The Impact of teledermatology during the COVID-19 pandemic.

Teledermatology has been widely adopted during the COVID-19 pandemic as virtual patient care promotes social distancing and decreases viral exposure risk. As teledermatology has become more prominent during this period, it is essential to assess whether virtual visits allow for adequate patient care. To assess perceptions of advantages and disadvantages of teledermatology, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv. Of the physicians surveyed, 94% reported their departments had implemented teledermatology during the COVID-19 pandemic. The majority (64%) described teledermatology as an effective tool for patient care because of improved access to care, decreased risk of COVID-19 exposure, and convenience. Frequently cited limitations of teledermatology were image quality, technical difficulties, and inability to perform a comprehensive skin examination. Thirty-seven percent of respondents reported teledermatology as a contributor to their professional burnout. Although teledermatology has become more prevalent as a result of the pandemic, its role moving forward is uncertain given its limitations.

Validation of a Short Form for Health Literacy Assessment Using Talking Touchscreen Technology.

BACKGROUND: Health literacy is an area of growing research and clinical interest, necessitating short, accurate measures of this complex construct. Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measures prose, document, and quantitative literacy by self-administration on a touchscreen computer. OBJECTIVE: The objective of this study was to assess the validity of a short form of Health LiTT and to identify a meaningful cutoff score for adequate health literacy. METHODS: A subsample of 137 participants from the Literacy and Cognitive Function among Older Adults study completed a 10-item Health LiTT short form and three interviewer-administered health literacy measures: Test of Functional Health Literacy in Adults (TOFHLA), Rapid Estimate of Adult Literacy in Medicine (REALM), and Newest Vital Sign (NVS). Convergent validity was assessed by correlating scores for all measures, and known-groups validity was assessed by comparing mean Health LITT scores across TOFHLA levels (inadequate, marginal, adequate). Internal consistency reliability was estimated with Cronbach's alpha. A cutoff score for adequate health literacy was established using the TOFHLA cutoff for adequate versus inadequate/marginal health literacy. KEY RESULTS: Spearman correlations between Health LiTT scores and total TOFHLA, REALM, and NVS scores were 0.65, 0.69, and 0.56, respectively (all p < .001). Mean Health LiTT scores were significantly and meaningfully different across inadequate (40.4), marginal (50.1), and adequate (57.1) TOFHLA categories (F = 60.6; p < .001). Cronbach's alpha for the Health LiTT short form was .73. A cutoff score of 55 on Health LiTT showed acceptable sensitivity and specificity to identify adequate health literacy. CONCLUSIONS: This 10-item Health LiTT short form demonstrated excellent convergent and known-groups validity and acceptable internal consistency reliability in older adults. The established cutoff also showed excellent sensitivity and specificity. Validation of other custom Health LiTT short forms with varying items from the bank and computer adaptive test-generated Health LiTT scores is ongoing. [HLRP: Health Literacy Research and Practice. 2020;4(4):e200-e207.] PLAIN LANGUAGE SUMMARY: This article provides evidence of the need for and psychometric properties of a valid and reliable short form of the flexible, technologically advanced Health Literacy Assessment Using Talking Touchscreen Technology measure, as well as a cutoff score to note adequate versus marginal/inadequate health literacy.

Visual fatigue during control room work in process industries.

BACKGROUND: Working in front of computer screens is visually demanding and related to adverse eye symptoms. Occurrence of glare further increases visual fatigue. OBJECTIVE: This paper presents results from an examination of visual ergonomics in control room environments at two Swedish process industries. METHODS: Visual conditions were examined and evaluated in nine control rooms and eighteen process operators answered questions about their perceived workload and visual experiences. RESULTS: When working in the control rooms, the mental workload was rated significantly higher by the participants, compared to experienced performance. The operators further experienced significantly higher visual fatigue and blurred vision compared to double vision and sore eyes. Visual demands were increased in conditions where contrast glare was present, as well as frequent changes of focusing distances, and low contrast between background and characters in computer screens. CONCLUSIONS: Suboptimal visual working conditions in the control rooms contributes to increased visual demands on the operators. Presence of glare is leading to visual fatigue and an unnecessary high mental load. The findings support the relevance of considering principles of general and visual ergonomics when designing and organizing work in control rooms. Workstation design should also be flexible to allow for individual and contextual adjustments.

Patient Empowerment and Nursing Clinical Workflows Enhanced by Integrated Bedside Terminals.

