Challenges in medical visualization: An interactive approach to explore the effect of 3-D technology on the visualization of pain

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Pain experienced as a result of a disabling medical condition is a frequent problem in the clinical community and can often be present in any individual with this kind of health concern. Such pain is typically characterized by severe implications reflected on both a person‘s personal life, as well as on a country‘s health and economic systems. Research on pain has revealed that patients not only experience several types of pain that could prove to be challenging to address, but also that each individual can interpret the same type, location and severity of this pain in different subjective ways, making the need for more effective pain measurement methods an imperative and troublesome effort. In retrospect, the healthcare field is currently trying to enhance the available medical methods with alternatives that would be more efficient in providing accurate pain assessment. Most efforts revolve around traditional methods of measuring pain characteristics, which typically involve the 2-Dimensional (2-D) representation of the human body, often used to collect information regarding the type and location of pain. However, these 2-D pain drawings can be limited in their ability to efficiently visualize pain characteristics for diagnosis purposes. Nonetheless, patients have been shown to prefer such drawings. This research develops an alternative interactive software solution to help in addressing the aforementioned situation, by employing the capabilities that advancements in 3-Dimension (3-D) technology offer. Subsequently, in the anticipation that limitations of current 2-D pain visualization will be solved, the developed approach facilitates the measurement of pain experiences via a 3-D visualization model of the patient. To ensure that it can effectively perform in real-world medical practice, the 3-D pain drawing is evaluated in this research through real-life case studies that are carried out in designated settings. The research findings have shown that the developed approach can potentially make significant contributions to society, science/technology and healthcare provision, with patients and clinicians suggesting that 3-D technology can be a promising means in the pursuit for more effective pain measurement solutions.Brunel University, Department of Information Systems and Computing (DISC

Development of an Advanced Practice Registered Nurse Primary Care Telephone Clinic

Abstract Development of an Advanced Practice Registered Nurse Primary Care Telephone Clinic This pilot project developed and implemented a telephone clinic based on established Veterans Affairs telephone policy and procedures and determined patient acceptability of this new visit type as an alternative to face to face visits. The review of the literature produced research that indicates telephone clinics are a viable visit option for patients. Telephone visits provide access to the primary care provider while being convenient and economical for patients. Research studies demonstrate that patients are satisfied with this visit option. The pilot project was successfully implemented in a Veterans Administration Community Based Outpatient Clinic. To evaluate the effectiveness of the project, cycle time measurements and patient satisfaction surveys for telephone visits and face to face visits were obtained. The telephone visits were found to have shorter provider visit wait times than patients having an in-clinic provider evaluation and also were found to have shorter provider visit durations than face to face visits. These findings did not affect patient satisfaction as patients who received telephone visits responded positively regarding their satisfaction with care. Overall, there was no statistical difference in patient satisfaction with patients who received telephone visits as compared to those who received a face to face provider visit. The telephone clinic improved clinic efficiency and provided more available appointment slots to care for more complex patients

A. Training Simulators for Gastrointestinal Endoscopy: Current and Future Perspectives

Over the last decades, visual endoscopy has become a gold standard for the detection and treatment of gastrointestinal cancers. However, mastering endoscopic procedures is complex and requires long hours of practice. In this context, simulation-based training represents a valuable opportunity for acquiring technical and cognitive skills, suiting the different trainees’ learning pace and limiting the risks for the patients. In this regard, the present contribution aims to present a critical and comprehensive review of the current technology for gastrointestinal (GI) endoscopy training, including both commercial products and platforms at a research stage. Not limited to it, the recent revolution played by the technological advancements in the fields of robotics, artificial intelligence, virtual/augmented reality, and computational tools on simulation-based learning is documented and discussed. Finally, considerations on the future trend of this application field are drawn, highlighting the impact of the most recent pandemic and the current demographic trends

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Implementing Computerized ST-Segment Analysis Utilizing 5-Lead ECG Cables during the Perioperative Period for Myocardial Ischemia Detection in Patients at Risk for Cardiovascular Disease

Cardiovascular disease (CVD) is one of the leading causes of death in the United States (U.S.) annually (Centers for Disease Control and Prevention, 2011). Mississippi has a disproportionately higher percentage of citizens likely to have CVD (Mississippi State Department of Health [MSDH], n.d.). The numerous stressors related to surgery are alone enough to increase the demand of the heart and lead to ischemia of the myocardium. Surgical stressors combined with preexisting CVD can exponentially increase the risk of ischemia. It is estimated that over a third of all surgical patients have ischemic heart disease. Puelacher et al. (2015) reported 40% of deaths after noncardiac surgery are attributable to cardiovascular (CV) complications and myocardial ischemia/infarction in particular. The most specific and gold standard of monitoring for such ischemia is the ST-segment on the electrocardiogram (ECG). An informal survey of anesthesia providers at several hospitals in Mississippi revealed that they did not place 5-lead ECG cables on patients at risk for CVD the majority of the time. A quality improvement (QI) educational project was prepared from the most recent literature and presented to anesthesia providers at a Southeastern hospital (N=12). The pre-survey percentage of 5-lead versus 3-lead ECG cables was determined and compared with the reported percentage of use after the presentation. The percentage of 5-lead ECG cable use before the intervention was 8.1% and post intervention was 30.5%, an obvious increase. The main barrier reported by anesthesia providers was not having the 5-lead ECG cables readily available. The most important factor for choosing to use the 5-lead ECG was a patient history of CVD. By updating the anesthesia providers on the most recent literature and guidelines by numerous professional organizations, the primary goal to increase the utilization of 5-lead ECG cables was met

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

An open source patient simulator for design and evaluation of computer based multiple drug dosing control for anesthetic and hemodynamic variables

We are witnessing a notable rise in the translational use of information technology and control systems engineering tools in clinical practice. This paper empowers the computer based drug dosing optimization of general anesthesia management by means of multiple variables for patient state stabilization. The patient simulator platform is designed through an interdisciplinary combination of medical, clinical practice and systems engineering expertise gathered in the last decades by our team. The result is an open source patient simulator in Matlab/Simulink from Mathworks(R). Simulator features include complex synergic and antagonistic interaction aspects between general anesthesia and hemodynamic stabilization variables. The anesthetic system includes the hypnosis, analgesia and neuromuscular blockade states, while the hemodynamic system includes the cardiac output and mean arterial pressure. Nociceptor stimulation is also described and acts as a disturbance together with predefined surgery profiles from a translation into signal form of most commonly encountered events in clinical practice. A broad population set of pharmacokinetic and pharmacodynamic (PKPD) variables are available for the user to describe both intra- and inter-patient variability. This simulator has some unique features, such as: i) additional bolus administration from anesthesiologist, ii) variable time-delays introduced by data window averaging when poor signal quality is detected, iii) drug trapping from heterogeneous tissue diffusion in high body mass index patients. We successfully reproduced the clinical expected effects of various drugs interacting among the anesthetic and hemodynamic states. Our work is uniquely defined in current state of the art and first of its kind for this application of dose management problem in anesthesia. This simulator provides the research community with accessible tools to allow a systematic design, evaluation and comparison of various control algorithms for multi-drug dosing optimization objectives in anesthesia

The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia