Interpreting Laboratory Results with Complementary Health Information: A Human Factors Perspective.

The desire to access personal and high-quality health information electronically is increasing, not only in Canada, but globally. With the advent of the COVID - 19 pandemic the desire and demand for telemedicine and timely access to personal health data such as online laboratory (lab) results has increased substantially. This study examines citizens' perspectives of being provided with high-quality information about a specific lab test (i.e., potassium) in the same display as a trend graph. Therefore, the objective of this study is to test how participants managed this additional information about the context of the test, understood, and applied it. The researchers analyzed the responses of semi-structured interviews with Canadian participants (N=24) using conventional content analysis. This paper examined four themes related to providing complementary information concurrently with lab results in the same display: 1) Benefits of Collocated Information, 2) Information Overload, 3) Misinterpretation, 4) Confusion. This study provided examples of some of the difficulties that the participants faced accessing their lab values online, while navigating and discerning complimentary high-quality health information available in their patient portal.

Tabular, Annotated, Visual, or Trends + Contextual Information? Preferences for Online Laboratory Results Displays.

People are increasingly offered access to their personal health information (e.g., laboratory results, clinical notes, diagnostic imaging results). However, this information is the same as that used by health care providers with clinical expertise and training in medical terminology, which citizens typically do not have. In this study, we examined participants (N = 24) preferences for four different types of displays for online laboratory (lab) results: Tabular, Annotated, Visual, and Trends + Contextual Information. The Friedman test of difference comparing participants' ratings of the four displays was significant, χ2(3)=10.8, P=.013, and the Wilcoxon signed rank pairwise comparison tests revealed that participants rated the visual lab results display significantly more favourably than the traditional display (Z=-2.746, P=.006). These findings indicate that many people prefer lab results displayed using more visual cues and some perceived this format as easier to understand than the other display formats. Given the importance of people accessing, understanding, and using their own health information, it is crucial for displays and systems to provide a better user experience. Displaying data (e.g., lab results) visually is one possible way to improve interpretability of personal health information provided to the public.

Crown-of-thorns starfish spines secrete defence proteins.

Background: The crown-of-thorns starfish (COTS; Acanthaster species) is a slow-moving corallivore protected by an extensive array of long, sharp toxic spines. Envenomation can result in nausea, numbness, vomiting, joint aches and sometimes paralysis. Small molecule saponins and the plancitoxin proteins have been implicated in COTS toxicity. Methods: Brine shrimp lethality assays were used to confirm the secretion of spine toxin biomolecules. Histological analysis, followed by spine-derived proteomics helped to explain the source and identity of proteins, while quantitative RNA-sequencing and phylogeny confirmed target gene expression and relative conservation, respectively. Results: We demonstrate the lethality of COTS spine secreted biomolecules on brine shrimp, including significant toxicity using aboral spine semi-purifications of >10 kDa (p > 0.05, 9.82 µg/ml), supporting the presence of secreted proteins as toxins. Ultrastructure observations of the COTS aboral spine showed the presence of pores that could facilitate the distribution of secreted proteins. Subsequent purification and mass spectrometry analysis of spine-derived proteins identified numerous secretory proteins, including plancitoxins, as well as those with relatively high gene expression in spines, including phospholipase A2, protease inhibitor 16-like protein, ependymin-related proteins and those uncharacterized. Some secretory proteins (e.g., vitellogenin and deleted in malignant brain tumor protein 1) were not highly expressed in spine tissue, yet the spine may serve as a storage or release site. This study contributes to our understanding of the COTS through functional, ultrastructural and proteomic analysis of aboral spines.

Consumers' Needs for Laboratory Results Portals: Questionnaire Study.

BACKGROUND: Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment. OBJECTIVE: We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety. METHODS: A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed. RESULTS: Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention. CONCLUSIONS: There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety.

Contextualizing Online Laboratory (lab) Results and Mapping the Patient Journey.

The 21st century has brought forth unprecedented technological advances, such as the advent of portable digital devices [1]. This trend has also permeated the health care sector, with the introduction of digital health services, like providing citizens with access to their online laboratory (lab) results. This qualitative study will illustrate the patient journey, namely participant 16 (P16), to address the research question: what phases does a person go through when accessing their lab results online? The findings revealed that lab results were accessed from two types of devices a tablet (e.g., portable computer) when at home and a mobile phone when away from home. We also found that interpretation of results can be a challenge and it was unclear if P16 was able to understand her lab results. To illustrate the complexity of interpreting and accessing online lab results, the authors created a Customer Journey Map to contextualize the experiences of P16. The journey map depicts a combination of factors such as: eHealth literacy, limited access to providers, difficulty interpreting lab test results. Additionally, recommendations for online lab portal functionality enhancements were discovered through the mapping exercise. This study demonstrated that along with providing citizens with access to digital health technologies and services, considerations to eHealth literacy, the digital divide and health equity are paramount. As evidenced by the visualization, journey maps hold promise to serve as efficient tools to build empathy and identify the unique needs and perspectives of citizens.

Hidden in Plain Sight: Overlooked Results and Other Errors in Evaluating Online Laboratory Results.

