Lab 2 – The Physics 500 Lab 3 – The Domino Effect Lab 4 – Merrily We Roll Along Lab 6 – Race Track Lab 7 – Bull’s Eye (b) Hsu – CPO Physics Lab 1A – Time, Distance and Speed (c) My Labs C-2: (from Topic 1): Walking Vectors (if this was not done in Topic 1) C-2: Walk a Number Line C-3: Velocity and Acceleration (a) Constant Motion.
- 8118 Fry RD Suite 1304 Cypress, TX 77433 [email protected] High-quality infographic templates which make your design workflow faster and easier.
- An infographic (or information graphic) is a visual representation of information, data, or knowledge. This interactive data visualization format has become incredibly popular over the last decade and has increased data literacy in fields such as: Media and journalism. Government communication. Team communication.
doi: 10.4103/0974-2948.71050
PMID: 21189983
This article has been cited by other articles in PMC.
Abstract
Wifi explorer 2 64. Dental records consist of documents related to the history of present illness, clinical examination, diagnosis, treatment done, and the prognosis. A thorough knowledge of dental records is essential for the practicing dentist, as it not only has a forensic application, but also a legal implication with respect to insurance and consumerism. This article reviews the importance of dental records in forensics.
Introduction
Forensic odontology is the application of the art and science of dentistry to resolve matters pertaining to the law. Some of the diverse facets of this unique discipline can range from the identification of human remains to mass disaster management, from the assessment of bite marks and patterned skin injuries to the use of dental materials in the examination of evidence.[1]
A dental record is the detailed document of the history of the illness, physical examination, diagnosis, treatment, and management of a patient. Dental professionals are compelled by law to produce and maintain adequate patient records. With the increasing awareness among the general public of legal issues surrounding healthcare, and with the worrying rise in malpractice cases, a thorough knowledge of dental record issues is essential for any practitioner. The ability of clinical practitioners to produce and maintain accurate dental records is essential for good quality patient care as well as it being a legal obligation. The dental record provides for the continuity of care for the patient and is critical in the event of a malpractice insurance claim.[]
Comprehensive and accurate records are a vital part of dental practice. Good record keeping is fundamental for good clinical practice and is an essential skill for practitioners. The primary purpose of maintaining dental records is to deliver quality patient care and follow-up. Dental records can also be used for forensic purposes and have an important role in teaching and research, as well as in legal matters. The code of practice on dental records documents the minimum requirements for recording and maintaining dental records and describes some of the underlying principles to be applied by the practitioners in their record keeping.
Patient Record
The record may consist of several different elements, which include written notes, radiographs, study models [Figures [Figures11–2], referral letters, consultants’ reports, clinical photographs, results of special investigations, drug prescriptions, laboratory prescriptions, patient identification information, and a comprehensive medical history. Obviously this is a large amount of information and it is essential that a practitioner maintains this in an easily accessible manner.
Dental records
Cartoon on significance of dental records
The information in the dental record should primarily be clinical in nature. The record includes a patient’s registration form with all the basic personal information. The dental team should be very meticulous and thorough in the dental office record keeping tasks. All information in the dental record should be clearly written, and the person responsible for entering new information should sign and date the entry. The information should not be ambiguous or contain many abbreviations. In practices with more than one dental practitioner, the identity of the practitioner rendering the treatment should be clearly noted in the record. All entries in the patient record should be dated, initialed, and handwritten in ink and / or computer printed. Although no specific color of ink is required, any copy of the record should be easy to read. Handwritten entries should be legible.
Within the written notes the following are examples of what is typically included in the dental record:[3,]
- Identification data — name, date of birth, phone numbers, and emergency contact information.
- Dental history
- Clinical examination to include an accurate charting
- Diagnosis
- Treatment plan
- Documentation of informed consent
- Medical history — a thorough investigation, to include a minimum of:-
- Name and phone number of physician
- Dentists’ own evaluation of patient’s general health and appearance
- List of systemic disease — diabetes, rheumatic fever, hepatitis, and the like
- Any ongoing medical treatment
- Any bleeding disorders, drug allergies, smoking and alcohol history
- Any cardiac disorders
- Relevant family medical history
- Pregnancy
- Physical and emotional tolerance for procedures
No financial information should be kept in the dental record. Ledger cards, insurance benefit breakdowns, insurance claims, and payment vouchers are not part of the patient’s clinical record. Financial records should be kept separately from the dental record. Other information best left out of the record would be personal opinions or criticisms. Do document a patient’s refusal to accept the recommended treatment plan and cancelled appointments.
