Information technologies for pain management

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. The importance of pain is attested by the fact that it is considered the fifth vital sign for indicating basic bodily functions, health and quality of life, together with the four other vital signs: blood pressure, body temperature, pulse rate and respiratory rate. However, while these four signals represent an objective physical parameter, the occurrence of pain expresses an emotional status that happens inside the mind of each individual and therefore, is highly subjective that makes difficult its management and evaluation. For this reason, the self-report of pain is considered the most accurate pain assessment method wherein patients should be asked to periodically rate their pain severity and related symptoms. Thus, in the last years computerised systems based on mobile and web technologies are becoming increasingly used to enable patients to report their pain which lead to the development of electronic pain diaries (ED). This approach may provide to health care professionals (HCP) and patients the ability to interact with the system anywhere and at anytime thoroughly changes the coordinates of time and place and offers invaluable opportunities to the healthcare delivery. However, most of these systems were designed to interact directly to patients without presence of a healthcare professional or without evidence of reliability and accuracy. In fact, the observation of the existing systems revealed lack of integration with mobile devices, limited use of web-based interfaces and reduced interaction with patients in terms of obtaining and viewing information. In addition, the reliability and accuracy of computerised systems for pain management are rarely proved or their effects on HCP and patients outcomes remain understudied. This thesis is focused on technology for pain management and aims to propose a monitoring system which includes ubiquitous interfaces specifically oriented to either patients or HCP using mobile devices and Internet so as to allow decisions based on the knowledge obtained from the analysis of the collected data. With the interoperability and cloud computing technologies in mind this system uses web services (WS) to manage data which are stored in a Personal Health Record (PHR). A Randomised Controlled Trial (RCT) was implemented so as to determine the effectiveness of the proposed computerised monitoring system. The six weeks RCT evidenced the advantages provided by the ubiquitous access to HCP and patients so as to they were able to interact with the system anywhere and at anytime using WS to send and receive data. In addition, the collected data were stored in a PHR which offers integrity and security as well as permanent on line accessibility to both patients and HCP. The study evidenced not only that the majority of participants recommend the system, but also that they recognize it suitability for pain management without the requirement of advanced skills or experienced users. Furthermore, the system enabled the definition and management of patient-oriented treatments with reduced therapist time. The study also revealed that the guidance of HCP at the beginning of the monitoring is crucial to patients' satisfaction and experience stemming from the usage of the system as evidenced by the high correlation between the recommendation of the application, and it suitability to improve pain management and to provide medical information. There were no significant differences regarding to improvements in the quality of pain treatment between intervention group and control group. Based on the data collected during the RCT a clinical decision support system (CDSS) was developed so as to offer capabilities of tailored alarms, reports, and clinical guidance. This CDSS, called Patient Oriented Method of Pain Evaluation System (POMPES), is based on the combination of several statistical models (one-way ANOVA, Kruskal-Wallis and Tukey-Kramer) with an imputation model based on linear regression. This system resulted in fully accuracy related to decisions suggested by the system compared with the medical diagnosis, and therefore, revealed it suitability to manage the pain. At last, based on the aerospace systems capability to deal with different complex data sources with varied complexities and accuracies, an innovative model was proposed. This model is characterized by a qualitative analysis stemming from the data fusion method combined with a quantitative model based on the comparison of the standard deviation together with the values of mathematical expectations. This model aimed to compare the effects of technological and pen-and-paper systems when applied to different dimension of pain, such as: pain intensity, anxiety, catastrophizing, depression, disability and interference. It was observed that pen-and-paper and technology produced equivalent effects in anxiety, depression, interference and pain intensity. On the contrary, technology evidenced favourable effects in terms of catastrophizing and disability. The proposed method revealed to be suitable, intelligible, easy to implement and low time and resources consuming. Further work is needed to evaluate the proposed system to follow up participants for longer periods of time which includes a complementary RCT encompassing patients with chronic pain symptoms. Finally, additional studies should be addressed to determine the economic effects not only to patients but also to the healthcare system

