BACKGROUND: Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients\' processing of the information.
OBJECTIVE: This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients\' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory.
METHODS: The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool.
RESULTS: A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants\' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants\' perception. Additionally, horizontal line bars significantly decreased participants\' tendency to search for information or to contact their physician, compared with numerical values with reference ranges.
CONCLUSIONS: In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants\' cognitive perception and perception of communication while decreasing participants\' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients\' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients\' information processing.

BACKGROUND: Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered.
OBJECTIVE: We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test-related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches.
METHODS: We collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects.
RESULTS: Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4-generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4\'s responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one\'s medical context, incorrect statements, and lack of references.
CONCLUSIONS: By evaluating LLMs in generating responses to patients\' laboratory test result-related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4\'s responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation.

A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results.
This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated.
Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients\' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers\' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes.
The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

UNASSIGNED: Non-typhoidal salmonella (NTS) infection is a leading cause of acute gastroenteritis in children. Recently, NTS infections have increased, especially those associated with Salmonella Typhimurium, which has become a global problem because of its high level of drug resistance. Diseases caused by NTS serotypes vary considerably. We summarised NTS infections among children in Fuzhou, Fujian, China, from 2012 to 2021, and synthesised studies indicating the clinical symptoms, laboratory test results, and drug resistance associated with S. Typhimurium and non-S. Typhimurium to enhance the knowledge of these infections and improve their diagnoses and treatment.
UNASSIGNED: Between January 2012 and December 2021, 691 children with NTS infections confirmed by positive culture test results were recruited from Fujian Children\'s Hospital and Fujian Maternity and Child Health Hospital. Clinical demographic data of each case were collected from the electronic medical records and analysed.
UNASSIGNED: A total of 691 isolates were identified. The number of NTS infections increased significantly in 2017 and increased sharply during 2020 and 2021, especially S. Typhimurium greatly increased and was the dominant serotype (58.3%). S. Typhimurium infection was commonly occurred in children younger than 3 years and most of them were gastrointestinal infection, while non-S. Typhimurium more often observed in older children and associated with extra-intestinal infection. The rate of multidrug-resistant S. Typhimurium was significantly higher than that of non-S. Typhimurium, especially during the last 2 years of this study (2020 and 2021).
UNASSIGNED: S. Typhimurium was the dominant serotype and greatly increased among children in Fuzhou city. There are significant differences in clinical symptoms, laboratory test results, and drug resistance between S. Typhimurium and non-S. Typhimurium. More attention should be paid on S. Typhimurium. Long-term high-quality surveillance and control measures should be conducted to prevent salmonella infections and drug resistance.

Laboratory (lab) test results are increasingly available online for patient review. However, there is a dearth of research with respect to users\' information needs, goals, and information processing strategies. In this exploratory qualitative study, we interviewed a sample of (N = 25) online lab results users to understand their objectives and search targets. We transcribed their responses and used affinity diagramming to identify themes in their responses. Our analysis identified six reasons why people look at their online lab results (i.e., health status, reassurance, health education, speed, self-management, and patient safety) and two themes about what people look for (i.e., abnormal and normal values, trends). Knowing what drives users and what information they are looking for can inform the design of online lab reporting, improve usefulness, and better satisfy user needs.

BACKGROUND: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups.
OBJECTIVE: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results.
METHODS: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients\' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale \"information and presentation\" of the eHIQ assessed the usability of the patient portal and the subscale \"motivation and confidence to act\" assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes.
RESULTS: The questionnaire was completed by 748 respondents, of which 428 (57.2%) were female, 423 (56.6%) were highly educated, and 509 (68%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95% CI -1147 to 0.042 (P<.001); b=-2.512, 95% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95% CI -6.469 to -0.572; P=.02). Other determinants were not significant.
CONCLUSIONS: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient\'s perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor.

