The RepVig framework for designing use-case specific representative vignettes and evaluating triage accuracy of laypeople and symptom assessment applications.

Most studies evaluating symptom-assessment applications (SAAs) rely on a common set of case vignettes that are authored by clinicians and devoid of context, which may be representative of clinical settings but not of situations where patients use SAAs. Assuming the use case of self-triage, we used representative design principles to sample case vignettes from online platforms where patients describe their symptoms to obtain professional advice and compared triage performance of laypeople, SAAs (e.g.

iKNOW-Supporting the counseling of women with hereditary risk of breast and ovarian cancer with digital technologies: A randomized controlled trial.

Purpose: We developed the online-based counseling tool iKNOW for women with a pathogenic germline variant in to improve risk understanding and quality of life.

Methods: With a randomized controlled trial, we investigated the efficacy of iKNOW with regard to risk understanding (primary endpoint), quality of life, risk perception, and anxiety (secondary endpoints). Self-report questionnaires were administered to  = 217 women with a pathogenic variant in before counseling (T0), immediately after (T1), 4 weeks after (T2), and 6 months after (T3).

Statistical refinement of patient-centered case vignettes for digital health research.

Digital health research often relies on case vignettes (descriptions of fictitious or real patients) to navigate ethical and practical challenges. Despite their utility, the quality and lack of standardization of these vignettes has often been criticized, especially in studies on symptom-assessment applications (SAAs) and self-triage decision-making. To address this, our paper introduces a method to refine an existing set of vignettes, drawing on principles from classical test theory.

Disease characteristics influence the privacy calculus to adopt electronic health records: A survey study in Germany.

Background: The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients' intention to use the EHR.

Teaching prudent antibiotic use on the go: a descriptive report on development, utilization and listener satisfaction of an educational podcast format for medical students and young professionals.

Background: An important component in fostering the responsible use of antibiotics is training of new and future prescribers in this interdisciplinary topic. Because podcasts are playing an increasing role in medical education, we aimed to develop and evaluate a podcast format with practice and guideline-oriented learning content on antibiotic therapy for medical students and young medical professionals.

Methods: We developed the concept for the podcast with the direct involvement of medical students and medical experts with teaching experience.

Influence of Disease-Related Stigma on Patients' Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial.

Background: The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, 3 out of 4 Germans stated that they intend to use the EHR, whereas other studies show that the intention to use a technology is not a reliable and sufficient predictor of actual use.

Talking about Familial Breast and Ovarian Cancer Risk-Evaluation of a Psychosocial Training Module for Gynecologists in Germany.

Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an increased HBOC risk and deal with emotional, stressful situations in this context. Our project aimed at developing a training module, 'iKNOWgynetics', addressing psychosocial challenges in the context of HBOC care for primary care gynecologists.

How suitable are clinical vignettes for the evaluation of symptom checker apps? A test theoretical perspective.

Objective: To evaluate the ability of case vignettes to assess the performance of symptom checker applications and to suggest refinements to the methodology used in case vignette-based audit studies.

Methods: We re-analyzed the publicly available data of two prominent case vignette-based symptom checker audit studies by calculating common metrics of test theory. Furthermore, we developed a new metric, the Capability Comparison Score (CCS), which compares symptom checker capability while controlling for the difficulty of the set of cases each symptom checker evaluated.

Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany.

Background: With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances.

Objective: This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies.

iKNOWgynetics - A web-based learning concept to empower primary care gynecologists to participate in the care of patients with a family history of breast and ovarian cancer.

Familial cancer burden and genetics play an increasingly important role in the early detection and prevention of gynecological cancers. However, people with hereditary cancer risks are often identified late when they already have cancer. We aimed at developing and evaluating a training concept for primary care gynecologists-iKNOWgynetics-to improve their knowledge and awareness of genetic cancer syndromes and their ability to identify patients with increased familial cancer risks based on up-to-date evidence and current guidelines (in Germany, primary care includes all doctors treating patients on an outpatient basis without a clear separation of the expertise of the doctor or of their specialty).