Audit of orthopaedic surgery operation notes at Chris Hani Baragwanath academic hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic surgeryIntroduction: The medical record is critical for the documentation of the patient’s current and possible future health status, as well as for communication between the healthcare professional and other service providers, statutory and regulatory bodies. Statutory and /or regulatory bodies and medical councils around the world emphasises the importance of accurate, adequate and comprehensive medical records. The operative notes are the official documentation of a surgical operation or procedure and serves as a key form of surgical communication between healthcare professionals and other healthcare service providers. Surgical operative notes also serve other important functions related to medical cost billing, quality assurance, medical education, research purposes and medico-legal issues. There is no consensus among surgical disciples on the required standard operative notes or acceptable operative notes documentation. The royal college of surgeons of England (RCSE) has published guidelines on the operative notes documentation that are widely accepted in the United Kingdom and supported by the British Orthopaedic Association. Aim: The aim of the study was to assess the completeness of the clinical records for the Orthopaedic surgery operative notes to: Evaluate the completeness of operative notes with respect to the RCSE 2008 guidelines Determine the essential information that was omitted from operative notes Methodology: The study was a retrospective, descriptive single centre study conducted at Chris Hani Baragwanath Academic Hospital between 01 August 2013 and 30 November 2013. Clinical records were evaluated specifically for the orthopaedic surgery operative notes details and compared to the guidelines based on the RCSE 2008. The data were collected from 25 % of all orthopaedic surgical procedures performed in the year 2013. Results: A total of 400 clinical records were available for the review of orthopaedic surgery operative notes. All operative notes were hand-written and no separate operative notes proforma or template was used for operative notes documentation; all operative notes were written in the daily ward round progress sheet. No aide-memoire was available or used to assist the surgeon and or assistant with writing of the operative notes. The study revealed poor documentation of essential information in the operative notes with only 0.25 % meeting all the parameters as per RCSE guidelines. Up to 93.3 % of the operative notes were written by the medical officers and registrars, whereas 4.3 % of the operative notes were written by the consultants. In addition, 56.8 % were missing 5 – 9 parameters, and of the additional parameters included in the study 50.6 % were missing 5 – 9 parameters and 48.5 % missing 10 or more parameters. Poor documentation was found with regards to details of prophylactic antibiotics missing in 90.8 % of all operative notes, tourniquet usage missing in 58.4 %, operative findings not mentioned in 55.8 %, identification of prosthetic material or implants missing in 77.0 % and use of blood and or blood products missing in 95.5 %. Discussion: The study represents 25 % of all orthopaedic surgery operations performed in the year 2013. The findings of the study are consistent with the previous published studies reporting poor operative notes documentation without the use of aide-memoire, proformas, computerised or paper based templates and procedure specific proforma following acceptable guidelines. Conclusions: The findings of this study confirm poor documentation and significant deficiency of essential parameters in the operative notes that is required for the patient safety and highlight lack of consensus on the essential parameters required for a complete operative notes details. Future research using the orthopaedic operative notes template and/or proformas is recommended to assess completeness of the operative notes documentation.MT201

Living alone but not lonely: a selection, optimisation, and compensation analysist

Free Paper Session IV: Long-Term CareINTRODUCTION: One observation of the ageing population in Hong Kong is the increasing percentage of older adults living alone over the past few decades. Although the image of older adults living alone is often associated with feelings of isolation and loneliness, not every older adult who lives alone feels lonely. This paper is intended to answer the following question: “How can older adults live alone and not feel lonely?” Specifically, the text examines the orchestrating process adopted by those in Hong Kong for living alone without generating feelings of loneliness; this examination is guided by a selection …published_or_final_versio

Conceptualising the spirituality of Chinese older adults: a Delphi study

Free Paper Session II : Mental Health / End-Of-Life CareINTRODUCTION: Service provision in geriatric health and social care is increasingly guided by holistic principles, in which many aspects, including physical, psychological, social, and spiritual aspects, are equally emphasized to enhance well-being and enrich life. However, little is known about the degree of consensus among multidisciplinary professionals in the Chinese context on the central components of spirituality that most promote spiritual well-being among Chinese older adults. This study is intended to identify the core components of ...published_or_final_versio

