Supporting medical ward rounds through mobile task and process management

In a hospital, ward rounds are crucial for task coordination and decision-making. In the course of knowledge-intensive patient treatment processes, it should be possible to quickly define tasks and to assign them to clinicians in a flexible manner. In current practice, however, task management is not properly supported. During a ward round, emerging tasks are jotted down using pen and paper and their processing is prone to errors. In particular, staff members must manually keep track of the status of their tasks. To relieve them from such a manual task management, we introduce the MedicalDo (MEDo) approach. It transforms the pen and paper worksheet to a digital user interface on a mobile device. Thereby, MEDo integrates process support, task management, and access to the patient record. Interviews of medical staff members have revealed that they crave for a mobile process and task support. This has been further confirmed in a case study we conducted in four different wards. Finally, in user experiments, we have demonstrated that MEDo puts task acquisition on a level comparable to that of pen and paper. Overall, MEDo enables users to create, monitor and share medical tasks based on a mobile and user-friendly platform

Management of adverse events with tailored sorafenib dosing prolongs survival of hepatocellular carcinoma patients

Sorafenib is associated with multiple adverse events (AEs), potentially causing its permanent interruption. The impact of the physicians experience on the management of these AEs and the relative implications on clinical outcomes are unknown. We verified if the AEs management changed over time and if these modifications impacted on treatment duration and overall survival (OS)

Hermeneutic single case efficacy design: A systematic review of published research and current standards

open4siThis article systematically reviews the methodological characteristics of Hermeneutic Single Case Efficacy Design (HSCED) studies published in peer-reviewed journals. HSCED provides researchers with a flexible and viable alternative to both between-groups and within-subject experimental designs. This article includes a description of the evolution of the methodology distinctive to HSCED; a discussion of results of HSCED studies considered within a framework of contemporary standards and guidelines for systematic case study research; a presentation of recommendations for key characteristics (e.g., diagnosis, hermeneutic analysis, adjudication procedure). Overall, the aim is provide researchers and reviewers with a resource for conducting and evaluating HSCED research. The results of a systematic review of 13 studies suggests that published HSCED research meets contemporary criteria for systematic case study research. Hermeneutic analysis and adjudication emerged as areas of HSCED practice characterized by a diversity of procedures. Although consensus exists along key dimensions of HSCED, there remains a need for further evaluation of adjudication procedures and reporting standards.openBenelli, Enrico; De Carlo, Alessandro; Biffi, Diana; Mcleod, JohnBenelli, Enrico; De Carlo, Alessandro; Biffi, Diana; Mcleod, Joh

Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy : combined analysis of routine and research data in the Born in Bradford cohort

BACKGROUND: Common mental disorders (CMD) such as anxiety and depression during the maternal period can cause significant morbidity to the mother in addition to disrupting biological, attachment and parenting processes that affect child development. Pharmacological treatment is a first-line option for moderate to severe episodes. Many women prescribed pharmacological treatments cease them during pregnancy but it is unclear to what extent non-pharmacological options are offered as replacement. There are also concerns that treatments offered may not be proportionate to need in minority ethnic groups, but few data exist on treatment disparities in the maternal period. We examined these questions in a multi-ethnic cohort of women with CMD living in Bradford, England before, during and up to one year after pregnancy. METHODS: We searched the primary care records of women enrolled in the Born in Bradford cohort for diagnoses, symptoms, signs ('identification'), referrals for treatment, non-pharmacological and pharmacological treatment and monitoring ('treatment') related to CMD. Records were linked with maternity data to classify women identified with a CMD as treated prior to, and one year after, delivery. We examined rates and types of treatment during pregnancy, and analysed potential ethnic group differences using adjusted Poisson and multinomial logistic regression models. RESULTS: We analysed data on 2,234 women with indicators of CMD. Most women were discontinued from pharmacological treatment early in pregnancy, but this was accompanied by recorded access to non-drug treatments in only 15 % at the time of delivery. Fewer minority ethnic women accessed treatments compared to White British women despite minority ethnic women being 55-70 % more likely than White British women to have been identified with anxiety in their medical record. CONCLUSIONS: Very few women who discontinued pharmacological treatment early in their pregnancy were offered other non-pharmacological treatments as replacement, and most appeared to complete their pregnancy untreated. Further investigation is warranted to replicate the finding that minority ethnic women are more likely to be identified as being anxious or having anxiety and understand what causes the variation in access to treatments

Patient-centered Coordination in Healthcare Service Networks - Measuring and Improving Inter-organizational Information Flow

This thesis investigates the idea of a coordination service that improves the information flow between independent stakeholders along the patient care pathway. Based on identified requirements regarding process, ICT-structure, and legal constraints, a stroke-specific coordination service was developed, validated, implemented, and evaluated. A randomized controlled trial showed improved patients\u27 HRQoL and competences, positive cost-benefit ratio, and acceptance by the involved stakeholders

IAPMA 2011: 2nd Workshop on information access to personal media archives

Towards e-Memories: challenges of capturing, summarising, presenting, understanding, using, and retrieving relevant information from heterogeneous data contained in personal media archives. Welcome to IAPMA 2011, the second international workshop on "Information Access for Personal Media Archives". It is now possible to archive much of our life experiences in digital form using a variety of sources, e.g. blogs written, tweets made, social network status updates, photographs taken, videos seen, music heard, physiological monitoring, locations visited and environmentally sensed data of those places, details of people met, etc. Information can be captured from a myriad of personal information devices including desktop computers, PDAs, digital cameras, video and audio recorders, and various sensors, including GPS, Bluetooth, and biometric devices

A framework for development of android mobile electronic prescription transfer applications in compliance with security requirements mandated by the Australian healthcare industry

This thesis investigates mobile electronic transfer of prescription (ETP) in compliance with the security requirements mandated by the Australian healthcare industry and proposes a framework for the development of an Android mobile electronic prescription transfer application. Furthermore, and based upon the findings and knowledge from constructing this framework, another framework is also derived for assessing Android mobile ETP applications for their security compliance. The centralised exchange model-based ETP solution currently used in the Australian healthcare industry is an expensive solution for on-going use. With challenges such as an aging population and the rising burden of chronic disease, the cost of the current ETP solution’s operational infrastructure is certain to rise in the future. In an environment where it is increasingly beneficial for patients to engage in and manage their own information and subsequent care, this current solution fails to offer the patient direct access to their electronic prescription information. The current system also fails to incorporate certain features that would dramatically improve the quality of the patient’s care and safety, i.e. alerts for the patient’s drug allergies, harmful dosage and script expiration. Over a decade old, the current ETP solution was essentially designed and built to meet legislation and regulatory requirements, with change-averting its highest priority. With little, if any, provision for future growth and innovation, it was not designed to cater to the needs of the ETP process. This research identifies the gap within the current ETP implementation (i.e. dependency on infrastructure, significant on-going cost and limited availability of the patient’s medication history) and proposes a framework for building a secure mobile ETP solution on the Android mobile operating system platform which will address the identified gap. The literature review part of this thesis examined the significance of ETP for the nation’s larger initiative to provide an improved and better maintainable healthcare system. The literature review also revealed the stance of each jurisdiction, from legislative and regulatory perspectives, in transitioning to the use of a fully electronic ETP solution. It identified the regulatory mandates of each jurisdiction for ETP as well as the security standards by which the current ETP implementation is iii governed so as to conform to those regulatory mandates. The literature review part of the thesis essentially identified and established how the Australian healthcare industry’s various prescription-related legislations and regulations are constructed, and the complexity of this construction for eTP. The jurisdictional regulatory mandates identified in the literature review translate into a set of security requirements. These requirements establish the basis of the guiding framework for the development of a security-compliant Android mobile ETP application. A number of experimentations were conducted focusing on the native security features of the Android operating system, as well as wireless communication technologies such as NFC and Bluetooth, in order to propose an alternative mobile ETP solution with security assurance comparable to the current ETP implementation. The employment of a proof-of-concept prototype such as this alongside / coupled with a series of iterative experimentations strengthens the validity and practicality of the proposed framework. The first experiment successfully proved that the Android operating system has sufficient encryption capabilities, in compliance with the security mandates, to secure the electronic prescription information from the data at rest perspective. The second experiment indicated that the use of NFC technology to implement the alternative transfer mechanism for exchanging electronic prescription information between ETP participating devices is not practical. The next iteration of the experimentation using Bluetooth technology proved that it can be utilised as an alternative electronic prescription transfer mechanism to the current approach using the Internet. These experiment outcomes concluded the partial but sufficient proofof- concept prototype for this research. Extensive document analysis and iterative experimentations showed that the framework constructed by this research can guide the development of an alternative mobile ETP solution with both comparable security assurance to and better access to the patient’s medication history than the current solution. This alternative solution would present no operational dependence upon infrastructure and its associated, ongoing cost to the nation’s healthcare expenditure. In addition, use of this mobile ETP alternative has the potential to change the public’s perception (i.e. acceptance from regulatory and security perspectives) of mobile healthcare solutions, thereby paving the way for further innovation and future enhancements in eHealth

Cramming for ZNO in English. Enhance Your Reading Skills

Cramming for ZNO in English is the first part of a series of books for undergraduate students who plan to apply for university Master course and pass independent external test of English (ZNO). The guidance manual covers a wide range of materials which help language learners enhance their skills of reading. Its units update students on the test features, equip them with effective strategies of approaching various task formats, and provide hands-on experience of practicing the tasks. The book can appear handy for both teachers and students, and can be used in a teacher-guided classroom setting as well as in students’ independent self-study work

Your Navy in Memphis 1970

A 60-page booklet titled Your Navy in Memphis 1970 introducing the United States Naval Air Station Memphis at Millington, Tennessee, published by Boone Publications in 1970.https://digitalcommons.memphis.edu/speccoll-pub-shelby/1133/thumbnail.jp