Information Systems and Health Care IX: Accessing Tacit Knowledge and Linking It to the Peer-Reviewed Literature

Clinical decision-making can be improved if healthcare practitioners are able to leverage both the tacit and explicit modalities of healthcare knowledge, yet at present there do not exist knowledge management systems that support any active and direct mapping between these two knowledge modalities. In this paper, we present a healthcare knowledge-mapping framework that maps (a) the tacit knowledge captured in terms of email-based discussions between pediatric pain practitioners through a Pediatric Pain Mailing List (PPML), to (b) explicit knowledge represented in terms of peer-reviewed healthcare literature available at PubMed. We report our knowledge mapping strategy that involves methods to establish discussion threads, organize the discussion threads in terms of topic-specific taxonomy, formulate an optimal search query based on the content of a discussion thread, submit the search query to PubMed and finally to retrieve and present the search results to the user

Decision Making by Emergency Room Physicians and Residents: Results From a Clinical Trial

Clinical decision-making is complex and uncertain and is dependent on accurate and timely information that is typically managed through Information Technology (IT) solutions. One particular class of IT that is becoming increasingly prevalent in the medical community is Clinical Decision Support Systems (CDSS). This paper will discuss results of the use of a CDSS that was developed for assisting triage decision making of pediatric abdominal pain in the Emergency department. We show how different user groups (staff physicians and residents) use the CDSS input variables in their triage decision making models

CLINICAL SITUATIONS OF UNCERTAINTY AND ACCESS TO RESOURCES: A STUDY OF COMMUNITY FAMILY PHYSICIANS

Aims: To explore the situational factors that are present during moments of uncertainty that lead family physicians to access external resources of varying type. Methods: Situational cues were identified using self-observational journaling. A survey was then performed to study physicians\u27 likelihood of accessing external resources in response to each situation. Findings: Identified situational cues included case aspects such as unfamiliar or complex presentations, potentially serious conditions, failure of previous treatments, and the patient or others in attendance being perceived as anxious, demanding, distrustful or dissatisfied. In all situations, physicians reported greatest likelihood to refer to specialists. However, with conditions that seem unfamiliar or complex, they reported similar likelihood to access internet sources, and in complex situations, to consult with peers. Conclusions: Both medical and social situational factors led family physicians to access external resources. Consultation with specialists and peers are considered highly valued resources in managing situations of uncertainty

An exploration of influences and changes in the diagnosis and management of gastro-oesophageal reflux in infants aged 0-1 year.

Gastro-oesophageal reflux (GOR) is common in infants. According to NICE (2015), it affects 40% or more of infants and generally resolves naturally without the need for medical treatment. However, preliminary indications suggest that there has been a rise in the use of medicines to manage GOR in young infants under the age of twelve months. This is particularly evident for acid suppressant medicines such as ranitidine and omeprazole – drugs that are currently not licensed for use in the 0-1 age group in the UK (BNFC, 2019). To gain a greater understanding of the extent to which this rise in prescribing rates is manifest in Scotland, and what underpins this shift in prescribing patterns, this thesis adopted a two-stage research approach to the study. Stage one of this study analysed national prescribing data from the Information Services Division of NHS Scotland (ISD), to explore how patterns of prescribing for alginate, domperidone, omeprazole and ranitidine have changed over time, and how they differ between NHS Board areas in Scotland. Findings from stage one confirmed that the prescribing of alginate, omeprazole and ranitidine increased significantly in Scotland over a 7-year period between 2010 and 2016. Prescribing of alginate increased from 15.7 per 100 infants in 2010 to 24.7 per 100 infants in 2016, whilst the prescribing rate for ranitidine increased over four-fold from 2.3 per 100 infants in 2010 to 9.7 per 100 infants in 2016, and for omeprazole the prescribing rate increased over three-fold from 0.9 per 100 infants in 2010 to 3.2 per 100 infants in 2016. Furthermore, the data revealed regional variation in the drugs prescribed. Stage two sought to investigate what underpinned this change in prescribing patterns in greater depth. Focusing on one NHS Board in Scotland that had a high prescribing rate for ranitidine, stage two adopted a qualitative approach and used in-depth interviews to explore issues contributing to this shift in prescribing patterns from the perspectives of health visitors, general practitioners and parents. Semi-structured interview schedules were used to guide in-depth interviews with 22 participants. Issues of adherence to national guidelines, the shift away from conservative to more pharmaceutical treatments for GOR and shifts in knowledge and power between clinicians and parents were explored. While general practitioners and health visitors remain the key players in diagnosing and treating GOR in infants in Scotland, general practitioners often rely on the expertise of health visitors whom they see as the experts in this field, whilst health visitors are often influenced by parental pressures. Parents were thus found to play an important role in influencing the diagnosis and the treatment approach offered, with the prescribing of medicines often seen by parents as the first-line of approach to the treatment of GOR. Parental pressures placed on clinicians was seen to arise from changing attitudes and expectations of parenthood, shifts in family support structures, and the growing accessibility of a wealth of health information from (both reliable and unreliable) sources on the worldwide web, as well as the subtle (and not so subtle) advertising of medicines to manage GOR on social media. These factors all play a key role in the pharmaceuticalisation of treatment for GOR and is likely to go some way toward accounting for changes in prescribing patterns over time. Theoretically, therefore, this study points to the medicalisation of everyday care practices for infants, especially the management of symptoms of GOR. Importantly, it is possible that some infants are being prescribed unlicensed acid suppressant medicines unnecessarily and this has financial implications for the NHS as well as health implications for young infants

How domestic violence counselors with personal histories of trauma experience their clients who were victims of domestic violence: a heuristic study

The heuristic inquiry-based phenomenological approach values focusing on a question or problem that has been a personal challenge in one’s quest to understand oneself and the phenomenon. Previous research has shown that counselors with a personal history of trauma who provide services to victims with a similar history report a range of negative consequences. The researcher utilized a heuristic research design to answer the following question: How do domestic violence counselors who have personal histories of trauma experience their clients who were victims of domestic violence? The methodology involved interviewing eight counselors, from whom four themes were identified: awareness of the counselor’s own experience, counselor’s demonstration of empathy, counselor’s self-care, and counselor’s countertransference. The counselors who were aware of their own traumatic experience conveyed empathy and demonstrated greater countertransference, which prompted the need for deliberate self-care activities. Four counselors who conveyed empathy demonstrated the overinvolvement form of countertransference, while counselors with low empathy demonstrated the distance or hostility form of countertransference. Keywords: awareness of the counselor’s own experience, clients, counselors, counselor’s demonstration of empathy, counselor’s self-care, counselor’s countertransference, counselors with personal history of trauma, countertransference, domestic violence, effects and management of countertransference, empathy, heuristic inquiry, personal reactions, qualitative research design, survivors, trauma, vicarious traumatization, victim

Musculoskeletal ultrasound imaging - an exploration of physiotherapists' interests and use in practice

Background: Musculoskeletal ultrasound imaging, (MSKUSI) is an appealing modality for many professions and professionals. There are indications that physiotherapists have tried to access MSKUSI but the evidence base exploring their interests and clinical use is extremely limited. Aim: To explore physiotherapists’ interest and use of MSKUSI in practice. Method: A questionnaire was developed and distributed to gain initial information relating to physiotherapists’ interest and use of MSKUSI. 75 responses were received, analysis informed topic-guide development for in-depth interviews and enabled a purposeful sampling strategy. 11 in-depth interviews explored physiotherapists’ interests, education and clinical use of MSKUSI. Results: Thematic analysis of the interview data identified 5 themes: 1. Professional skill set – physiotherapists’ suitability for MSKUSI 2. Factors that have impacted physiotherapists’ ability to use MSKUSI ii 3. Physiotherapists’ motivation to use ultrasound - improving patient focused care 4. Quality assurance strategies 5. Application of biopsychosocial model These themes revealed links between physiotherapists’ core skills, knowledge and professional experiences that align well to the requirements of MSKUSI. Some participants reported support whilst accessing education but many described challenges that had influenced their ability to use MSKUSI. A common challenge was accessing mentorship responsive to physiotherapists’ requirements. Participants observed the variation in their practice when compared to other professionals was not always reflected in education. Application of clinical reasoning processes to ensure scanning was responsive to individual patient’s requirements was emphasised. Conclusion: Physiotherapists are amongst a number of professional groups interested in MSKUSI. Proposed roles include verification of clinical assessment findings for diagnosis and facilitation of patient education. The potential to reduce patient attendances, streamline management pathways and optimise resource management warrants further investigation. Professional and regulatory issues need evaluation to support physiotherapists’ use of MSKUSI. Professional organisations including the Chartered Society of Physiotherapy should extend current guidance to protect professionals and patients

Identifying informal advisors among neuromuscular specialists

Quality improvement efforts in healthcare services often center on influencing provider behavior through clinical practice guidelines and research evidence. Passive dissemination of such information has quite limited effects on medical practice. Active implementation strategies focus on translating knowledge into practice, at times recruiting local physicians as opinion leaders to act as change agents, champion the adoption of new practice parameters, and promote the diffusion of medical innovation; This study developed an instrument to identify neuromuscular specialists whose advice is valued by colleagues, thus extending and updating similar work among educationally influential community physicians by Hiss, Macdonald, and Davis (1978). Neuromuscular specialists from across the United States rated the importance of various traits of colleagues whose advice they seek on patient care problems. These traits denoted approachability (pleasant personality), declarative knowledge (factual information), procedural knowledge (clinical skill), and translational ability (making clear how to apply information to clinical practice). As hypothesized, the respondents rated procedural, practical knowledge as most important. Also as expected, approachability was not as important to the specialists surveyed as it had been to general practitioners surveyed in the Hiss et al. (1978) research. The hypothesized high value of the advisor\u27s ability to translate information, including research findings, into practice was not supported; Traits highlighting interest in the latest published research were not strongly endorsed. The finding that such interest was not a trait required of informal advisors is examined from the perspective of the cognitive psychology of expertise and experts\u27 use of heuristics. The discussion includes recommendations for incorporating the procedural nature of clinical expertise in quality improvement efforts

Pediatric Physical Therapists and Evidence Based Practice: A Participatory Action Research Project

Introduction: The purpose of this project was to describe in detail the attitudes, beliefs, and practices of a group of pediatric physical therapists regarding evidence-based practice. In addition, utilizing a collaborative, participatory action research approach, several strategies and outcomes were identified as a means to aid these individuals in improving their ability to use research evidence for clinical decision making. Methods: The primary investigator and a group of five pediatric physical therapists collaborated to develop and implement strategies and outcomes that were best suited for each individual. During phase I, information was gathered to describe the participants\u27 current beliefs, attitudes, and practices with regard to evidence-based practice. This information was used to develop group and individual strategies, which were implemented during phase II. During phase III, the outcomes were identified and described. A variety of methods were used to gather information throughout all phases, including individual and focus group interviews, document review, surveys and questionnaires, and self-reported Goal Attainment Scaling scores. Results: The results were organized into five individual case reports for each of the participants and a description of the Practice. Practice: Most of the participants worked in a setting as the only physical therapist and most were over 40 years of age and had been practicing for longer than 15 years. All had a positive attitude toward evidence-based practice. However most reported reading less than two articles per month and performing less than two database searches per month and lacked confidence with these skills. The participants demonstrated a significant improvement (p \u3c .05) in their knowledge and behaviors regarding research and evidence-based practice at the conclusion of the project. Participant K reported little confidence with evidence-based practice skills. The group and individual strategies during the acting phase were helpful but insufficient in helping her overcome her barriers to make a significant improvement. Participant P, the owner of the Practice, reported functioning at a high level with regard to evidence-based practice, and therefore reported little improvement in evidence-based practice skills or activities. Participant A, a recent graduate, ranked herself fairly highly initially and indicated that the strategies in this project were an impetus to resume utilizing the skills she had learned during her entry-level education. Participant R described less confidence with her evidence-based practice skills and reported an improvement in these skills at the conclusion of the project. Participant L reported some confidence initially with her evidence-based practice skills, and this project was helpful, although she reported a persistent lack of confidence with article analysis skills. Discussion: Each of the participants described positive attitudes and beliefs towards the construct of evidence-based practice, along with a desire to increase their skills in this area. The quantitative and qualitative data seem to suggest that there was some improvement in the participants\u27 knowledge and behavior with regard to research evidence. However, the participants also reported continued struggles with carrying out evidence-based practice activities

Co-design of health literacy interventions to improve understanding, access and use of health services

This study examined the relationship between health literacy and use of hospital services. Having both low and high health literacy resulted in higher use of hospital services. An established relationship with a health professional may act as a potential mediator and prevent avoidable emergency department presentations and hospital admissions

How Do Individuals with Cerebral Palsy and their Families Prefer to Receive and Use Evidence-Based Information to Individualize Services to Optimize Outcomes?

The main objectives of this study were to: (1) describe the format in which children with cerebral palsy (CP) and their parents prefer to receive information pertaining to development; (2) understand how children with CP and their parents intend to use this information; and (3) gain insight on how children with CP wish to be represented in the information in terms of being both comprehensive and respectful. Ten children with CP and their parent(s) or guardian(s) participated. Semi-structured interviews were conducted and analyzed using constant comparative analysis. Eight themes were created related to the type and format of information preferred by children with CP and their parents. The results of this study provide a next step for disseminating the individualized information obtained in the OnTrack study, as well as for narrowing the gaps that currently exist in the literature related to information preferences of children with CP and their families