BACKGROUND: Integrated bedside terminals (IBTs) were implemented at Humber River Hospital with the goal of supporting patient independence and autonomy and improving nursing workflows. The IBTs provide access to a range of convenience and entertainment services as well as access to personal health information. Due to the novelty of the technology, there is a paucity of empirical data on patients' use of, satisfaction with and perceptions of bedside terminals. AIM: The purpose of this study was to evaluate the impact of IBTs on patient empowerment and nursing workflows. METHODS: A mixed methods design was employed using a cross-sectional patient survey and semi-structured interviews with nurses. The patient survey assessed patient empowerment and satisfaction with the range of services offered through the IBT. Patient scores were summarized using descriptive statistics. Additionally, face-to-face interviews with nurses were used to illicit feedback regarding the IBTs' impacts on nursing workflows. RESULTS: In total, 113 patients and 11 nurses participated in the study. Analysis of patient satisfaction surveys indicated that the IBTs enhanced the patient experience and increased self-care management. Nurses reported that the IBTs helped patients feel comfortable and entertained and helped enhance the nurse-patient relationship. However, nurses also expressed concern that elderly patients were less inclined to use the IBT. CONCLUSION: The results from the present study suggest that the IBT system has the potential to empower patients and decrease demands on nurses. Patients' notes incorporated into the IBT may provide the necessary level of involvement to garner a greater sense of patient empowerment. The IBT does not replace the need for nurses to deliver information to patients in a manner that supports their trust.

Improving Patient Safety Through Video Monitoring.

PURPOSE: Falls are a major safety issue in rehabilitation settings. Patients receive mixed messages-try to be as independent as possible, but don't do anything in your room without calling for assistance. Despite the use of multiple falls interventions at this facility, the fall rate remained high. To impact this rate, the facility implemented a video monitoring system. This system allows for patients at risk for falling to be monitored from a remote location. The monitor technician is able to speak to the patient directly and/or contact staff members to respond to the room, preventing a fall. DESIGN: Sequential cohort design. METHOD: Fifteen video monitoring units were installed on high-risk units in a 115-bed inpatient rehabilitation facility. Total falls and falls rates were tracked and reported pre- and postimplementation. FINDINGS: Over a 21-month period prior to implementing the video monitoring system, the average hospital-wide rate of falls was 6.34 per 1,000 patient-days (SD = 1.7488). After a year of usage, that average has decreased to 5.099 falls per 1,000 patient-days (SD = 1.524). The reduction in falls was statistically significant. In addition, there have been significant cost savings by reducing sitter usage. CONCLUSIONS: Video monitoring can improve patient safety by decreasing falls; decreasing sitter usage and cost; and improving patient, family, and staff satisfaction. CLINICAL RELEVANCE: Falls are a significant issue in rehabilitation settings, and current fall prevention strategies fall short of reducing fall rates. Implementation of new video monitoring technology can help reduce fall rates in inpatient rehabilitation settings.

Risk factors and visual fatigue of baggage X-ray security screeners: a structural equation modelling analysis.

This study identified the risk factors influencing visual fatigue in baggage X-ray security screeners and estimated the strength of correlations between those factors and visual fatigue using structural equation modelling approach. Two hundred and five X-ray security screeners participated in a questionnaire survey. The result showed that satisfaction with the VDT's physical features and the work environment conditions were negatively correlated with the intensity of visual fatigue, whereas job stress and job burnout had direct positive influences. The path coefficient between the image quality of VDT and visual fatigue was not significant. The total effects of job burnout, job stress, the VDT's physical features and the work environment conditions on visual fatigue were 0.471, 0.469, -0.268 and -0.251 respectively. These findings indicated that both extrinsic factors relating to VDT and workplace environment and psychological factors including job burnout and job stress should be considered in the workplace design and work organisation of security screening tasks to reduce screeners' visual fatigue. Practitioner Summary: This study identified the risk factors influencing visual fatigue in baggage X-ray security screeners and estimated the strength of correlations between those factors and visual fatigue. The findings were of great importance to the workplace design and the work organisation of security screening tasks to reduce screeners' visual fatigue.

Viewing your digital radiographs: which monitor is best?

Many dental practitioners use flat panel monitors in their practices on a daily basis, and for those practitioners who have made the move to digital imaging, the use of this device often extends to viewing digital radiographs. Monitors that present good quality images should be used and the image quality should be checked. This article provides practitioners with some of the key areas they should consider when selecting or buying a flat panel monitor for dental radiology purposes.

Characterization of Luminance and Color Properties of 6-MP Wide-Screen Displays.

