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Trofimova E, Asgharzadeh Kangachar S, Weynberg KD, Willows RD, Jaschke PR. A bacterial genome assembly and annotation laboratory using a virtual machine. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2023; 51:276-285. [PMID: 36866633 PMCID: PMC10947226 DOI: 10.1002/bmb.21720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 05/15/2023]
Abstract
With the global increase of infections caused by antibiotic-resistant bacterial strains, there is an urgent need for new methods of tackling the issue. Genomic analysis of bacterial strains can help to understand their virulence and antibiotic resistance profile. Bioinformatic skills are in great demand across the biological sciences. We designed a workshop that allows university students to learn the process of genome assembly using command-line tools within a virtual machine on a Linux operating system. We use Illumina and Nanopore short and long-read raw sequences to reveal the advantages and disadvantages of short, long, and hybrid assembly methods. The workshop teaches how to assess read and assembly quality, perform genome annotation, and analyze pathogenicity, antibiotic and phage resistance. The workshop is intended for a five-week teaching period and is concluded by a student poster presentation assessment.
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Affiliation(s)
- Ellina Trofimova
- School of Natural SciencesMacquarie UniversitySydneyNew South WalesAustralia
- ARC Centre of Excellence in Synthetic BiologyMacquarie UniversitySydneyAustralia
| | - Shahla Asgharzadeh Kangachar
- Australian Centre for Ecogenomics, School of Chemistry and Molecular BiosciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Karen D. Weynberg
- Australian Centre for Ecogenomics, School of Chemistry and Molecular BiosciencesUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Robert D. Willows
- School of Natural SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Paul R. Jaschke
- School of Natural SciencesMacquarie UniversitySydneyNew South WalesAustralia
- ARC Centre of Excellence in Synthetic BiologyMacquarie UniversitySydneyAustralia
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2
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Morstead T, DeLongis A. Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing. J Genet Couns 2023. [PMID: 36734314 DOI: 10.1002/jgc4.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
Direct-to-consumer (DTC) genetic tests have become an attractive product for those hoping to gain insight into their health, ancestry, and biological relatedness. In some cases, test results are unexpected, and lead to the revelation of previously undisclosed family secrets. A subset of individuals may pursue testing explicitly for this purpose; however, the psychosocial processes underlying this motivation remain unexamined. Grounded in the literature on family secrecy, trauma, and the development of self-concept, we tested a hypothesized mediation model to provide insight into this motivation among a sample of 433 individuals in pursuit of DTC genetic testing. In line with the documented association between maladaptive family communication patterns and trauma exposure in childhood, we found that exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets. We also found evidence of an indirect effect through reduced self-concept clarity. These findings suggest that impaired identity formation processes may have played a role in transmitting the effect. Furthermore, the findings highlight a novel way in which family histories may contribute to DTC genetic testing motivations. Future examination of these and other psychosocial phenomena that contribute to DTC genetic testing will be crucial to consider as the tests become increasingly accessible, and as the information they can provide becomes increasingly comprehensive. Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and the conditions under which the act of testing and receipt of results could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.
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Affiliation(s)
- Talia Morstead
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita DeLongis
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
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3
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Direct-to-consumer genetic testing in the news: a descriptive analysis. J Community Genet 2023; 14:63-69. [PMID: 36239910 PMCID: PMC9947208 DOI: 10.1007/s12687-022-00613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/04/2022] [Indexed: 10/17/2022] Open
Abstract
Direct-to-consumer genetic testing (DTC GT) diagnostic tools do not entail referral through a healthcare provider and are used by consumers to screen for genetic health risk, pharmacogenomics, and predisposition to certain diseases and to learn more about ancestry. The purpose of this study was to describe the content of DTC DNA online news articles - specifically to characterize how rising concerns related to consumer privacy, medical advancements, and bioethics are covered in online news as access to these testing kits continues to grow. One hundred news articles identified on Google News using the search term "direct to consumer DNA testing" were coded for pre-determined content categories. Only 34.0% of news articles were created by healthcare professionals. Only 10.0% of online news articles mentioned testing confidentiality and privacy protection. Articles that mentioned > 5 commercial DTC DNA products more often discussed how DTC DNA testing provides personalized information about health and link to family disease risk and other traits (85.7% vs. 61.1%, p = 0.02), can lead to the location of family members or ancestors (78.6% vs. 55.63%, p = 0.03), and that the testing results housed in DNA databases can be utilized by law enforcement to track suspects or their relatives (32.1% vs. 9.7%, p = 0.01). Articles that mentioned ≤ 5 commercial DTC DNA products failed to mention that there exists a potential for data breaches (75.0% vs. 53.6%, p = 0.04). Online news articles should adequately inform consumers regarding the benefits and risks of DTC GT tests to facilitate informed decision-making.
