Identifying Actionability as a Key Factor for the Adoption of ‘Intelligent’ Systems for Drug Safety: Lessons Learned from a User-Centred Design Approach

Abstract Background Patients with rheumatoid arthritis are generally seen at arbitrary intervals in secondary care. Patients with active disease may not always be seen at the most appropriate time and those with low disease activity may be seen more frequently than necessary. The NHS Long Term Plan expects outpatient appointments to be reduced by up to a third, with digital transformation a key enabler. The remote capture of patient-reported outcome measures (PROMs) has the potential to facilitate more flexible and responsive outpatient services. Methods This project aimed to design a digital remote monitoring platform to test the hypothesis that PROMs can be used to proactively monitor and trigger consultations when patients need them most. The Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, a validated multidimensional PROM, was used. Waiting room testing with patients informed the design of an acceptable mobile device format of the RAID. Recruitment criteria and acceptable cut-offs for defining flare were agreed by the rheumatology multidisciplinary team. Patients in low disease activity or remission (DAS <3.2) were invited to the service via SMS. All patients were informed regarding the governance of handling patient data and an opt-out option was offered. Patients were sent an automated monthly SMS with a PROM link and weekly reminder SMS if required. They also had the option to send in SMS messages at other times or add free text comments. Patients submitting a RAID score of ≥ 4 received a SMS with a link to the rheumatology advice service advising a remote consultation. The SMS-based service went live in January 2019 and all incoming communication was monitored on a daily basis. Results 104 RA patients are currently using the remote monitoring service with 10.3% (13/117) opting-out. 847 monthly PROMs have been sent via SMS. The PROM completion rate has been 68.9% (range 59.0-85.1%). 120 RAID (21.8%) scored 2-≤4 indicating low disease activity and 136 RAID (24.7%) ≤ 2 indicating disease remission. 480 SMS have been sent manually to patients who have engaged in two-way communication or returned a RAID score ≥4. 44 telephone advice appointments were triggered through the remote monitoring service by patients in disease flare. 80% (35/44) of remote consultation were considered to have to have averted a face to face consultation with the remaining 20% providing advice alone. Interviews have been conducted with PROM ‘non-completers’ to learn and inform further service design. Conclusion This project has demonstrated how a user-centred design approach to utilising technology can support access to rheumatology care when patients need it most, such as disease flare. The identification of patients self-reporting low disease activity using multidimensional PROMs may enable more efficient utilisation of clinical capacity through patient-initiated appointment deferment and lead to improved patient-centred care. Disclosures M.J. Martin: Honoraria; Novartis, Abbvie. Grants/research support; National Ankylosing Spondylitis Society. N. Ng None. L. Blackler None. T. Garrood None.

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Pressure conditions in coupled magma bodies and their evolution during eruptions and caldera collapse: Piton de la Fournaise 2007

10.5194/egusphere-egu2020-19454 ◽

2020 ◽

Author(s):

Freysteinn Sigmundsson ◽

Aline Peltier ◽

Siqi Li ◽

Valerie Ferrazzini ◽

Andrea Di Muro

Keyword(s):