Luminance and color performance are routinely evaluated as part of acceptance testing of displays used in diagnostic radiology. Previous work has indicated that as some diagnostic liquid crystal displays (LCDs) increase in backlight hours (BLH), the luminance measured with an external luminance meter exceeds the luminance reported by the manufacturer's built-in meter. The purposes of this work were as follows: first, to characterize several luminance and color performance characteristics for 23 Barco Coronis Fusion 6-MP MDCC 6230 color displays and, second, to provide initial data for a longitudinal study evaluating changes in luminance and color performance as BLH increase. Grayscale display conformance and maximum luminance were evaluated using a calibrated luminance meter and AAPM Task Group 18 test patterns, and agreement between target and measured luminance was calculated. Luminance uniformity was evaluated by calculating maximum luminance deviation. Color point and color uniformity were evaluated using a spectrophotometer, and the radial color distances between the corners and center of the display were calculated. Above 3 cd/m(2), there was good agreement between the target and measured luminance. At the maximum luminance, the mean difference was less than 1 %. The mean maximum luminance deviation for these displays was 10.40 ± 2.38 %. Color point was observed to be very consistent between displays with mean values of u' and v' of 0.187 ± 0.002 and 0.474 ± 0.004, respectively. Among all displays, maximum radial color distance had a mean value of 0.003 ± 0.001. These data provide a baseline for the acceptance of future displays as well as for longitudinal studies of luminance and color performance.

Positioning patient status monitors in a family waiting room.

OBJECTIVE: To determine where to place patient status displays for family members in the operating room family waiting room at The Children's Hospital of Philadelphia. METHODS: We calculated the percentage of seats from which wall monitors placed in hypothetical positions would be usable. We validated the usability of the new monitors by observing nonemployees' use of monitors in the waiting room 1 week before and 1 week after implementation. RESULTS: Compared to the legacy monitor, the new monitors were observed to be used from more locations within the waiting room and more people were observed to use the new monitors soon after entering the waiting room. CONCLUSIONS: Seemingly trivial decisions like where in a waiting room to place monitors can be informed by careful data collection and the consequences can observably impact communication between hospital staff and family members waiting for loved ones in surgery.

Effect of display resolution on time to diagnosis with virtual pathology slides in a systematic search task.

Performing diagnoses using virtual slides can take pathologists significantly longer than with glass slides, presenting a significant barrier to the use of virtual slides in routine practice. Given the benefits in pathology workflow efficiency and safety that virtual slides promise, it is important to understand reasons for this difference and identify opportunities for improvement. The effect of display resolution on time to diagnosis with virtual slides has not previously been explored. The aim of this study was to assess the effect of display resolution on time to diagnosis with virtual slides. Nine pathologists participated in a counterbalanced crossover study, viewing axillary lymph node slides on a microscope, a 23-in 2.3-megapixel single-screen display and a three-screen 11-megapixel display consisting of three 27-in displays. Time to diagnosis and time to first target were faster on the microscope than on the single and three-screen displays. There was no significant difference between the microscope and the three-screen display in time to first target, while the time taken on the single-screen display was significantly higher than that on the microscope. The results suggest that a digital pathology workstation with an increased number of pixels may make it easier to identify where cancer is located in the initial slide overview, enabling quick location of diagnostically relevant regions of interest. However, when a comprehensive, detailed search of a slide has to be made, increased resolution may not offer any additional benefit.

DICOM part 14: GSDF-calibrated medical grade monitor vs a DICOM part 14: GSDF-calibrated "commercial off-the-shelf" (COTS) monitor for viewing 8-bit dental images.

OBJECTIVES: To investigate whether there is any difference in the presented image quality between a medical grade monitor and a "commercial off-the- shelf" (COTS) monitor when displaying an 8-bit dental image. METHODS: The digital imaging and communications in medicine (DICOM) part 14: greyscale standard display function (GSDF) was verified for both monitors. A visual grading characteristics (VGC) curve was constructed to measure the difference in image quality between the two monitors by comparing radiological structures displayed on each monitor with a DICOM part 14: GSDF-calibrated laptop monitor as reference. RESULTS: All of the monitors conformed to within the American Association of Physicists in Medicine Task Group 18 10% tolerance levels for the assessment of the DICOM part 14: GSDF. There was no difference in the preferred perceived visual sensation for the displayed image between the two tested monitors with the area under the VGC curve = 0.53 and 95% confidence interval = 0.47-0.59. CONCLUSIONS: A DICOM part 14: GSDF COTS monitor is capable of displaying an image quality that is equally preferred to a DICOM part 14: GSDF medical grade monitor for an 8-bit image file.