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Liu Y, Yin Z, Wan Z, Yan C, Xia W, Ni C, Clayton EW, Vorobeychik Y, Kantarcioglu M, Malin BA. Implicit Incentives Among Reddit Users to Prioritize Attention Over Privacy and Reveal Their Faces When Discussing Direct-to-Consumer Genetic Test Results: Topic and Attention Analysis. JMIR INFODEMIOLOGY 2022; 2:e35702. [PMID: 37113452 PMCID: PMC9987181 DOI: 10.2196/35702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 04/29/2023]
Abstract
Background As direct-to-consumer genetic testing services have grown in popularity, the public has increasingly relied upon online forums to discuss and share their test results. Initially, users did so anonymously, but more recently, they have included face images when discussing their results. Various studies have shown that sharing images on social media tends to elicit more replies. However, users who do this forgo their privacy. When these images truthfully represent a user, they have the potential to disclose that user's identity. Objective This study investigates the face image sharing behavior of direct-to-consumer genetic testing users in an online environment to determine if there exists an association between face image sharing and the attention received from other users. Methods This study focused on r/23andme, a subreddit dedicated to discussing direct-to-consumer genetic testing results and their implications. We applied natural language processing to infer the themes associated with posts that included a face image. We applied a regression analysis to characterize the association between the attention that a post received, in terms of the number of comments, the karma score (defined as the number of upvotes minus the number of downvotes), and whether the post contained a face image. Results We collected over 15,000 posts from the r/23andme subreddit, published between 2012 and 2020. Face image posting began in late 2019 and grew rapidly, with over 800 individuals revealing their faces by early 2020. The topics in posts including a face were primarily about sharing, discussing ancestry composition, or sharing family reunion photos with relatives discovered via direct-to-consumer genetic testing. On average, posts including a face image received 60% (5/8) more comments and had karma scores 2.4 times higher than other posts. Conclusions Direct-to-consumer genetic testing consumers in the r/23andme subreddit are increasingly posting face images and testing reports on social platforms. The association between face image posting and a greater level of attention suggests that people are forgoing their privacy in exchange for attention from others. To mitigate this risk, platform organizers and moderators could inform users about the risk of posting face images in a direct, explicit manner to make it clear that their privacy may be compromised if personal images are shared.
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Affiliation(s)
- Yongtai Liu
- Department of Computer Science Vanderbilt University Nashville, TN United States
| | - Zhijun Yin
- Department of Computer Science Vanderbilt University Nashville, TN United States
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Zhiyu Wan
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Chao Yan
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Weiyi Xia
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Congning Ni
- Department of Computer Science Vanderbilt University Nashville, TN United States
| | - Ellen Wright Clayton
- School of Law, Vanderbilt University Nashville, TN United States
- Department of Pediatrics, Vanderbilt University Medical Center Nashville, TN United States
- Department of Health Policy Vanderbilt University Medical Center Nashville, TN United States
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis St. Louis, MO United States
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas Richardson, TX United States
| | - Bradley A Malin
- Department of Computer Science Vanderbilt University Nashville, TN United States
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
- Department of Biostatistics Vanderbilt University Medical Center Nashville, TN United States
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5
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Toussaint PA, Renner M, Lins S, Thiebes S, Sunyaev A. Direct-to-Consumer Genetic Testing on Social Media: Topic Modeling and Sentiment Analysis of YouTube Users' Comments. JMIR INFODEMIOLOGY 2022; 2:e38749. [PMID: 37113449 PMCID: PMC10014090 DOI: 10.2196/38749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/15/2022] [Accepted: 08/18/2022] [Indexed: 04/29/2023]
Abstract
Background With direct-to-consumer (DTC) genetic testing enabling self-responsible access to novel information on ancestry, traits, or health, consumers often turn to social media for assistance and discussion. YouTube, the largest social media platform for videos, offers an abundance of DTC genetic testing-related videos. Nevertheless, user discourse in the comments sections of these videos is largely unexplored. Objective This study aims to address the lack of knowledge concerning user discourse in the comments sections of DTC genetic testing-related videos on YouTube by exploring topics discussed and users' attitudes toward these videos. Methods We employed a 3-step research approach. First, we collected metadata and comments of the 248 most viewed DTC genetic testing-related videos on YouTube. Second, we conducted topic modeling using word frequency analysis, bigram analysis, and structural topic modeling to identify topics discussed in the comments sections of those videos. Finally, we employed Bing (binary), National Research Council Canada (NRC) emotion, and 9-level sentiment analysis to identify users' attitudes toward these DTC genetic testing-related videos, as expressed in their comments. Results We collected 84,082 comments from the 248 most viewed DTC genetic testing-related YouTube videos. With topic modeling, we identified 6 prevailing topics on (1) general genetic testing, (2) ancestry testing, (3) relationship testing, (4) health and trait testing, (5) ethical concerns, and (6) YouTube video reaction. Further, our sentiment analysis indicates strong positive emotions (anticipation, joy, surprise, and trust) and a neutral-to-positive attitude toward DTC genetic testing-related videos. Conclusions With this study, we demonstrate how to identify users' attitudes on DTC genetic testing by examining topics and opinions based on YouTube video comments. Shedding light on user discourse on social media, our findings suggest that users are highly interested in DTC genetic testing and related social media content. Nonetheless, with this novel market constantly evolving, service providers, content providers, or regulatory authorities may still need to adapt their services to users' interests and desires.