People are increasingly accessing their own laboratory (lab) results online. However, Canadians may be expected to use different systems to access their results, depending upon where they are tested (e.g., community lab vs. hospital), and these results may be displayed differently. This study examined the extent to which participants without medical expertise (N = 25) made errors identifying lab results (i.e., missing or mis-identifying abnormal results) in a mock report. Six participants overlooked each of the flagged values, 20 participants missed an abnormal result that was not flagged, and 2 participants mis-identified a normal value as out of range. We describe potential causes of these errors and the implications for the design of consumer-facing lab results.

Why Do People Use Online Lab Results and What Do They Look For: A Qualitative Study.

Laboratory (lab) test results are increasingly available online for patient review. However, there is a dearth of research with respect to users' information needs, goals, and information processing strategies. In this exploratory qualitative study, we interviewed a sample of (N = 25) online lab results users to understand their objectives and search targets. We transcribed their responses and used affinity diagramming to identify themes in their responses. Our analysis identified six reasons why people look at their online lab results (i.e., health status, reassurance, health education, speed, self-management, and patient safety) and two themes about what people look for (i.e., abnormal and normal values, trends). Knowing what drives users and what information they are looking for can inform the design of online lab reporting, improve usefulness, and better satisfy user needs.

A User Experience and eHealth Literacy Inspection of a Lab Test Interpretation Mobile App for Citizens.

People are increasingly able to access their laboratory (lab) results using patient-facing portals. However, lab reports for citizens are often identical to those for clinicians; without specialized training they can be near impossible to interpret. In this study, we inspected a mobile health application (app) that converts traditional lab results into a citizen-centred format. We used the Health Literacy Online (HLO) checklist to inspect the app. Our inspection revealed that most of the app's strengths were related to its Organization of Content and Simple Navigation and most of its weaknesses were related to Engage Users. We also identified several usability and user experience (UX) issues that were beyond the purview of the HLO checklist. Although this app represents an important step towards making lab results universally accessible, we identified several opportunities for improvements that could increase its value to citizens.

Team-Based Integrated Knowledge Translation for Enhancing Quality of Life in Long-term Care Settings: A Multi-method, Multi-sectoral Research Design.

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.

Calorie restriction dose-dependently abates lipopolysaccharide-induced fever, sickness behavior, and circulating interleukin-6 while increasing corticosterone.

In mice a 50% calorie restriction (CR) for 28days attenuates sickness behavior after lipopolysaccharide (LPS) and these mice demonstrate a central anti-inflammatory bias. This study examined the dose-dependent effect of CR on sickness behavior (fever, anorexia, cachexia) and peripheral immune markers post-LPS. Male Sprague-Dawley rats fed ad libitum or CR by 50% for 14, 21, or 28days were injected on day 15, 22, or 29 with 50µg/kg of LPS or saline (1mL/500g). Changes in body temperature (Tb), locomotor activity, body weight, and food intake were determined. A separate cohort of rats was fed ad libitum or CR by 50% for 28days and serum levels of corticosterone (CORT), interleukin 6 (IL-6), and IL-10 were determined at 0, 2, and 4h post-LPS. The rats CR for 28days demonstrated the largest attenuation of sickness behavior: no fever, limited reduction in locomotor activity, no anorexia, and reduced cachexia following LPS. Rats CR for 14 and 21days demonstrated a partial attenuation of sickness behavior. Rats CR for 14days demonstrated a larger increase in Tb, larger reduction in locomotor activity, and larger weight loss compared to rats CR for 21days. Serum CORT was increased at 2h post-LPS in ad libitum and CR groups; however it was two times larger in the CR animals. Levels of IL-6 were significantly attenuated at 2h post-LPS in the CR animals. IL-10 levels were similar post-LPS. CR results in an enhanced anti-inflammatory response in the form of increased CORT and diminished pro-inflammatory signals.

Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature.

OBJECTIVE: To describe the long-term outcomes after laparoscopic adjustable gastric banding (LAGB) and compare these with the published literature on bariatric surgery. BACKGROUND: Because obesity is a chronic disease, any proposed obesity treatment should be expected to demonstrate long-term durability to be considered effective. Yet for bariatric surgery, few long-term weight loss data are available. We report our 15-year follow-up data after LAGB and provide a systematic review of the peer-reviewed literature for weight loss at 10 years or more after bariatric surgical procedures. METHODS: We performed a prospective longitudinal cohort study of LAGB patients using an electronic database system (LapBase) to track progress, measure weight changes, and document revisional procedures. The evolution of the LAGB procedure was recognized, and revisional rates for 3 separate periods between September 1994 and December 2011 were described. In addition, we performed a systematic review of the peer-reviewed published literature collecting all reports that included weight loss data at or beyond 10 years. RESULTS: A total of 3227 patients, with a mean age of 47 years and a mean body mass index of 43.8 kg/m, were treated by laparoscopic adjustable gastric band placement between September 1994 and December 2011. Seven hundred fourteen patients had completed at least 10 years of follow-up. Follow-up was intact in 81% of patients overall and 78% of those beyond 10 years. There was no perioperative mortality for the primary placement or for any revisional procedures. There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. Revisional procedures were performed for proximal enlargement (26%), erosion (3.4%), and port and tubing problems (21%). The band was explanted in 5.6%. The need for revision decreased as the technique evolved, with 40% revision rate for proximal gastric enlargements in the first 10 years, reducing to 6.4% in the past 5 years. The revision group showed a similar weight loss to the overall group beyond 10 years. The systematic review of all bariatric procedures with 10 or more years of follow-up showed greater than 50% EWL for all current procedures. The weighted mean at maximum follow-up for LAGB was 54.2% EWL and for Roux-en-Y gastric bypass was 54.0% EWL. CONCLUSIONS: The LAGB study from 1 center demonstrates a durable weight loss with 47% EWL maintained to 15 years. This weight loss occurred regardless of whether any revisional procedures were needed. A systematic review shows substantial and similar long-term weight losses for LAGB and other bariatric procedures.

