Comparing the impact of an icon array versus a bar graph on preference and understanding of risk information: Results from an online, randomized study.

BACKGROUND: Few studies have examined the best way to convey the probability of serious events occurring in the future (i.e., risk of stroke or death) to persons with low numeracy or graph literacy proficiency. To address this gap, we developed and user-tested a bar graph and compared it to icon arrays to assess its impact on understanding and preference for viewing risk information. OBJECTIVES: To determine the: (i) formats' impact on participants' understanding of risk information; (ii) formats' impact on understanding and format preference across numeracy and graph literacy subgroups; (iii) rationale supporting participants' preference for each graphical display format. METHODS: An online sample (evenly made up of participants with high and low objective numeracy and graph literacy) was randomized to view either the icon array or the bar graph. Each format conveyed the risk of major stroke and death five years after choosing surgery, a stent, or medication to treat carotid artery stenosis. Participants answered questions to assess their understanding of the risk information. Lastly, both formats were presented in parallel, and participants were asked to identify their preferred format to view risk information and explain their preference. RESULTS: Of the 407 participants, 197 were assigned the icon array and 210 the bar graph. Understanding of risk information and format preference did not differ significantly between the two trial arms, irrespective of numeracy and graph literacy proficiency. High numeracy and graph literacy proficiency was associated with high understanding (p<0.01) and a preference for the bar graph (p = 0.01). CONCLUSION: We found no evidence to demonstrate the superiority of one format over another on understanding. The majority of participants preferred viewing the risk information using the bar graph format.

Audit of NZ COVID Tracer QR poster display and use in Dunedin.

AIMS: To assess how well the NZ COVID Tracer QR (Quick Response) code poster is displayed by Dunedin businesses and other venues in which groups of people gather indoors, and to calculate the proportions of visitors to those venues who scan the QR code poster. METHODS: We randomly selected 10 cafes, 10 restaurants, 10 bars, five churches, and five supermarkets and visited them at their busiest times. We evaluated the display of QR code posters using a six-item assessment tool that was based on guidance provided to businesses and services by the Ministry of Health, and we counted the number of people who entered each venue during a one-hour period and the number who scanned the QR code poster. RESULTS: All six criteria for displaying QR code posters were met at half of the hospitality venues, four of five churches, and all supermarkets. Scanning proportions were low at all venues (median 10.2%), and at 12 (30%) no visitors scanned; eight of these venues were bars. CONCLUSION: This audit provides a snapshot of the display and scanning of QR code posters in a city with no managed isolation and quarantine facilities and where no COVID-19 cases have been detected for 10 months.

Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study.

BACKGROUND: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. OBJECTIVE: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. METHODS: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). RESULTS: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. CONCLUSIONS: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge.

Starviewer and its comparison with other open-source DICOM viewers using a novel hierarchical evaluation framework.

METHODS: The aim of the paper is twofold. First, we present Starviewer, a DICOM viewer developed in C++ with a core component built on top of open-source libraries. The viewer supports extensions that implement functionalities and front-ends for specific use cases. Second, we propose an adaptable evaluation framework based on a set of criteria weighted according to user needs. The framework can consider different user profiles and allow criteria to be decomposed in subcriteria and grouped in more general categories making a multi-level hierarchical structure that can be analysed at different levels of detail to make scores interpretation more comprehensible. RESULTS: Different examples to illustrate Starviewer functionalities and its extensions are presented. In addition, the proposed evaluation framework is used to compare Starviewer with four open-source viewers regarding their functionalities for daily clinical practice. In a range from 0 to 10, the final scores are: Horos (7.7), Starviewer (6.2), Weasis (6.0), Ginkgo CADx (4.1), and medInria (3.8). CONCLUSIONS: Starviewer provides basic and advanced features for daily image diagnosis needs as well as a modular design that enables the development of custom extensions. The evaluation framework is useful to understand and prioritize new development goals, and can be easily adapted to express different needs by altering the weights. Moreover, it can be used as a complement to maturity models.

Comparing medical grade to commercial grade display in a radiation oncology environment.