DICOM gray-scale standard display function: clinical diagnostic accuracy of chest radiography in medical-grade gray-scale and consumer-grade color displays.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy achieved with and without the calibration method established by the DICOM standard in both medical-grade gray-scale displays and consumer-grade color displays. MATERIALS AND METHODS: This study involved 76 cases, six radiologists, three displays, and two display calibrations for a total of 2736 observations in a multireader-multicase factorial design. The evaluated conditions were interstitial opacities, pneumothorax, and nodules. CT was adopted as the reference standard. One medical-grade gray-scale display and two consumer-grade color displays were evaluated. Analyses of ROC curves, diagnostic accuracy (measured as AUC), accuracy of condition classification, and false-positive and false-negative rate comparisons were performed. The degree of agreement between readers was also evaluated. RESULTS: No significant differences in image quality perception by the readers in the presence or absence of calibration were observed. Similar forms of the ROC curves were observed. No significant differences were detected in the observed variables (diagnostic accuracy, accuracy of condition classification, false-positive rates, false-negative rates, and image-quality perception). Strong agreement between readers was also determined for each display with and without calibration. CONCLUSION: For the chest conditions and selected observers included in this study, no significant differences were observed between the three evaluated displays with respect to accuracy performance with and without calibration.

POSTURE ADJUSTMENT PROCEDURES FOR CHILDREN WHEN USING ADULT VDT WORKSTATIONS WITH LIMITED ADJUSTABILITY.

Children are likely to assume very awkward seated postures when using a desktop computer at workstations with limited adjustability. This also includes the workstations that are not built for them such as adult visual display terminal (VDT) workstations. This paper proposes simple step-by-step procedures for estimating necessary adjustments so that children can sit and maintain an appropriate seated posture at VDT workstations with limited adjustability (i.e., fixed keyboard and monitor heights). From the anthropometric and VDT workstation data, the procedures compute the recommended VDT workstation settings for a concerned child, compare them with the actual workstation adjustment ranges, determine the appropriate settings, and suggest necessary accessories. The posture adjustment procedures are tested on four Thai children seated at two different types of adult VDT workstation. A rapid upper limb assessment (RULA) technique is used to evaluate the children's seated postures both before and after the posture adjustment. Applying the procedures, children need their own VDT workstation that should be fully adjustable. In using an adult workstation, adjustment accessories and the correct settings are required.

[Imaging monitors--requirements and pitfalls]. / Befundmonitore--Anforderungen und Fallstricke.

When applying the standard DIN V 6868-57 rule "acceptance testing for image display devices" it always comes to misunderstandings in the practical implementation. In a brief summary the most important requirements are presented. With the pending replacement of DIN V 6868-57 by DIN 6868-157 "acceptance and constancy tests of image display systems in their environment" there will be fundamental changes. Future requirements are presented as examples. Besides the introduction of a classroom concept and new test images, the focus of the standard is aligned with the image display system. This change places new demands on the management concept of picture archiving and communication system (PACS) workstations. For testing the unit, consisting of a computer system, video card, operating system and image display equipment only one organizational unit should be responsible.

Could standardizing "commercial off-the-shelf" (COTS) monitors to the DICOM part 14: GSDF improve the presentation of dental images? A visual grading characteristics analysis.

OBJECTIVES: To investigate whether standardizing commercial off-the-shelf (COTS) display devices to the digital imaging and communications in medicine part 14: greyscale standard display function (DICOM part 14: GSDF) would affect the presentation of dental images. METHODS: Two COTS display devices from the radiology department of a dental teaching hospital and a laptop computer monitor for reference were calibrated to conform to DICOM part 14: GSDF. Four dental surgeons and two final-year students undertook a relative visual grading analysis of the two devices before and after calibration, under control of the viewing environment. RESULTS: Calibrating COTS display devices to conform to the DICOM part 14: GSDF and viewing under reduced ambient light result in a consistent, perceived visual sensation for the presented radiological image. The area under the visual grading characteristics curve (AUCVGC) before calibration is 0.62 CI (0.56, 0.68) and AUCVGC after calibration is 0.51 CI (0.45, 0.57). CONCLUSIONS: Standardizing COTS display devices to the DICOM part 14: GSDF can improve image presentation.

TB or Not TB: interreader and intrareader variability in screening diagnosis on an iPad versus a traditional display.

Mobile displays may have the ability to increase the flexibility of consulting radiologists if they can be shown not to negatively influence a reader's performance in clinical tasks. The authors report a comparison of a mobile display with a larger liquid crystal display for the task of making a binary decision for the diagnosis of tuberculosis on chest radiography. Deidentified DICOM images of 240 chest x-rays were transferred from a PACS to an iPad 2 running OsiriX HD software. The images were reviewed independently by 5 radiologists of varying experience and were graded as positive or negative for tuberculosis on both the liquid crystal display monitor and the iPad. The reading sessions were a minimum of 2 weeks apart to minimize recall bias. Agreement was measured in terms of κ statistics. Overall, multirater generalized κ was 0.9694. These results suggest that there is no detectable effect of monitor type (liquid crystal display or iPad 2) on the reader's decision for the task of tuberculosis diagnosis.