Calorie restricted rats do not increase metabolic rate post-LPS, but do seek out warmer ambient temperatures to behaviourally induce a fever.

Due to previous work where we have demonstrated attenuated febrile responses post-lipopolysaccharide (LPS) in calorie restricted (CR) rodents we aimed to explore metabolic rate and behavioral thermoregulation in these CR animals post-LPS. Male Sprague-Dawley rats fed ad libitum (AL) or restricted to 50% (CR50%) of the AL animals' food intake for 28 days were injected on the 29th day with 50 µg/kg of LPS. Core body temperature (T(b)), self-selected self-selected ambient temperature (T(a)), indirect calorimetry [to determine energy expenditure (EE) and respiratory quotient (RQ)] were measured in AL and CR animals for 8 hours post-LPS. The CR rats chose to sit at a higher T(a) (28.1±0.4°C) compared to the AL rats (23.7±1.4°C) at baseline and the AL rats chose to sit at a warmer T(a) from 30 min until 420 min post-LPS; however, the CR rats selected a warmer T(a) only at 270 min post-LPS. AL rats demonstrated a higher T(b) compared to baseline at 120, 150, and from 240 until 480 min post-LPS. In contrast to our previous findings the CR rats also demonstrated a higher T(b) compared to baseline for most of the time between 270 and 420 min post-LPS. When allowed to select a warmer T(a) the CR rats do so and thereby mount a febrile response, although significantly delayed and shorter-lived. In the indirect calorimetry experiment the AL rats demonstrated an elevated T(b) from 150 until 480 min post-LPS; however, the CR rats fever profile was attenuated, with the only increase occurring at 270 min post-LPS. Indirect calorimetry indicated that the CR rats demonstrated significantly reduced EE (-17.9%±1.3) compared to the AL rats at baseline. After LPS, the AL rats demonstrated an increase in EE at multiple time points between 90 and 420 min, whereas no change was observed in the CR rats. The AL and CR rats demonstrated similar profiles of RQ at baseline and after LPS the AL rats demonstrated a decrease in their RQ at 360, 450, and 480 min, whereas the CR rats demonstrated no difference. The metabolic cost for rats to mount a fever during a period of low food availability may outweigh the benefits of producing a febrile response to a relatively small dose of LPS.

Calorie restriction attenuates LPS-induced sickness behavior and shifts hypothalamic signaling pathways to an anti-inflammatory bias.

Calorie restriction (CR) has been demonstrated to alter cytokine levels; however, its potential to modify sickness behavior (fever, anorexia, cachexia) has not. The effect of CR on sickness behavior was examined in male C57BL/6J mice fed ad libitum or restricted 25% (CR25%) or restricted 50% (CR50%) in food intake for 28 days and injected with 50 µg/kg of LPS on day 29. Changes in body temperature, locomotor activity, body weight, and food intake were determined. A separate cohort of mice were fed ad libitum or CR50% for 28 days, and hypothalamic mRNA expression of inhibitory factor κB-α (IκB-α), cyclooxygenase-2 (COX-2), prostaglandin E(2) (PGE(2)), suppressor of cytokine signaling 3 (SOCS3), IL-10, neuropeptide Y (NPY), leptin, proopiomelanocortin (POMC), and corticotrophin-releasing hormone (CRH) were determined at 0, 2, and 4 h post-LPS. CR50% mice did not develop fevers, whereas the CR25% mice displayed a fever shorter in duration but with the same peak as the controls. Both CR25% and CR50% mice showed no sign of anorexia and reduced cachexia after LPS administration. Hypothalamic mRNA expression of NPY and CRH were both increased by severalfold in CR50% animals preinjection compared with controls. The CR50% mice did not demonstrate the expected rise in hypothalamic mRNA expression of COX-2, microsomal prostaglandin E synthase-1, POMC, or CRH 2 h post-LPS, and leptin expression was decreased at this time point. Increases in SOCS3, IL-10, and IκB-α expression in CR50% animals were enhanced compared with ad libitum-fed controls at 4 h post-LPS. CR results in a suppression of sickness behavior in a dose-dependent manner, which may be due to CR attenuating proinflammatory pathways and enhancing anti-inflammatory pathways.