The outside cover of the chart should only display the patient’s name and / or account number. Use of abstract is advantageous in the in-office system (color or symbol coding), so that only your office staff will be able to decipher it. For all offices, a single sticker on the outside cover can alert the team to look on the inside for important information regarding allergies, medications, antibiotic pre-medications, and clinical conditions that can affect dental treatment. All medical notations inside the chart, to be seen only by the authorized personnel.
Maintenance of dental records
Most dentists make notes on paper dental records. However, many more dentists are making use of computerized filing systems to maintain patient dental records. Electronic records have great quality and patient-safety benefits, and will likely increase as more dental clinics and hospitals become computerized. Many dental clinics use the traditional paper charts; the traditional filing systems are labeled with the following information,
- Patient’s surname
- Patient’s first name
- Patient’s middle name
- Patient’s degree or seniority (i.e., Senior, II)
The files are then arranged in a way for easy retrieval — usually in a lateral, open-shelf filing system.[5]
Color Coding
Many dental offices use a color-coded filing system for patient record files. Color-coded labels — usually the first two letters of the patient’s last name and active date of treatment — are placed on the patient’s file. This can help make record retrieval fast and easy.
Active and Inactive
Most offices have two categories of patient records files: (1) Active and (2) Inactive.
Active files hold the records of patients currently having their dental care provided by the practice. Inactive patients are considered to be those who have not returned for 24 months. Keep files of active patients on-site. These records should be conveniently located in the office.
Inactive files hold the records of patients who have been treated in the office in the past, but are not currently under care in the office. These files are generally located in the office, but in a remote area.
A system should be established in the office to identify a change from active to inactive status on a timely basis. All records, active and inactive, should be maintained carefully to be certain that they are not destroyed or lost.
Lawney describes a simple ten-step procedure to ensure that your records are adequate. A modified and expanded version, appropriate to the National Health Service and UK dentistry, which has been followed in UK is as follows,[,3] (adopting the same in our country will be very helpful)
- Use a consistent style for entries — the appearance of the record is enhanced by using the same colour and type of pen, use the same abbreviations and notations, and so on
- Date and explain any corrections — it may be a fatal error in a malpractice case if records appear doctored in any way. These unexplained corrections can undermine the credibility of the entire record and of the treating dentist
- Use single-line crossout — this preserves the integrity of the record and shows that you have nothing to hide
- Do not use correction fluids — not only is this messy, but it is conspicuous and may indicate that there has been an attempt to hide information.
- Use ink — pencil can fade and opens up the question of whether or not the records have been altered.
- Write legibly — an illegible record may be as bad as no record at all. Difficult to read entries can lead to guesswork by others and this may not be favorable to you.
- Express concerns about patient needs — by doing this you are documenting that you have listened, empathized, understood, and acted upon the wishes of your patient. It also enables an explanation to be given should a patient’s wishes be unobtainable or unrealistic, and can help instantly diffuse a malpractice case. Use quotations to indicate patient comments as distinct from your own.
- Never write derogatory remarks in the record — Superfluous entries only serve to convey a feeling of unprofessionalism and may create doubts regarding the overall credibility of the remainder of the record. Negative views about patients, such as their failure to follow your advice or attend appointments, should be recorded in a dispassionate and objective manner.
- Document fully — there is no need to be sparse with notes, a detailed explanation is always better than one lacking information.
- Only use accepted abbreviations for treatments — this is helpful both in a malpractice situation and also when transferring records to a different dentist for referral, prior approval or a change in dentist.
- Collate documents — insurance details and other materials from third parties should be separate from those items that pertain directly to patient care.
- Maintain a chronological order — the use of a hole punch and metal retainer clips on the top of the record may be helpful to keep loose sheets organized.
By following these steps the production of accurate and defensible records is possible.
Record Management
The recording of accurate patient information is essential to dentistry. The dental record, also referred to as the patient chart, is the official office document that records all diagnostic information, clinical notes, treatment given, and patient-related communications that occur in the dental office, including instructions for home care and consent to treatment. Protecting health information — and diligent and complete record keeping — is extremely important for many reasons,
Care for the patient: Patient records document the course of treatment and may provide data that can be used in evaluating the quality of care that has been provided to the patient.[]
Means of communication: Records also provide a communication between the treating dentist and any other doctor who will care for that patient. Complete and accurate records provide enough information to allow another provider who has no prior knowledge of the patient to know the patient’s dental experience.
Defense of allegations of malpractice: Besides, the dental record may be used in a court of law to establish the diagnostic information that was obtained and the treatment that was rendered to the patient. This information helps in determining whether the diagnosis and treatment conformed to the standards of care in the community.
Aid in the identification of a dead or missing person: Another way the dental record may be used is to help provide information to appropriate legal authorities that will aid in the identification of a dead or missing person. The most common element of forensic dentistry that a general practitioner is likely to encounter is to supply antemortem (before death) records to a forensic odontologist.[]
Retention and storage
There is usually a different requirement for the retention of records of children. These records must be kept for a certain period after the child becomes a major. The dental office should have a records retention policy and all the staff should understand it. The office’s professional liability insurance company will likely have recommendations about retention.
Dental records may be preserved on microfilm or microfiche, stored with a records storage service (fairly common in many jurisdictions) or scanned for electronic storage. The great benefit of storing records electronically or on microfilm or microfiche is that they take up less space than paper records. Diagnostic and / or treatment casts may be photographed and stored in some cases. However, prior to completely converting the records to one of these methods, a dentist should consult with his / her own attorney and a professional liability insurance company.
The accurate health / dental history may provide important and valuable information for the dentist, prior to beginning treatment. All dentists should take health histories initially and update the same periodically as necessary. Dentists have a responsibility to obtain and maintain the current health histories of patients. Team members are most often responsible for having patients complete their health / dental history forms, but that is only part of the process. It is also important that a patient understands the questions, provides appropriate answers, and signs the completed form. A health history form provides a starting point for the dental team to fulfill its professional obligations.[5,]
The NHS Terms of Service, state that dental records should be kept for a period of two years. The Regulations state that treatment records, radiographs, photographs, and study models should be retained after the completion of any course of treatment and care, under a continuing care or capitation arrangement for this period. There are strict time limits applied to such actions,[3]
- Within three years of the date when the cause of action occurred
- Within three years of the patient’s date of knowledge that the treatment may have been negligent
- If a claim is based upon a Breach of Contract, the action must be raised within five years in Scotland and six years in England and Wales
![Lab Lab](https://www.merckmanuals.com/-/media/manual/home/images/1/4/6/14679-xy-chromosomes-public-image-health-library-high.jpg?mw=350&thn=0&sc_lang=en)
It is therefore possible that a claim for negligence could happen many years after the event, and that retention of records for the minimum of two years is inadequate. The defense organizations suggest that records be kept permanently. This is often impossible due to space constraints and so the advice given by defense organization is as follows,
- Treatment Records, X-rays, Study Models, and Correspondence is to be retained for 11 years after the completion of treatment
- For children, retention of records until the patient is 25 years old
- Orthodontic Models — retain the original pre- and post-operative models permanently, discard any intermediates after a period of five years.
The storage area of these records should be secure and access strictly controlled. By following these guidelines the dental records of a patient will be available whenever they are needed. Following these guidelines will be very supportive for forensics at our place.
Confidentiality
Dentists are in a privileged position to learn a lot about their patients and this knowledge is acquired under the assumption that it is confidential. Confidentiality encourages open and honest communication, enhancing the dentist–patient relationship, and encourages respect for patient autonomy and privacy.
There are certain circumstances when information can be disclosed and they include,
- Sharing of relevant information with other healthcare professionals involved in a patient’s treatment
- Information may be passed to a third part if the patient or legal adviser gives written consent, for example, an insurance company
- Where information is requested about a deceased patient and consent of the estate or relative is sought and there is an investigation of sudden, suspicious or unexplained death
- Information is required in the preparation of legal reports containing only relevant dental treatments
- Access to dental records by the police. Search and seizure warrants may not include dental records, and therefore should be carefully checked
- Clinical research protocols and peer review procedures. The name of the patient must be kept confidential. If information is to be used for teaching purposes then the patient’s consent must be obtained
The area of confidentiality of childrens’ dental information can be confusing. Those individuals of 16 years and older should be considered adults, however, for those who are 16 years and under, the dentist still has a duty of care and therefore confidentiality to the child. This duty is combined with a duty to the parents, especially in the area of consent to treatment. Children who are victims of abuse require special management and the dentist may have an overriding responsibility to break confidentiality and report their findings to the appropriate authorities.
Special guidelines exist for patients with AIDS / HIV and sexually transmitted diseases. Strict confidentiality must be maintained when dealing with these individuals. Disclosure of such information could lead to a complaint of serious professional misconduct.[,]
Forensic Uses of Patient Records
Infographics Lab 3 4 8 Notes Template
Forensic dentistry is the overlap of the dental and legal professions. The most common element of forensic dentistry that a general practitioner is likely to encounter is to supply antemortem (before death) records to aid in personal identification. Forensic dentists are frequently called upon to identify the remains of individuals who cannot be identified visually. This encompasses a large number of situations such as burnt, grossly decomposed or mutilated remains. The identification is normally carried out by the comparison of antemortem (before death) and postmortem (after death) records.[]
The identification of the deceased individuals is an essential element in the process of death certification and is a crucial component in the investigation of homicides or other suspicious deaths. It is vital to have expeditious and accurate identification both for law enforcing authorities and relatives. Until identification can be confirmed, estates cannot be settled, death benefits cannot be paid, and surviving spouses are unable to remarry. Perhaps of most importance is that the identification of the dead is an essential component of the grieving process and is a necessary part of human dignity in a civilized society.[]
The police officers in charge of the case will normally call upon the dentist to provide details of dental records. It must be remembered that police officers have no statutory rights to inspect or remove a patient’s records without their consent. However, the law allows for special circumstances and it is reasonable to hand over an individual’s record if it enables them to be identified or excluded. The consent of the nearest relative or estate executor may also be sought if required.[,]
The availability of contemporaneous and clear notes is essential in forensic dental identification. If notes are incorrectly dated, it can complicate and even negate a positive identification. It is in such situations where the errors highlighted by Borrman and others can cause crucial mistakes to be made. When a request for records is received the entire record is useful, including such items as laboratory prescriptions and study models. Many documented cases have used the unique pattern of the palatal rugae recorded on an orthodontic study model to identify young individuals with no dental restorations.[]
The police may require access to an individual’s record for another criminal matter. They may, for example, want to see an appointment book to establish an alibi or time line. In these circumstances a warrant is required if the patient has not agreed to the release, as it can be argued that the release of notes in this instance is not in the patient’s best interest. If in doubt always contact your legal adviser.
Summary and Conclusion
Doubt about what should be documented or how records need to be kept, practitioners should ask themselves: “Will this action serve the best interests of my patient? Does this action helps in my patient’s safety and the continuity of his or her dental care?” The principles applying to handwritten records also apply to computer records, for example, entries must be date, time, and operator-stamped, all changes made must be traceable, and any codes used must be readily convertible to conventional language. Records must be readily accessible and understandable data needs to be controlled, for example, via use of passwords.
The production, retention, and release of clear and accurate patient records are an essential part of the dentist’s professional responsibility. Success in this task will assist the dentist should a medicolegal claim be made and can assist the police and coroners in the correct identification of individuals.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared
References
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Articles from Journal of Forensic Dental Sciences are provided here courtesy of Wolters Kluwer -- Medknow Publications
PMID: 27601757
This article has been cited by other articles in PMC.
SUMMARY
Infographics are an innovative and engaging method of visually communicating information in a colourful and concise manner. There has been substantial interest in their use within the commercial and health sectors.
Healthcare professionals already use infographics to communicate medical information to their patients. A firm grasp of health information enhances patients’ decision making capabilities and may improve the practitioner-patient relationship. Infographics can also be used at the population level for public health messages.
Because healthcare practitioners are likely to be consulted during their creation and use, this article aims to walk the reader through a number of different infographics in order to outline how they may be used to communicate healthcare information.
WHAT IS AN INFOGRAPHIC?
Infographics are an innovative and engaging method of visually communicating information in a colourful and concise manner. Evidence suggests that the representation of information in graphic format enhances our understanding and ability to make decisions.
The concept of presenting information in graphical format is not new. A number of early examples of data visualisation exist from the eighteenth century; most notably the depiction of the deck layout of the British slave ship Brookes in 17882. This information poster (see figure 1) depicted views of the reprehensible living conditions suffered by slaves during their voyage to the colonies and was reproduced countless times by the abolitionist movement in Georgian Britain. The combination of text, images, and narrative arguably make this an early predecessor of the modern charticle, which is a type of infographic discussed later in this article.
Stowage of the British slave ship Brookes under the regulated slave trade. Courtesy of the Library of Congress, LCUSZ62-341602
Other noteworthy examples of data visualisation can be found in the nineteenth century. Florence Nightingale’s graphical representation of causes of mortality amongst British forces fighting in the Crimean war illustrated forcefully that death from preventable disease outnumbered other causes including battle wounds3. This was achieved using a type of infographic called a polar area diagram, which is also discussed later in this article. Nightingale was incredibly successful at reaching her target audience whilst simultaneously triggering attitudinal change. These remain important aims in modern infographic design4. Another historical example of data visualisation came in the early twentieth century in the form of Otto Neurath’s isotype picture language5. Neurath and his associates produced a vast library of communicative graphics addressing a variety of socio-political topics, many of which remain in use today. The philosophy of isotype picture language is elaborated upon during discussion of figure 3.
Isotype array infographics communicate part to whole relationship between positive and negative outcomes and may be suited to visualisation of dichotomous information such as riskreward ratio of statin usage
Infographics Lab 3 4 8 Notes Answers
Whereas Neurath principally designed his isotype language for people who had poor literacy or numeracy, the modern infographic is designed for quick assimilation to match the frenetic lives of a general public who are often unwilling or unable to spend time focusing on a piece of information long enough to understand it6. The commercial sector has enthusiastically taken up infographic design within the last decade or so as a means of communicating large quantities of otherwise difficult to assimilate information in a single easily understood and visually attractive product. There is evidence to suggest that an increasing demand for healthcare information exists, particularly amongst the ‘baby boomer’ generation who, as they age and develop greater risk of illness, are increasingly demanding access to good quality healthcare information in order to make decisions about their care, for example, breast screening, prostate specific antigen testing, and decisions surrounding the risk-reward ratio of statin usage.
Infographics may be designed for mass consumption as a digital or print resource, for instance, via social media or traditional mediums such as newspapers. Alternatively, they may be used as a means of communicating with the public on a smaller scale (e.g. as a poster within a general practice). The use of infographics on a one-to-one scale has also been explored. A recent article by Harvard Medical School Professor David P Steensma evaluated the potential role of infographics in counselling patients affected by myelodysplastic syndrome. Steensma concluded that the representation of outcomes in picture format might be a useful aid when counselling some of his patients about treatment complications. We anticipate that other similarly complex medical or surgical conditions could also benefit from this visually orientated approach to counselling.
Furthermore, infographics can be used to overcome language barriers. Communicating with patients who do not speak English as their first language has become increasingly common in Northern Ireland due to changing trends in migration9. A research team from Columbia University investigated the efficacy of infographics as a primary care communicative tool in the Washington Heights neighbourhood of Northern Manhattan. Residents of this neighbourhood are majority Latino and overwhelmingly from the Dominican Republic, where the primary language is Spanish. Researchers found that successful infographics are those in which viewers could form symbolic or colour analogies. For example, blood pressure was visually linked with a traffic light system. High blood pressure was shown as a ‘red light’, therefore informing the viewer of ‘danger’ or the need to ‘stop’, whilst the opposite was true of healthy blood pressures and the colour green. Mildly elevated blood pressures were shown in amber to highlight need for caution (see figure 2). Similar analogies will likely also work well for communicating other results such as HbA1c or blood cholesterol.
Traffic light infographic adapted with permission from Arcia et al designed to communicate blood pressure results using a metaphor most members of the public will be familiar with
Five different types of infographics will be discussed within this article and we hope to demonstrate how they may be used to communicate a variety of healthcare information.
ISOTYPE ARRAYS
An isotype array represents increasing quantity as multiple identically sized graphics5. Isotype arrays are a useful means of negating the effects of framing bias, a type of bias that relates to which part of a sentence one decides to place emphasis upon. For instance, it would be factually correct to state to patients that 90% of women within figure 3 were side effect free after treatment. However, because favourable outcomes are exclusively focused upon and the 10% of women experiencing side effects are not mentioned, evidence suggests many patients will be unable to make a fully informed decision about their care.
Figure 3 shows fifty female icons, five of which are coloured grey to show how many women experience treatment induced side effects whilst the remainder are coloured pink to demonstrate absence of side effects. Communicating this type of information with the aid of an isotype array allows viewers to judge their future risk by visualising positive and negative outcomes.
However, researchers found that a significant number of people who did not speak English as their first language had a tendency to misunderstand isotype arrays because they interpreted them too literally. For instance, infographics advising on quantity of fruit to consume each week (with an apple icon depicting fruit) were interpreted to mean apples were the only fruit that should be eaten. Similarly, the presence of male or female stick figures may be mistaken as implying gender specific disease. Both can be addressed by clearly presenting context in infographic design and publication.
POLAR AREA DIAGRAMS
A polar area diagram (also known as a ‘coxcomb graph’) is a pie chart combined with some of the features of a stacked bar chart11. Unlike pie charts, where slices differ in angle and area but are equal in radius, each slice within a polar area diagram is equal in angle but different in area and radius. Individual slices are colourfully divided in a similar manner to stacked bars. Figure 4 represents fictional virology lab data for the year 2015.
Polar area diagram shows annual incidence of three viruses (A-C) within a fictional virology laboratory. Each slice is equal in angle (30°) but differs in area and radius
Each slice represents one month of the year and is therefore 30° (360/12). Slice area differs based upon total number of viruses diagnosed each month. Slices are broken down into three different types of viruses, which are always represented in the same order from virus A (innermost) to virus C (outermost). Slices advance in a clockwise direction as we progress through a calendar year.
Three pieces of information are contained within this infographic. Firstly, virus A has a year round incidence and remains the most common of the three viruses. Secondly, there are two annual peaks in incidence (summer and winter). Finally, whilst there is a spike in the incidence of virus B during winter months, it is virus C that increases in incidence during summer months. If a more precise comparison of viral incidence is desired, then this graphic would benefit from inclusion of an explanatory key equating slice area with a numerical value.
WORD CLOUDS
A word cloud is a method of visualising text in a colourful and eye catching manner. Words are clustered together and ranked in importance according to size, prominence, and colour. An earlier draft of this article was analysed for the most frequently used words and after removing conjunctive words like ‘and’ or ‘but’, a list of remaining words were used to produce figure 5. The importance of words such as ‘infographic’ and ‘communicate’ is emphasised by their size, location, and colour.
Word cloud infographic. The size, position, and colour of words communicate importance
Less prominent words are smaller and coloured differently. Therefore, there is a hierarchy of differently sized and coloured words to highlight the logical order readers should approach our word cloud. In the healthcare setting, word clouds can be used as a means of summarising and linking users to sections of text such as those found within public health documents or clinical guidelines. They may also be used online to link web users to parts of a website based upon previous popular search terms or content.
HUB AND SPOKE DIAGRAMS
These involve the depiction of a central ‘hub’ surrounded by branching ‘spokes’ that connects the central topic to a number of peripheral topics. This form of infographic has become a powerful communicative tool in the explanation of a range of scientific phenomenon. Figure 6 illustrates the link between a fictional type of cancer and a number of aetiological factors. Four short branching spokes surround the central hub ‘cancer’ linking it to four causative genes. These are the innermost, and by extension, most important risk factors for cancer in this diagram. Each individual gene is directly connected to cancer and capable of causing cancer in isolation. If we progress to the second layer from the central hub we can see two factors that are directly linked to the central hub (‘smoking’ and ‘alcohol’) whilst the other two are connected to genes found in the innermost layer (‘obesity’ and ‘infection’). This is a method of representing direct vs. indirect causation. In this diagram smoking has the potential to directly cause cancer but infection will only lead to cancer in the presence of gene B or C (i.e. infection is connected to the central hub but only indirectly through other spokes).
Hub and spoke diagrams involve a central ‘hub’ surrounded by a number of ‘spokes’ similar to a bicycle wheel. This infographic illustrates the relationship between a fictional cancer and a number of causative factors
The outermost layer of this diagram contains a number of letters of the Greek alphabet that do not have any attachment (direct or indirect) to the central hub. These are intended to represent risk factors that correlate with but do not cause cancer. This is probably one of the more difficult to understand infographics discussed within this article and, for this reason, it is primarily targeted at members of the public with an interest in healthcare science. However, with the aid of an accompanying text based explanation, hub and spoke diagrams could have a place in the visual explanation of multifactorial disease.
CHARTICLES
A charticle contains a combination of attractive colours, easily understood text, and key graphs or charts that aid in the delivery of a central message. They are excellent alternatives to traditional articles when it is anticipated that viewers may not have the time or patience to read and understand large quantities of text. Figure 7 is a charticle addressing the relationship between cancer and ageing. Colours are an important means of attracting viewers to the infographic and not only grab attention, but also alter mood and energy levels13. We found that pale colours worked best as a background whilst bold colours were suited to emphasising key pieces of information within the charticle. The key ‘take home message’ was purposefully placed centrally so as to draw the viewer’s eye whilst information above and below gives additional detail for those interested.
Charticle infographic outlines relationship between cancer risk and ageing using incidence and prevalence data from the N.Ireland Cancer Registry database
Psychological studies suggest that terms such as ‘doubtful’, ‘probable’, or ‘likely’ were inconsistently understood amongst the general public14. For this reason, such terms are avoided in this charticle. In addition, it is possible to inadvertently introduce bias into a statement via something called denominator neglect. This is a form of cognitive bias that influences the viewer’s ability to correctly understand fractions by focusing attention on the wrong aspect of the ratio, for example mistakenly identifying 1 in 3 as being smaller than 2 in 6. It is recommended that where ratios are used, consistent denominators should be employed15. The denominator is maintained as 100,000 to allow for an unbiased comparison of cancer risk as we age.
Pie charts are familiar and acceptable to the general public. Therefore, one is included in figure 7 to visually emphasise the fact that most people living with cancer in Northern Ireland are over the age of 70. A Pareto chart is also included. This type of graph combines bars and lines on a double axis grid in order to communicate two different data trends. In this example, we demonstrate that as the population of Northern Ireland ages there is a simultaneous dramatic increase in number of cancer cases diagnosed and number of people living with cancer between the ages of 40 and 80. An explanatory key below reveals the meaning of data point size by representing increased cancer incidence as increasingly large red circles.
CONCLUSION
Infographics are a useful and innovative means of communication with great potential for making medical information more accessible to the general public. Five different infographics have been discussed and we welcome constructive feedback or creative ideas from interested readers.
Footnotes
9.Northern Ireland Statistics and Research Agency, 2011 Census: Aggregate data (Northern Ireland) [computer file]. Sprite lamp 1 0 download free. UK Data Service Census Support. Downloaded from: http://infuse.mimas.ac.uk. This information is licensed under the terms of the Open Government License [http://www.nationalarchives.gov.uk/doc/open-government-licence/version/2].
CONFLICTS OF INTEREST
The authors declare no conflicts of interest. The N.Ireland Cancer Registry is funded by the Public Health Agency Northern Ireland. Infographics were produced using a combination of Microsoft Word 2011, Infographics Word Edition 1.1, and Adobe Photoshop CC 2015. The mention of named computer software is not intended as an endorsement of these products.
Please note, this was the original reference given by the author regarding “Communicating with patients who do not speak English as their first language has become increasingly common in Northern Ireland due to changing trends in migration9.”
The reference is exactly as NISRA recommend citations, unfortunately it doesn’t provide access to the information as quoted by the author. The reference I’ve included is easily accessible and gives the same information, namely that Northern Ireland are undergoing changing trends in migration.
Obviously it is up to you, but the following reference doesn’t actually do the job of referencing the material, unless the author wants to give a more exact reference.
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