Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review.

BACKGROUND: Chronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers are a massive burden to health care facilities. Many randomized controlled trials on different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, health care professionals are forced to rely on their own experience when making decisions regarding wound care. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems (CDSS) that help health care providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas of the health care sector, partly because they have increased the quality of care, and partially because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on CDSS within the field of wound care to chronic wounds. OBJECTIVE: The aims of this systematic literature review are (1) to identify models used in CDSS that support health care professionals treating chronic wounds, and (2) to classify each clinical decision support model according to selected variables and to create an overview. METHODS: A systematic review was conducted using 6 databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The search strategy consisted of three facets, respectively: Facet 1 (Algorithm), Facet 2 (Wound care) and Facet 3 (Clinical decision support system). Studies based on acute wounds or trauma were excluded. Similarly, studies that presented guidelines, protocols and instructions were excluded, since they do not require progression along an active chain of reasoning from the clinicians, just their focus. Finally, studies were excluded if they had not undergone a peer review process. The following aspects were extracted from each article: authors, year, country, the sample size of data and variables describing the type of clinical decision support models. The decision support models were classified in 2 ways: quantitative decision support models, and qualitative decision support models. RESULTS: The final number of studies included in the systematic literature review was 10. These clinical decision support models included 4/10 (40%) quantitative decision support models and 6/10 (60%) qualitative decision support models. The earliest article was published in 2007, and the most recent was from 2015. CONCLUSIONS: The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the health care professionals, while qualitative models required interaction with the user.

Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment.

Complicated and long-lasting wound care of diabetic foot ulcers are moving from specialists in wound care at hospitals towards community nurses without specialist diabetic foot ulcer wound care knowledge. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. A situational case study design was adopted in an archetypical Danish community nursing setting. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. Peer-to-peer training is the prevailing way to learn about diabetic foot ulcer, however, this contributes to the risk of low evidence-based practice. Finally, a frequent behaviour among the community nurses is to consult colleagues before treating the diabetic foot ulcers.

An Iterative, Mixed Usability Approach Applied to the Telekit System from the Danish TeleCare North Trial.

Objective. The aim of the present study is to evaluate the usability of the telehealth system, coined Telekit, by using an iterative, mixed usability approach. Materials and Methods. Ten double experts participated in two heuristic evaluations (HE1, HE2), and 11 COPD patients attended two think-aloud tests. The double experts identified usability violations and classified them into Jakob Nielsen's heuristics. These violations were then translated into measurable values on a scale of 0 to 4 indicating degree of severity. In the think-aloud tests, COPD participants were invited to verbalise their thoughts. Results. The double experts identified 86 usability violations in HE1 and 101 usability violations in HE2. The majority of the violations were rated in the 0-2 range. The findings from the think-aloud tests resulted in 12 themes and associated examples regarding the usability of the Telekit system. The use of the iterative, mixed usability approach produced both quantitative and qualitative results. Conclusion. The iterative, mixed usability approach yields a strong result owing to the high number of problems identified in the tests because the double experts and the COPD participants focus on different aspects of Telekit's usability. This trial is registered with Clinicaltrials.gov, NCT01984840, November 14, 2013.

Participatory Heuristic Evaluation of the Second Iteration of the eWALL Interface Application.

The number of people having a chronic disease is increasing. Telehealth may provide an alternative to traditional medicine as telehealth solutions have shown to have a positive influence on quality of live and to decrease the number of hospital visits. A new telehealth solution is the eWALL system. Previously, the eWALL interface application has been evaluated using participatory heuristic evaluation (PHE). The previous round of PHE lead to drastic changes of the eWALL interface application. Consequently, a second round of PHE was performed. Five usability experts and two work-domain professionals inspected the eWALL interface application and identified usability problems (n = 384). The work domain professionals had a tendency to use other heuristics than the usability experts highlighting the relevance of using PHE in an interface development process.

Assessing the Potential Use of Eye-Tracking Triangulation for Evaluating the Usability of an Online Diabetes Exercise System.

The Online Diabetes Exercise System was developed to motivate people with Type 2 diabetes to do a 25 minutes low-volume high-intensity interval training program. In a previous multi-method evaluation of the system, several usability issues were identified and corrected. Despite the thorough testing, it was unclear whether all usability problems had been identified using the multi-method evaluation. Our hypothesis was that adding the eye-tracking triangulation to the multi-method evaluation would increase the accuracy and completeness when testing the usability of the system. The study design was an Eye-tracking Triangulation; conventional eye-tracking with predefined tasks followed by The Post-Experience Eye-Tracked Protocol (PEEP). Six Areas of Interests were the basis for the PEEP-session. The eye-tracking triangulation gave objective and subjective results, which are believed to be highly relevant for designing, implementing, evaluating and optimizing systems in the field of health informatics. Future work should include testing the method on a larger and more representative group of users and apply the method on different system types.

A multi-method pilot evaluation of an online diabetes exercise system.

The American Diabetes Association and The European Association of The Study of Diabetes recommend people with Type 2 diabetes to do moderate to vigorous aerobic exercise for 150 min per week to avoid late diabetic complications. However, most people with diabetes do not follow the recommendation. Consumer health information technology (CHIT) might play a role in supporting behavior changes that promote health and well-being. A CHIT prototype of an online diabetes exercise system, which contained the newest research of low volume high-intensity interval training (HIT), was developed. To test the system we used a multi-method pilot evaluation that includes; interviews, paper prototyping, heuristic evaluation, and test with patients. The patients expressed satisfaction with HIT and appreciated that the system was web-based. The findings from this pilot study inspire to further development and evaluation of online CHIT systems to diabetics.

Heuristic evaluation and thinking aloud test of a digitized questionnaire for diabetes outpatient clinics.

Diabetes is a chronic disease characterized by hyperglycaemia. The number of patients with diabetes is expected to exceed 592 million in 2035. The growing number of diabetics is a great burden for the Danish healthcare system. The Danish government desires a modern and efficient healthcare system with a high patient security and a coherent continuity of care. To achieve these outcomes medical record-keeping, paper questionnaires and notes must be digitized. The current system enforces that the diabetics fill out questionnaires in paper form after which the healthcare personnel enter the same information in the electronic health record. In this study, an online questionnaire was designed and the usability was evaluated using the following parameters: learnability, efficiency, memorability, errors, and satisfaction. The parameters were evaluated by using the discount usability engineering method. 5 double specialists and 6 patients diagnosed with diabetes provided the data of the study. The results indicated that simple and obvious figures were preferred in the online questionnaire, as well as error preventing in the form of validation fields. This study inspire to further development in the digitizing process.