Electronic displays are used in every modern day medical clinic. They are used to view images that are needed to diagnose, treat, and follow-up on patients with a variety of conditions. The type of electronic display used varies from department to department. Currently, a type of displays called medical grade displays are used to evaluate and diagnose disease and conditions. Alternatively, commercial or entry level professional displays are used for almost everything else. In the field of radiation oncology medical images are often used to plan the treatment course for each patient. These images are always viewed using a commercial grade display. An experiment was completed to examine the role a medical grade display might have in a radiation oncology setting. Our study had certified dosimetrists and radiation oncologists view medical images on both a medical grade and commercial grade display and rank their preference on a scale. The observers assessed the images in different categories (Contrast, resolution, and sharpness) and also commented on their preference. Results indicated that the medical grade display performed better than the commercial grade display in every image quality category.

Evaluation of diagnostic accuracy of intracranial aneurysm detection using medical-grade versus commercial consumer-grade displays and different image reconstructions against the background of process optimization for telemedicine.

BACKGROUND: Process optimization in computed tomography (CT) and telemedicine. PURPOSE: To compare image quality and objective diagnostic accuracy of medical-grade and consumer-grade digital displays/computer terminals for detection of intracranial aneurysms. MATERIAL AND METHODS: Four radiologists with different levels of experience retrospectively read a total of 60 patients including 30 cases of proven therapy-naïve intracranial aneurysm detectable on a medical-grade grayscale calibrated display. They had 5 min per case reading the first 20 datasets using only axial slices, the next 20 patients using axial slices and multiplanar reconstructions (MPRs), and the last 20 patients using axial slices, MPRs, and maximum intensity projections (MIPs). Three months after the first reading session on a medical-grade display, they read all datasets again under the same standardized conditions but on a consumer-grade display. Diagnostic performance, subjective diagnostic confidence, and reading speed were analyzed and compared. Readers rated image quality on a five-point Likert scale. RESULTS: Diagnostic accuracy did not differ significantly with areas under the curve of 0.717-0.809 for all readers on both display devices. Sensitivity and specificity did not increase significantly when adding MPRs and/or MIPs. Reading speed was similar with both devices. There were no significant differences in subjective image quality scores, and overall inter-reader variability of all subjective parameters correlated positively between the two devices (P <0.001-0.011). CONCLUSION: Diagnostic accuracy and readers' diagnostic confidence in detecting and ruling out intracranial aneurysm were similar on commercial-grade and medical-grade displays. Additional reconstructions did not increase sensitivity/specificity or reduce the time needed for diagnosis.

Too much or too little? Investigating the usability of high and low data displays of the same electronic medical record.

The high data density on electronic medical record screens is touted as a major usability issue. However, it may not be a problem if the data is relevant and well-organized. Our objective was to test this assumption using a comprehensive set of measures that assess the three pillars of usability: efficiency (both physical and cognitive), effectiveness, and satisfaction. Physicians were asked to go through a series of tasks using two versions of the same electronic medical record: one where all the display items were separated into tabs (the original display), and one where important display items were grouped logically in one tab (the redesigned display). Results supported the hypothesis that combining relevant data in organized fashion into a smaller location would improve usability. The findings highlight the role of good display organization to mitigate the effects of high data density, as well as the importance of assessing cognitive load as part of usability studies.

Performance of primary diagnostic monitors (PDMs) over time.

In this work, we evaluated the change of primary monitor characteristics in two consecutive years. Sixty-six primary monitors were included in the analysis. The monitors were located at radiology physicians' offices and radiology reading rooms. All primary monitors were equipped with the manufacturer's built-in photometers and connected to the BarcoMediCalQA web service for manual and automatic quality control measurements. External photometer/illuminance meter (RaySafe Solo Light) was used to measure the luminance values. Measured luminance values of the TG18LN1-18 and TG18UNL80 test patterns were used to evaluate the primary monitors performance. In a comparison of the quality assurance (QA) measurement results for the same monitors that were performed within 2 years, the luminance of 25 displays remained statistically the same (P > 0.01). The luminance of 17 displays decreased (P < 0.01) in 2017 when compared with 2016, the luminance of 24 displays increased (P < 0.01) in 2017 when compared with 2016. For the annual measurements of the MLD in 2016 and 2017, 25 out of 66 displays showed a decrease of MLD values in 2017 compared with the same measurements in 2016 and 41 displays showed an increase of MLD in 2017. All tested primary displays had the MLD value less than 17.2%. The mean value of illuminance measured in 2016 was 5.8 lux ± 3.1 lux. In 2017, the mean value of illuminance measured was 8.7 lux ± 5.3 lux. Although it is expected that monitors luminance values will decrease over time, we found displays with increased luminance. This is possibly due to the multiple monitor calibrations that were performed between two annual monitor QA tests. Based on the findings of this work, more efficient display QA programs with a shorter time interval than 1 year are needed.