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Affiliation(s)
- Philipp A Toussaint
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health Karlsruhe/Heidelberg Germany
| | - Maximilian Renner
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Sebastian Lins
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Scott Thiebes
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
| | - Ali Sunyaev
- Department of Economics and Management Karlsruhe Institute of Technology Karlsruhe Germany
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6
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Wan Z, Hazel JW, Clayton EW, Vorobeychik Y, Kantarcioglu M, Malin BA. Sociotechnical safeguards for genomic data privacy. Nat Rev Genet 2022; 23:429-445. [PMID: 35246669 PMCID: PMC8896074 DOI: 10.1038/s41576-022-00455-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/21/2022]
Abstract
Recent developments in a variety of sectors, including health care, research and the direct-to-consumer industry, have led to a dramatic increase in the amount of genomic data that are collected, used and shared. This state of affairs raises new and challenging concerns for personal privacy, both legally and technically. This Review appraises existing and emerging threats to genomic data privacy and discusses how well current legal frameworks and technical safeguards mitigate these concerns. It concludes with a discussion of remaining and emerging challenges and illustrates possible solutions that can balance protecting privacy and realizing the benefits that result from the sharing of genetic information. In this Review, the authors describe technical and legal protection mechanisms for mitigating vulnerabilities in genomic data privacy. They also discuss how these protections are dependent on the context of data use such as in research, health care, direct-to-consumer testing or forensic investigations.
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Affiliation(s)
- Zhiyu Wan
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Computer Science, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James W Hazel
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA.,Vanderbilt University Law School, Nashville, TN, USA
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, USA
| | - Bradley A Malin
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Computer Science, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Huang J, Liang ZS, Pallotti S, Ranson JM, Llewellyn DJ, Zheng ZJ, King DA, Zhou Q, Zheng H, Napolioni V. PAGEANT: personal access to genome and analysis of natural traits. Nucleic Acids Res 2021; 50:e39. [PMID: 34928375 PMCID: PMC9023285 DOI: 10.1093/nar/gkab1245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
GWASs have identified numerous genetic variants associated with a wide variety of diseases, yet despite the wide availability of genetic testing the insights that would enhance the interpretability of these results are not widely available to members of the public. As a proof of concept and demonstration of technological feasibility, we developed PAGEANT (Personal Access to Genome & Analysis of Natural Traits), usable through Graphical User Interface or command line-based version, aiming to serve as a protocol and prototype that guides the overarching design of genetic reporting tools. PAGEANT is structured across five core modules, summarized by five Qs: (i) quality assurance of the genetic data; (ii) qualitative assessment of genetic characteristics; (iii) quantitative assessment of health risk susceptibility based on polygenic risk scores and population reference; (iv) query of third-party variant databases (e.g. ClinVAR and PharmGKB) and (v) quick Response code of genetic variants of interest. Literature review was conducted to compare PAGEANT with academic and industry tools. For 2504 genomes made publicly available through the 1000 Genomes Project, we derived their genomic characteristics for a suite of qualitative and quantitative traits. One exemplary trait is susceptibility to COVID-19, based on the most up-to-date scientific findings reported.
