or record symptoms and signs in free text notes, and choose not to code a definite diagnosis. If coding, they often choose a more general non specific code, even when they have inferred and acted on a clear diagnosis. These approaches reflect processes of progressing from differential to definite diagnosis, and the surgery’s administrative and consultation processes. Conclusion: Our findings may explain apparent delays in diagnosis often observed in epidemiological analyses. The picture portrayed within records may not be at all clear to researchers relying on coded data. Our results have implications for secondary users of data and assessment of data for quality of care. Follow on work might result in typologies of diseases liable to coded data deficits and support software development

Using mobile technology to create flexible learning contexts

This paper discusses the importance of learning context with a particular focus upon the educational application of mobile technologies. We suggest that one way to understand a learning context is to perceive it as a Learner Centric Ecology of Resources. These resources can be deployed variously but with a concern to promote and support different kinds of mediations, including those of the teacher and learner. Our approach is informed by sociocultural theory and is used to construct a framework for the evaluation of learning experiences that encompass various combinations of technologies, people, spaces and knowledge. The usefulness of the framework is tested through two case studies that evaluate a range of learning contexts in which mobile technologies are used to support learning. We identify the benefits and challenges that arise when introducing technology across multiple locations. An analytical technique mapped from the Ecology of Resources framework is presented and used to identify the ways in which different technologies can require learners to adopt particular roles and means of communication. We illustrate how we involve participants in the analysis of their context and highlight the extent to which apparently similar contexts vary in ways that are significant for learners. The use of the Ecology of Resources framework to evaluate a range of learning contexts has demonstrated that technology can be used to provide continuity across locations: the appropriate contextualization of activities across school and home contexts, for example. It has also provided evidence to support the use of technology to identify ways in which resources can be adapted to meet the needs of a learner

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

The Locales Framework: Understanding and Designing for CooperativeWork

The key challenge for the Computer Supported Cooperative Work (CSCW) community is how best to understand work for the purposes of design, and how best to design systems for the purposes of work. The lack of pervasive use of CSCW technologies despite widespread growth of networked computers, and over twelve years of CSCW research, indicates that we are yet to answer the challenge effectively. We suggest that a significant part of what makes building cooperative work support so hard is that CSCW design is a wicked problem, where there are no definitive solutions, and better solutions can only come about through an ongoing dialogue between understanding and designing activities. Thus far, the dialogue has been hampered by an absence of a set of shared abstractions among the stakeholders (designers, sociologists, users, etc.). Traditional computer science backgrounds do not equip designers to deal with the complexity and unpredictability of the social realm. Traditional social science backgrounds do not equip their proponents to translate descriptions of social life to the needs of technological design. This thesis takes up the challenge of continuing the dialogue between understanding and designing by evolving a new abstraction that can facilitate better communication between the two. Against a background of general CSCW experiences with understanding and designing, we report on our first hand experiences of the difficulties in designing and constructing a spatially-based system called wOrlds, and at the same time trying to understand the nature of work for a group of systems engineers for whom the system was to be deployed. This leads us to critique spatial metaphors in general as a basis for design activities and to search for a more appropriate abstraction that can serve both understanding and designing. For this we draw on our own and the general CSCW experiences, and on sociologist Strauss theory of action. The main contribution of this thesis is to present the Locales Framework and its five aspects of locale foundations, civic structures, individual view, interaction trajectory, and mutuality, as a principled approach that allows for construction of shared abstractions among stakeholders. The Locales Framework is based on a metaphor of place, with locale as its primary unit of analysis. Locale can function as a shared abstraction because it is constituted in the relationship between the interactional needs of a social world (group of people with shared purpose) and the sites and means it uses to meet those needs. Hence, locale only makes sense when we understand both the social and the technical. We argue that the Locales Framework can be used in a two phase approach, to understand social worlds and their locales as they exist now, and to design new or enhanced locales to better facilitate social world interactions. We show the use of the framework by applying it to understand the work of a group of distributed researchers, and for requirements analysis and design of a telehealth system connecting three Intensive Care Units. We also discuss a prototype CSCWenvironment called Orbit in which we interpret the implications of the Locales Framework aspects for generic toolkit environments. Finally, we reflect on the usability and usefulness of the framework, and lay out an agenda for future work for its evolution in the ongoing dialogue between understanding the nature of work and designing systems to support that work

Planning human computer interaction field studies in primary care: patient records ergonomics project

Our Wellcome funded, multidisciplinary project involves collaborators from health, epidemiology, statistics, informatics, natural language processing and HCI. Our work centres on issues around the free text held in electronic records, which is less easily used and not easily available to secondary researchers. We will explore the variability of information in records and in particular how much the information held in free text alters estimations of prevalence and incidence of disease. The Interact Lab is interested in the human side of technologies and our previous work has found that health professionals use records in innovative ways in order to support their working practices and to better manage their workload and patient management. Our pilot work has analysed free text in sample records from the GP Research Database and issues about electronic records raised by health record user groups. We are about to embark on a series of field studies and interviews in general practice settings to better understand what information is (or is not) put into the electronic record, what is coded and what is entered as free text, by whom and why. Later in the project we will be investigating visualization of information held in and across health record