The Improvement of the Electronic Health Record User Experience by Screen Design Principles.

The amount and complexity of data accumulated in electronic health record (EHR) is quite large, and the quantity of information that clinicians can examine and handle is very limited. Thus, it is necessary to enhance the accessibility of EHR by improving the user experience (UX). To apply information visualization that turns EHR data into an understandable visual format, we propose following five screen design principles when designing UX interfaces. #1: One view should contain single patient data. #2: Data should be summarized or titled for overview and details should be given on-demand. #3: Data should be displayed in time-series. #4: Data should be categorized by primary type. #5: More data should be displayed at the same time. Three screen designs are plausible utilizing the above-mentioned principles. To measure the UX of screen designs and validate the design principles, we built an EHR viewer system that has three windows corresponding to these screen designs and had it tested by medical staff. The results of the test revealed that the UX of the screen design is proportional to the number of design principles that the screen design incorporates. It shows that the proposed screen design principles improve the UX of EHR.

Improving Medication Information Presentation Through Interactive Visualization in Mobile Apps: Human Factors Design.

BACKGROUND: Despite the detailed patient package inserts (PPIs) with prescription drugs that communicate crucial information about safety, there is a critical gap between patient understanding and the knowledge presented. As a result, patients may suffer from adverse events. We propose using human factors design methodologies such as hierarchical task analysis (HTA) and interactive visualization to bridge this gap. We hypothesize that an innovative mobile app employing human factors design with an interactive visualization can deliver PPI information aligned with patients' information processing heuristics. Such an app may help patients gain an improved overall knowledge of medications. OBJECTIVE: The objective of this study was to explore the feasibility of designing an interactive visualization-based mobile app using an HTA approach through a mobile prototype. METHODS: Two pharmacists constructed the HTA for the drug risperidone. Later, the specific requirements of the design were translated using infographics. We transferred the wireframes of the prototype into an interactive user interface. Finally, a usability evaluation of the mobile health app was conducted. RESULTS: A mobile app prototype using HTA and infographics was successfully created. We reiterated the design based on the specific recommendations from the usability evaluations. CONCLUSIONS: Using HTA methodology, we successfully created a mobile prototype for delivering PPI on the drug risperidone to patients. The hierarchical goals and subgoals were translated into a mobile prototype.

Presentation of scientific poster information: Lessons learned from evaluating the impact of content arrangement and use of infographics.

BACKGROUND: Scientific poster content and delivery methodology have evolved in recent years. The objective of this observational cross-sectional survey-based study was to evaluate pharmacists' preferences of two different scientific poster formats conducted at a conference in May 2017. Two posters on the same topic were developed and presented utilizing different formatting; one in the traditional, text-based format and the other in an infographic-based format. Study participants (n = 61) included 23 (38%) preceptors and 37 (61%) residents. Preceptors and residents scored clarity and comprehensibility similarly for both poster formats respectively, but rated aesthetic appeal higher for the infographic format. Both groups found more detailed information to be missing from the infographic poster format. Overall, residents did not prefer one poster format to another, while preceptors overwhelmingly preferred the infographic poster format over the traditional poster format. IMPACT: Several key confounders limit the interpretations of the study results. These confounders include lack of large and well-distributed sample size, inability to control for the effect of preference on comprehension scores, and differences between resident and preceptor experience that may ultimately influence preferences and results. RECOMMENDATIONS: In repeating this study, investigators should consider capturing a national and larger sample size to increase applicability of results, design questions to assess comprehension, and collect participant baseline characteristics. DISCUSSION: Variations in preferences and perceptions for optimal scientific poster content and design among pharmacists exist. The findings of this study suggest infographic poster formats are more aesthetically appealing, but demonstrate similar clarity and comprehensibility as a traditional poster format.