OBJECTIVE: For the correct interpretation of test results, it is important to be aware of drug-laboratory test interactions (DLTIs). If DLTIs are not taken into account by clinicians, erroneous interpretation of test results may lead to a delayed or incorrect diagnosis, unnecessary diagnostic testing or therapy with possible harm for patients. A DLTI alert accompanying a laboratory test result could be a solution. The aim of this study was to test a multicentre proof of concept of an electronic clinical decision support system (CDSS) for real-time monitoring of DLTIs.
METHODS: CDSS was implemented in three Dutch hospitals. So-called \'clinical rules\' were programmed to alert medical specialists for possible DLTIs based on laboratory test results outside the reference range in combination with prescribed drugs. A selection of interactions from the DLTI database of the Dutch society of clinical chemistry and laboratory medicine were integrated in 43 clinical rules, including 24 tests and 25 drugs. During the period of one month all generated DTLI alerts were registered in the laboratory information system.
RESULTS: Approximately 65 DLTI alerts per day were detected in each hospital. Most DLTI alerts were generated in patients from the internal medicine and intensive care departments. The most frequently reported DLTI alerts were potassium-proton pump inhibitors (16%), potassium-beta blockers (11%) and creatine kinase-statins (11%).
CONCLUSIONS: This study shows that it is possible to alert for potential DLTIs in real-time with a CDSS. The CDSS was successfully implemented in three hospitals. Further research must reveal its usefulness in clinical practice.

Reflective testing, i.e. interpreting, commenting on and, if necessary, adding tests in order to aid the diagnostic process in a meaningful and efficient manner, is an extra service provided by laboratory medicine. However, there have been no prospective randomized controlled trials investigating the value of reflective testing in patient management.
In this trial, primary care patients were randomly allocated to an intervention group, where general practitioners received laboratory tests results as requested as well as add-on test results with interpretative comments where considered appropriate by the laboratory specialist, or to a control group, where general practitioners only received the laboratory test results requested. Patients\' medical records were evaluated with a follow-up period of six months. For both groups, the primary outcome measures, i.e. both intended action and actual management action, were blindly assessed by an independent expert panel as adequate, neutral or inadequate.
In 226 of the 270 cases (84%), reflective testing was considered to be useful for the patient. In the intervention group (n = 148), actual management by the general practitioner was scored as adequate (n = 104; 70%), neutral (n = 29; 20%) or not adequate (n = 15; 10%). In the control group (n = 122), these numbers were 57 (47%), 37 (30%) and 28 (23%). This difference was statistically significant (P < 0.001).
This randomized controlled trial showed a positive effect of reflective testing in primary care patients on the adequacy of their management, as documented in medical records.

UNASSIGNED: Epistaxis is a common cause of otorhinolaryngological clinic visits and admissions into accident and emergency. Severe epistaxis could remarkably alter the hemodynamic milieu of individuals and results into significant morbidity and occasional mortality.
UNASSIGNED: To review the clinical pattern and laboratory test results of individuals treated for epistaxis in a tertiary health care center in northern Nigeria.
UNASSIGNED: This study was a 10-year retrospective review of patients managed for epistaxis in the department of otorhinolaryngology, Aminu Kano teaching hospital, Kano, Nigeria. Case files of patients were retrieved, reviewed, and clinical and laboratory data were extracted. The data were analyzed using Statistical Product and Service Solution version 23.
UNASSIGNED: A total of 256 were reviewed with 149 (58.2%) male and 107 (41.8%) female with M: F of 1.4:1. A mean age ± SD of 33.86 ± 20.06 years. Anterior epistaxis was the most prevalent, 126 (49.2%), and majority of the patients presented with severe epistaxis, 75 (29.3%). Most were treated with nasal packing, 93 (36.3%). Majority had abnormal full blood counts and clotting profile results, 158 (61.75) and 104 (40.6%), respectively. There was a significant association between patient\'s genotype and outcome. Anterior epistaxis and AA genotype were significant positive predictors of outcome.
UNASSIGNED: Coagulopathies, anaemia, and hemoglobinopathies are common findings among our patients with epistaxis.

BACKGROUND: Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health.
OBJECTIVE: This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results.
METHODS: We used the online-administered eHealth Impact Questionnaire to explore patients\' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively.
RESULTS: The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales (r345=.77, P<.001).
CONCLUSIONS: Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients\' self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health.