[Virtual hallway chats and status updates: collaboration in avatar-based work environments].

This article focuses on the collaboration of hybrid teams in avatar-based virtual office environments. Based on the three dimensions of virtuality, we pursue the following research questions: (1) How is everyday work and collaboration coordinated in these environments? and (2) Which advantages and challenges do users perceive in relation to this form of work? Based on a multi-method study consisting of qualitative interviews with experienced users and a participatory focus group discussion with new users, we illustrate that collaboration in avatar-based work environments is marked by a diverse array of work practices-ranging from co-present to mobile work-and that promising implementation methods exist to coordinate these practices. However, our results also suggest that to exploit this potential, not only the virtual environments but also teams' work practices and digital infrastructure must be further developed.

Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study.

Background: Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people's awareness of SCs and the perception of usefulness.

Objective: We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population.

Appropriate antibiotic use and antimicrobial resistance: knowledge, attitudes and behaviour of medical students and their needs and preferences for learning.

Background: The impact of an appropriate use of antibiotics on the prevention of antimicrobial resistance (AMR) has been demonstrated. Surveys have shown, however, that medical students do not feel sufficiently trained to use antibiotics wisely. The aims of our study were (1) to describe what medical students currently know about appropriate antibiotic use, and (2) to identify students' learning preferences as a basis for developing student-centred teaching modules to convey the basics of AMR prevention.

Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW).

iKNOW is the first evidence-based digital tool to support personalized counseling for women in Germany with a hereditary cancer risk. The counseling tool is designed for carriers of pathogenic gBRCA (germline breast cancer gene) variants that increase the lifetime risk of breast and ovarian cancer. Carriers of pathogenic variants are confronted with complex, individualized risk information, and physicians must be able to convey this information in a comprehensible way to enable preference-sensitive health decisions.

Boosting for insight and/or boosting for agency? How to maximize accurate test interpretation with natural frequencies.

Background: Many physicians do not know how to accurately interpret test results using Bayes' rule. As a remedy, two kinds of interventions have been shown effective: boosting insight and boosting agency with natural frequencies. To boost insight, test statistics are provided in natural frequencies (rather than conditional probabilities), without instructions on how to use them.

The Triage Capability of Laypersons: Retrospective Exploratory Analysis.

Background: Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health-related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient's health.

What Causes Cancer in Women with a Pathogenic Variant? Counselees' Causal Attributions and Associations with Perceived Control.

Laypersons have a strong need to explain critical life events, such as the development of an illness. Expert explanations do not always match the beliefs of patients. We therefore assessed causal attributions made by women with a pathogenic germline variant in BRCA1/2 (gBRCA1/2-PV), both with and without a cancer diagnosis.

Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation.

Background: Symptom checkers are digital tools assisting laypersons in self-assessing the urgency and potential causes of their medical complaints. They are widely used but face concerns from both patients and health care professionals, especially regarding their accuracy. A 2015 landmark study substantiated these concerns using case vignettes to demonstrate that symptom checkers commonly err in their triage assessment.

Determinants of Laypersons' Trust in Medical Decision Aids: Randomized Controlled Trial.

Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons' self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps' suggestions.

Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center.

Objective: Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems.

"You Never Get a Second Chance": First Impressions of Physicians Depend on Their Body Posture and Gender.

A first impression matters, in particular when encounters are brief as in most doctor-patient interactions. In this study, we investigate how physicians' body postures impact patients' first impressions of them and extend previous research by exploring posture effects on the perception of roles of a physician - not just single aspects such as scholarly expertise or empathy. In an online survey, 167 participants ranked photographs of 4 physicians (2 female, 2 male) in 4 postures (2 open, 2 closed).

A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation.

Background: Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians).

Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial.

Background: During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs' underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree's nodes step-by-step in an interactive manner.

Patient Monitoring Alarms in an Intensive Care Unit: Observational Study With Do-It-Yourself Instructions.

Background: As one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients' vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients.

Objective: This study focused on providing a complete and repeatable analysis of the alarm data of an ICU's patient monitoring system.