Knowledge integration in routine work: why it works or breaks

Organisations spend a great deal of efforts on information management, but if they are not successful in information mediation and use, it can be a waste of resources. In this paper we have applied a knowledge perspective on mediation and use. The purpose is to describe and explain why knowledge integration processes in knowledge-intensive routine work may work or fail. As an example of such work we have used a case study from the Swedish healthcare sector, more specifically a microbiology laboratory and some of its customers. Empirical data were collected by interviews and observations, and analysed with the help of theories about knowledge boundaries, knowledge integration and knowledge mediators (boundary objects and brokers). The case analysis shows that the boundaries between these groups are more complicated than they may appear to be at first sight, but also that there are methods to create a common understanding and overcome the complications. The main conclusion is that in this type of work, there are in fact several different boundaries between groups, depending on differences in work tasks, interest and motivation and that various ways to attain knowledge integration, directed both to groups and to individuals, can be required

Artificial Intelligence Implementation in Healthcare: A Theory-Based Scoping Review of Barriers and Facilitators

There is a large proliferation of complex data-driven artificial intelligence (AI) applications in many aspects of our daily lives, but their implementation in healthcare is still limited. This scoping review takes a theoretical approach to examine the barriers and facilitators based on empirical data from existing implementations. We searched the major databases of relevant scientific publications for articles related to AI in clinical settings, published between 2015 and 2021. Based on the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR), we used a deductive, followed by an inductive, approach to extract facilitators and barriers. After screening 2784 studies, 19 studies were included in this review. Most of the cited facilitators were related to engagement with and management of the implementation process, while the most cited barriers dealt with the intervention’s generalizability and interoperability with existing systems, as well as the inner settings’ data quality and availability. We noted per-study imbalances related to the reporting of the theoretic domains. Our findings suggest a greater need for implementation science expertise in AI implementation projects, to improve both the implementation process and the quality of scientific reporting

Interactivity, computers and orthodontic training for undergraduates

This phenomenological study investigates the interactivity taking place when students use computer-assisted-learning (CAL) in orthodontics and what can be inferred about why these interactions occur. CAL has been proposed in orthodontics because it provides an opportunity to follow a case through to completion. This training is needed if only to give all dentists sufficient knowledge to identify and refer cases for treatment. Two programs have been developed for the pilot: an introductory e-book and a narrative case study based on real records that takes students through a series of decisions relating to case assessment, treatment planning and appliance design.The mixed-methodology approach of the main study uses activity theory to provide a. framework combining qualitative and quantitative data to analyse the interactivity of 48 students as they work through the case study. Observations and transcripts of recordings of conversations between pairs of students, together with post-session interviews, facilitate a deeper understanding of students' conceptions of orthodontics particularly when they explain their reasoning in negotiations over answers, clarified where necessary by data recorded by computer activity log-files. The linear sequence of questions in the program allows students'interactions to be compared on a "like-for-like" basis.Activity systems are used to identify various tensions in students' responses whilst using CAL, facilitating a deeper understanding of the observed interactivity. A phenomenological profile of the students has been developed based on these interactions, particularly in response to the unexpected caused by the complex reality of the case. Further supporting quantitative data is obtained from a questionnaire survey and end-of-year examination results used to provide contextual background material particularly when presenting the results to a domain heavily dominated by a scientific epistemology.Throughout the program many students seem to ignore features not in their immediate focus. Students' reactions to the unexpected (extraction of 7s) indicates about half of the students are so reliant on simplified taught procedure they are unable to relate the extractions to these "hidden" features. Other students adopt a deeper approach and are able to identify reasons why the unexpected occurs. The program has been found to promote an active approach to learning in most students, whether their approach is surface or deep. Most students learn from the feedback provided by the program, even when this feedback is not explicit on a point. Students also benefit from working with a partner. The deeper understanding of students' misconceptions afforded by the adopted research methodology enables the development of guidelines for the future design of CAL in dentistry