Lessons Learned ◽

Driving Pressure ◽

Caldera Collapse ◽

Flank Eruption ◽

Magma Flow ◽

Magma Body ◽

Piton De La Fournaise ◽

Key Factor ◽

Elevation Difference ◽

Pressure Evolution

<p>Understanding the interplay between pressure evolution in magma bodies in volcano roots and caldera collapses is important to for the general understanding of volcanoes and how calderas form. We use lessons-learned regarding caldera collapse dynamics and inferred 2014-2015 pressure evolution in a magma body under the Bardarbunga caldera, Iceland, to revisit the dynamics of the 2007 caldera collapse at Piton de La Fournaise volcano, La Reunion, in a project supported by EUROVOLC trans-national access. At Piton de la Fournaise, (rising to 2632 m above sea leve) a shallow and small magma body (close to sea-level; volume less than one cubic kilometer) played a central role. The overpressure compared to lithostatic prior to collapse is inferred to have been small (< 5 MPa), based on models of driving pressure for minor eruptions that occurred on 18-19 February and 30 March prior to the caldera forming lateral flank eruption that occurred 2 April &#8211; 1 May, 2007. The site of the lateral flank eruption occurred at an elevation of 500 m, much lower than the summit.&#160; This elevation difference is inferred to a key factor for creating high driving pressure for magma flow. We infer that rapid flow of magma led to fast drop in pressure in a shallow magma body under the caldera, triggering inflow of magma from a deeper magma body under Piton de la Fournaise, that was in important element of the 2007 eruptive activity.&#160; This deep inflow did, however, not sustain enough the pressure in the shallow magma body during the eruption, causing development of significant under-pressure leading to the collapse.</p>

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VARIOUS ASPECTS OF INTELLIGENT COLLABORATIVE EDUCATIONAL SYSTEMS

Environment Technology Resources Proceedings of the International Scientific and Practical Conference ◽

10.17770/etr2017vol2.2549 ◽

2017 ◽

Vol 2 ◽

pp. 67

Author(s):

Sabina Katalnikova ◽

Leonids Novickis

Keyword(s):

Intelligent Systems ◽

Intelligent System ◽

System Development ◽

Effective Means ◽

Educational Systems ◽

Knowledge Based ◽

Knowledge Based Economy ◽

Wide Range ◽

Key Factor ◽

System Knowledge

In connection with the transition to a knowledge-based economy, at a time when a key factor in the development of society is the accumulated human knowledge and skills, as well as the availability of a wide range of users, intelligent systems are becoming very popular. Accordingly, the demand of the ergonomic and effective means of designing this class system is growing as well. The most time-consuming and most important stage of intelligent system development is the formation of the system knowledge base which ultimately determines the efficiency and quality of the entire intelligent system. Knowledge representation and processing models and methods as well as the intelligent system development techniques operating on the basis of these methods and models have a crucial role in relation to this. The article explores the different aspects of intelligent collaborative educational systems, describes the overall structure of an intelligent collaborative educational system and reflects the different steps of development the system.

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Answers linked to Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21

Journal of Hospital Infection ◽

10.1016/j.jhin.2007.07.027 ◽

2008 ◽

Vol 68 (2) ◽

pp. 178

Keyword(s):

Hand Hygiene ◽

Design Approach ◽

Hosp Infect ◽

User Centred Design

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The development of an mHealth tool for children with long-term illness to enable person-centred communication: a user centred-design approach (Preprint)

JMIR Pediatrics and Parenting ◽

10.2196/30364 ◽

2021 ◽

Author(s):

Angelica Wiljén ◽

John Chaplin ◽

Vanessa Crine ◽

William Jobe ◽

Ensa Johnson ◽

...

Keyword(s):

Design Approach ◽

User Centred Design

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The Development of a Point of Care Clinical Guidelines Mobile Application Following a User-Centred Design Approach

Lecture Notes in Computer Science - Design, User Experience, and Usability. Case Studies in Public and Personal Interactive Systems ◽

10.1007/978-3-030-49757-6_21 ◽

2020 ◽

pp. 294-313

Author(s):

James Mitchell ◽

Ed de Quincey ◽

Charles Pantin ◽

Naveed Mustfa

Keyword(s):

Clinical Guidelines ◽

Mobile Application ◽

Point Of Care ◽

Design Approach ◽

User Centred Design

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The development of a clinical interface for a novel newborn resuscitation device; a Human Factors approach to understand cognitive user requirements. (Preprint)

10.2196/preprints.12055 ◽

2018 ◽

Author(s):

Laura Pickup ◽

Alexandra Lang ◽

Lara Shipley ◽

Caroline Henry ◽

James Carpenter ◽

...

Keyword(s):

Heart Rate ◽

Human Factors ◽

Medical Device ◽

Interface Design ◽

New Technology ◽

Unmet Need ◽

Neonatal Resuscitation ◽

Design Approach ◽

New Device ◽

User Centred Design

BACKGROUND A novel medical device has been developed to address an unmet need in standardising and facilitating heart rate recording during neonatal resuscitation. In a time critical emergency resuscitation, where failure can mean death of an infant, it is vital that clinicians are provided with information in a timely, precise and clear manner to capacitate appropriate decision making. This new technology provides a hands free, wireless heart rate monitoring solution that easily fits the clinical pathway and procedure for neonatal resuscutation. To understand the requirements of the interface design for this new device, a human factors approach was implemented. This combined a traditional user-centred design approach with an Applied Cognititive Task Analysis (ACTA) to understand the tasks involved, the cognitive requirements and the potential for error during a neonatal resusciation scenario. OBJECTIVE 1. To understand the cognitive requirements of clinicians for a novel medical device to facilitate neonatal resuscitation; 2. To apply a human factors approach and a traditional user-centred design approach to provide a device interface specification. METHODS Fourteen clinical staff were involved in producing the final design requirements. Two paediatric doctors supported the development of a visual representation of the activities associated with neonatal resucitation. This was used to develop a scenario based workshop. Two workshops were carried out in parallel and involved three paediatric doctors, three neonatal nurses, two advance neonatal practitioners and four midwives. Both groups came together at the end to reflect on the findings which emerged during the separate sessions. RESULTS The outputs of this study have provided a comprehensive description of information requirements during neonatal resuscitation, and enabled product developers to understand the core and preferred requirements of the user interface design for the device. The study raised three key areas for the designers to consider, which had not previously been highlighted. These related to interface layout and information priority, size and portability of the device and auditory feedback. CONCLUSIONS This study demonstrates the value of the ACTA approach to inform the development of resuscitation devices, and more generally for medical device development.

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Guidelines for cell-type heterogeneity quantification based on a comparative analysis of reference-free DNA methylation deconvolution software

10.1101/698050 ◽

2019 ◽

Cited By ~ 4

Author(s):

Clementine Decamps ◽

Florian Privé ◽

Raphael Bacher ◽

Daniel Jost ◽

Arthur Waguet ◽

...

Keyword(s):

Dna Methylation ◽

Cell Types ◽

R Package ◽

Lessons Learned ◽

Future Research ◽

Cell Type ◽

Software Packages ◽

Response To Chemotherapy ◽

Key Factor ◽

Pre Treatment

AbstractCell-type heterogeneity of tumors is a key factor in tumor progression and response to chemotherapy. Tumor cell-type heterogeneity, defined as the proportion of the various cell-types in a tumor, can be inferred from DNA methylation of surgical specimens. However, confounding factors known to associate with methylation values, such as age and sex, complicate accurate inference of cell-type proportions. While reference-free algorithms have been developed to infer cell-type proportions from DNA methylation, a comparative evaluation of the performance of these methods is still lacking.Here we use simulations to evaluate several computational pipelines based on the software packages MeDeCom, EDec, and RefFreeEWAS. We identify that accounting for confounders, feature selection, and the choice of the number of estimated cell types are critical steps for inferring cell-type proportions. We find that removal of methylation probes which are correlated with confounder variables reduces the error of inference by 30-35%, and that selection of cell-type informative probes has similar effect. We show that Cattell’s rule based on the scree plot is a powerful tool to determine the number of cell-types. Once the pre-treatment steps are achieved, the three deconvolution methods provide comparable results. We observe that all the algorithms’ performance improves when inter-sample variation of cell-type proportions is large or when the number of available samples is large. We find that under specific circumstances the methods are sensitive to the initialization method, suggesting that averaging different solutions or optimizing initialization is an avenue for future research. Based on the lessons learned, to facilitate pipeline validation and catalyze further pipeline improvement by the community, we develop a benchmark pipeline for inference of cell-type proportions and implement it in the R package medepir.

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