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Affiliation(s)
- Jie Huang
- Department of Global Health, Peking University School of Public Health, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China
| | - Zhi-Sheng Liang
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Stefano Pallotti
- Genetics and Animal Breeding Group, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK.,Alan Turing Institute, London, UK
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Daniel A King
- Northwell Health Cancer Institute and Feinstein Institutes for Research, Lake Success, NY, USA
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Shenzhen, China
| | - Houfeng Zheng
- Diseases & Population (DaP) Geninfo Lab., School of Life Sciences, Westlake University, Hangzhou, China
| | - Valerio Napolioni
- Genomic and Molecular Epidemiology (GAME)Lab., School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
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Hazel JW, Hammack-Aviran C, Brelsford KM, Malin BA, Beskow LM, Clayton EW. Direct-to-consumer genetic testing: Prospective users' attitudes toward information about ancestry and biological relationships. PLoS One 2021; 16:e0260340. [PMID: 34843533 PMCID: PMC8629298 DOI: 10.1371/journal.pone.0260340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Direct-to-consumer genetic testing is marketed as a tool to uncover ancestry and kin. Recent studies of actual and potential users have demonstrated that individuals’ responses to the use of these tests for these purposes are complex, with privacy, disruptive consequences, potential for misuse, and secondary use by law enforcement cited as potential concerns. We conducted six focus groups with a diverse sample of participants (n = 62) who were aware of but had not used direct-to-consumer genetic tests, in an effort to understand more about what people considering these tests think about the potential value, risks, and benefits of such testing, taking into account use by third parties, such as potential kin and law enforcement. Participants differed widely in the perceived value of direct-to-consumer genetic tests for ancestry and kinship information for their own lives, including the desirability of contact with previously unknown relatives. Some perceived ancestry testing as mere curiosity or entertainment, while others, particularly those who had gaps in their family history, few living relatives, or who were adopted, saw greater value. Concerns about intrusion into one’s life by purported kin and control of data were widespread, with many participants expressing concern about secondary uses of data that could harm users or their families. The use of direct-to-consumer genetic tests data for forensic genealogy elicited a particularly wide array of reactions, both spontaneously and in response to specific discussion prompts, mirroring the current public debate about law enforcement access to such data. The themes uncovered through our investigation warrant specific attention in the continued development of the science, policy, and practice of commercial direct-to-consumer genetic testing.
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Affiliation(s)
- James W. Hazel
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bradley A. Malin
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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Yin Z, Liu Y, McCoy AB, Malin BA, Sengstack PR. Contribution of Free-Text Comments to the Burden of Documentation: Assessment and Analysis of Vital Sign Comments in Flowsheets. J Med Internet Res 2021; 23:e22806. [PMID: 33661128 PMCID: PMC7974764 DOI: 10.2196/22806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/11/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background Documentation burden is a common problem with modern electronic health record (EHR) systems. To reduce this burden, various recording methods (eg, voice recorders or motion sensors) have been proposed. However, these solutions are in an early prototype phase and are unlikely to transition into practice in the near future. A more pragmatic alternative is to directly modify the implementation of the existing functionalities of an EHR system. Objective This study aims to assess the nature of free-text comments entered into EHR flowsheets that supplement quantitative vital sign values and examine opportunities to simplify functionality and reduce documentation burden. Methods We evaluated 209,055 vital sign comments in flowsheets that were generated in the Epic EHR system at the Vanderbilt University Medical Center in 2018. We applied topic modeling, as well as the natural language processing Clinical Language Annotation, Modeling, and Processing software system, to extract generally discussed topics and detailed medical terms (expressed as probability distribution) to investigate the stories communicated in these comments. Results Our analysis showed that 63.33% (6053/9557) of the users who entered vital signs made at least one free-text comment in vital sign flowsheet entries. The user roles that were most likely to compose comments were registered nurse, technician, and licensed nurse. The most frequently identified topics were the notification of a result to health care providers (0.347), the context of a measurement (0.307), and an inability to obtain a vital sign (0.224). There were 4187 unique medical terms that were extracted from 46,029 (0.220) comments, including many symptom-related terms such as “pain,” “upset,” “dizziness,” “coughing,” “anxiety,” “distress,” and “fever” and drug-related terms such as “tylenol,” “anesthesia,” “cannula,” “oxygen,” “motrin,” “rituxan,” and “labetalol.” Conclusions Considering that flowsheet comments are generally not displayed or automatically pulled into any clinical notes, our findings suggest that the flowsheet comment functionality can be simplified (eg, via structured response fields instead of a text input dialog) to reduce health care provider effort. Moreover, rich and clinically important medical terms such as medications and symptoms should be explicitly recorded in clinical notes for better visibility.
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Affiliation(s)
- Zhijun Yin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Yongtai Liu
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
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