Técnicas de control de calidad en cirugía. Aplicación de las gráficas de control cumulative sum / Quality control techniques in surgery: Application of cumulative sum (CUSUM) charts

Las gráficas cumulative sum (CUSUM) se engloban dentro de gráficas de control de calidad, son posiblemente las que mejor se adaptan y las más utilizadas en la monitorización de los procesos clínico-asistenciales. Una de sus principales ventajas es su empleo en casos raros y en eventos con baja incidencia, en los cuales sería necesario obtener una muestra y un tiempo de seguimiento amplio, imposible en determinados casos, mediante métodos estadísticos convencionales. También por ello, son útiles para estudiar curvas de aprendizaje, la introducción de nuevas tecnologías y, en general, para valorar la calidad de los propios resultados asistenciales, porque su perfil es sensible a cambios de tendencias (positivas o negativas) muy sutiles en los resultados, que no se observarían con otros métodos. Por otra parte, su uso se puede expandir más allá de lo que es el control o la monitorización de calidad, aspecto que resulta novedoso en investigación clínica

Cumulative sum graphs are quality control charts that are possibly the most frequently used for monitoring clinical-care processes. One of their main advantages is the use in rare cases and in events with low incidence, where it would be necessary to obtain a large sample and a long follow-up time with conventional statistical methods, which is impossible in certain cases. This is also why they are useful for studying learning curves, the introduction of new technologies and, in general, for assessing the quality of care outcomes themselves, because their profile is sensitive to very subtle changes in trends (positive or negative), which would not be observed with other methods. On the other hand, their use can be expanded beyond quality control or monitoring, which is a new aspect in clinical research

Requirements for a quality dashboard: Lessons from National Clinical Audits.

Healthcare organizations worldwide use quality dashboards to provide feedback to clinical teams and managers, in order to monitor care quality and stimulate quality improvement. However, there is limited evidence regarding the impact of quality dashboards and audit and feedback research focuses on feedback to individual clinicians, rather than to clinical and managerial teams. Consequently, we know little about what features a quality dashboard needs in order to provide benefit. We conducted 54 interviews across five healthcare organizations in the National Health Service in England, interviewing personnel at different levels of the organization, to understand how national (UK) clinical audit data are used for quality improvement and factors that support or constrain use of these data. The findings, organized around the themes of choosing performance indicators, assessing performance, identifying causes, communicating from ward to board, and data quality, have implications for the design of quality dashboards, which we have translated into a series of requirements.

A track of the clones: new developments in cellular barcoding.

International experts from multiple disciplines gathered at Homerton College in Cambridge, UK from September 12-14, 2018 to consider recent advances and emerging opportunities in the clonal tracking of hematopoiesis in one of a series of StemCellMathLab workshops. The group included 35 participants with experience in the fields of theoretical and experimental aspects of clonal tracking, and ranged from doctoral students to senior professors. Data from a variety of model systems and from clinical gene therapy trials were discussed, along with strategies for data analysis and sharing and challenges arising due to underlying assumptions in data interpretation and communication. Recognizing the power of this technology underpinned a group consensus of a need for improved mechanisms for sharing data and analytical protocols to maintain reproducibility and rigor in its application to complex tissues.

Creating "wizards" on the library's website.

OBJECTIVES: The library website is the virtual front door to the variety of services that the authors' library offers. Library staff found confusion arose focused on two areas: how to reserve rooms in the library and how to reuse images using best practices. Two interactive forms were created that would hide and reveal content based on choices and lead the patron to answers. METHODS: Brainstorming meetings were held to create a flow chart that identified the specific questions to be answered that would lead users to a logical answer. Once the correct flow was created, we approached each of these challenges by creating a custom module decision tree, using code through Drupal's application programming interface (API) for forms. RESULTS: The image reuse decision tree went live on the library website on February 17, 2017, and the room reservation wizard went live on August 27, 2017. By the end of the spring 2018 semester on May 18, 2018, the room reservation wizard had been accessed 1,945 times and risen to number 7 on the list of top-accessed website pages, and the image reuse wizard had been accessed 484 times. CONCLUSIONS: The popularity of both the decision tree pages is exciting. Both "wizards" have empowered users to find an answer to their questions virtually, especially during nonbusiness hours.

A Picture Tells 1000 Words (but Most Results Graphs Do Not): 21 Alternatives to Simple Bar and Line Graphs.

Graphical representation of results are a central component of original research articles in sports medicine. There has been recent criticism in the scientific community of a heavy reliance on simple bar graphs and line graphs to illustrate results because they often fail to clearly represent the measures and changes to interventions of individual participants. This article aims to suggest alternatives to bar and line graphs, including those that emphasize the illustration of (1) individual subject measures and data set distribution, (2) magnitude of group differences, (3) the relationships between multiple variables, and (4) unique ways of displaying time series data.

Use of Blood Glucose Meters Featuring Color Range Indicators Improves Glycemic Control in Patients With Diabetes in Comparison to Blood Glucose Meters Without Color (ACCENTS Study).

BACKGROUND: The ability of patients to improve glycemic control depends partly on their ability to interpret and act on blood glucose results. We investigated whether switching people with diabetes to blood glucose meters (BGMs) featuring a color range indicator (CRI) could improve glycemic control compared to remaining on their current BGM without color. METHODS: 163 adults with type 1 (T1D) or type 2 diabetes (T2D) and a hemoglobin A1c (A1c) of 7.5-11% were randomized to: One Touch Verio™ (Verio), OneTouch Verio Flex™ (Flex), or controls remaining on their current BGM. Diabetes nurses had standard conversations about diabetes management with all subjects at baseline. No changes in medication, insulin dosing, or SMBG frequency were recommended. RESULTS: After 12 weeks, subjects who switched to Verio or Flex meters with CRI (n = 108) had a mean change in A1c 0.36% lower than controls (n = 55) ( P = .017). A1c reductions were greatest in T1D subjects (n = 45), with a decrease of 0.50% ( P = .004). T1D subjects using Verio meters (n = 25) contributed a 0.59% reduction compared to controls ( P < .008), whereas T1D subjects using Flex meters (n = 20) had a clinical meaningful reduction in A1c of 0.40% without reaching statistical significance ( P > .05). Verio and Flex users reported taking more action and easier understanding of diabetes management compared to previous BGMs. CONCLUSIONS: This study demonstrated that switching patients to BGMs featuring a CRI resulted in improvements in glycemic control compared to subjects using currently marketed BGMs that do not use a CRI. Registration: Clinicaltrials.gov NCT02929654 https://clinicaltrials.gov/ct2/show/NCT02929654.

Ecological Interface Design for Computer Network Defense.

OBJECTIVE: A prototype ecological interface for computer network defense (CND) was developed. BACKGROUND: Concerns about CND run high. Although there is a vast literature on CND, there is some indication that this research is not being translated into operational contexts. Part of the reason may be that CND has historically been treated as a strictly technical problem, rather than as a socio-technical problem. METHODS: The cognitive systems engineering (CSE)/ecological interface design (EID) framework was used in the analysis and design of the prototype interface. A brief overview of CSE/EID is provided. EID principles of design (i.e., direct perception, direct manipulation and visual momentum) are described and illustrated through concrete examples from the ecological interface. RESULTS: Key features of the ecological interface include (a) a wide variety of alternative visual displays, (b) controls that allow easy, dynamic reconfiguration of these displays, (c) visual highlighting of functionally related information across displays, (d) control mechanisms to selectively filter massive data sets, and (e) the capability for easy expansion. Cyber attacks from a well-known data set are illustrated through screen shots. CONCLUSION: CND support needs to be developed with a triadic focus (i.e., humans interacting with technology to accomplish work) if it is to be effective. Iterative design and formal evaluation is also required. The discipline of human factors has a long tradition of success on both counts; it is time that HF became fully involved in CND. APPLICATION: Direct application in supporting cyber analysts.

Examining barriers to healthcare providers' adoption of a hospital-wide electronic patient journey board.

BACKGROUND: The dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. AIM: This study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB)1 application in acute wards of a hospital. METHOD: Data were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. RESULTS: Two manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. CONCLUSION: Multiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards.