Context-based task ontologies for clinical guidelines

Evidence-based medicine relies on the execution of clinical practice guidelines and protocols. A great deal of of effort has been invested in the development of various tools which automate the representation and execution of the recommendations contained within such guidelines and protocols by creating Computer Interpretable Guideline Models (CIGMs). Context-based task ontologies (CTOs), based on standard terminology systems like UMLS, form one of the core components of such a model. We have created DAML+OIL-based CTOs for the tasks mentioned in the WHO guideline for hypertension management, drawing comparisons also with other related guidelines. The advantages of CTOs include: contextualization of ontologies, providing ontologies tailored to specific aspects of the phenomena of interest, dividing the complexity involved in creating ontologies into different levels, providing a methodology by means of which the task recommendations contained within guidelines can be integrated into the clinical practices of a health care set-up

Attention deficit hyperctivity disorder –aviable training module for school teachers

Attention Deficit Disorders in children is a problem that teachers face in classrooms universally, and it can be particularly challenging. Despite this, there is a great paucity of work either in evaluating the existing knowledge levels of the teachers of Primary schools concerning this neurobehavioral problem, or in formulating attempts to train them in classroom management. The aim of the present study is the development of an evaluation and Training Module for Teachers, comprising of a three-step ADD group training method, with evaluation included. The target group comprised of 30 primary school teachers representing various schools in D. K. District. Following a baseline evaluation, the group training was performed. The curriculum included ADD/ADHD theory, case study and discussions. The specific objectives of the 3 day activity were to: assess them on their knowledge of ADD on a pre evaluation Test, obtaining relevant socio-demographic details, and providing them with specific training, after which they were re-assessed. The experience showed that the training facilitates knowledge of this clinical condition. The age, sex, teaching experience, qualifications and the residential area, were not found to be associated with the knowledge levels of teachers. The inclusion of this time and cost effective module in awareness and management skill building of Primary teachers as part of their in- service training as well as the implications of a successful culture and context specific training programe for the inclusion of ADD children in the regular classroom is discussed

Assessment and Management of Suicide Risk in Primary Care

Abstract Background Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aim To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method Data collection from clinical proformas, case records, and semi-structured face–to-face interviews with general practitioners. Results Primary and secondary care data was available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall kappa = 0.127; p = 0.10). Depression, care setting (post discharge), suicidal ideation at last contact and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices and 33% of staff received training in suicide risk assessments. Conclusion Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care

A survey of orthopaedic journal editors determining the criteria of manuscript selection for publication

Background: To investigate the characteristics of editors and criteria used by orthopaedic journal editors in assessing submitted manuscripts. Methods: Between 2008 to 2009 all 70 editors of Medline listed orthopaedic journals were approached prospectively with a questionnaire to determine the criteria used in assessing manuscripts for publication. Results: There was a 42% response rate. There was 1 female editor and the rest were male with 57% greater than 60 years of age. 67% of the editors worked in university teaching hospitals and 90% of publications were in English.The review process differed between journals with 59% using a review proforma, 52% reviewing an anonymised manuscript, 76% using a routine statistical review and 59% of journals used 2 reviewers routinely. In 89% of the editors surveyed, the editor was able to overrule the final decision of the reviewers.Important design factors considered for manuscript acceptance were that the study conclusions were justified (80%), that the statistical analysis was appropriate (76%), that the findings could change practice (72%). The level of evidence (70%) and type of study (62%) were deemed less important. When asked what factors were important in the manuscript influencing acceptance, 73% cited an understandable manuscript, 53% cited a well written manuscript and 50% a thorough literature review as very important factors. Conclusions: The editorial and review process in orthopaedic journals uses different approaches. There may be a risk of language bias among editors of orthopaedic journals with under-representation of non-English publications in the orthopaedic literature

The prevalence of cocaine-associated chest pain in a London hospital

Objectives: To determine the prevalence of cocaine misuse in patients presenting to an Accident and Emergency department with chest pain. 4 of 12 FAEM abstracts www.emjonline.co

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

Information Transfer and Communication in Surgical Care

Effective Information transfer and Communication is one of the key aspects of good medical practice and essential for surgical safety. High reliability organisations such as aviation have highlighted the importance of communication for safety and regularly provide communication skills training to their team members via Crew resource management (CRM) module. This report discusses important aspects of communication research in high-risk environments and confers its application in surgery. It analyses the nature and scope of communication failures in surgical field. The thesis has taken bottom-up approach unlike other research in this field, which has taken a top-down approach. First we have mapped and analysed the communication failures across the entire surgical pathway. Analysis of full pathway is critical as communication failures are not discrete events; information loss in one phase of care can potentially compromise safety in a subsequent phase. After the analysis, user-centred interventions were developed and implemented to enhance the information transfer and communication in the postoperative handover phase. Results show that information transfer and communication failures are ubiquitous and distributed across the continuum of surgical care. These findings indicate that there is a room for improvement for enhancing ITC in surgical care. There is an imminent need for standardizing and structuring communication through use of checklists, proformas, care pathways and information technology. Subsequently we have demonstrated that standardization of ITC process through the implementation of postoperative handover proforma has improved the information transfer and decreased the ITC errors. It is hoped that this thesis provides a first step towards understanding, assessing and improving information transfer and communication through entire surgical care pathway, which in a long run will improve surgical safety

Integrated assessment : new assessment methods evaluation of an innovative method of assessment-critical incident analysis

For many people, the term “assessment” is associated with tasks, which are less than inspiring, which are undertaken only because they are hurdles, which must be crossed in order to achieve some form of accreditation or to enable entry into work or a further course of study. In this worldview, what is important for the student is the final determination or grade assigned to their work. While summative assessment, in which students submit work that is marked by experts and which contributes partially or fully to a final grade, plays an important role in the lives of students and educators, contemporary thinking about “assessment” is much more expansive