A pragmatic cluster randomised trial evaluating three implementation interventions

Background Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. Methods A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients' experiences, and stakeholders' experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. Results Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. Conclusions This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions' impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. Trial registration ISRCTN18046709 - Peri-operative Implementation Study Evaluation (POISE

Researching Identities: Impact of the Performance-Base Research Fund on the Subject(s) of Education

My argument begins by introducing key conceptual tools, applying them to the formative years of Education as a university subject. Second, I sketch a brief history of the subject in New Zealand in the 1980s and 1990s, emphasising its contradictory mandates as both academic and professional/clinical discipline. Third, I explore interviewees’ experiences and perspectives during and immediately after the quality evaluation process (Middleton, 2005a). The conclusion suggests ways the evaluation model might change to support (not penalise) Education’s dual mandate to enhance research capacity and outputs and to produce good practitioners for the teaching professions

Designing a web-application to support home-based care of childhood CKD stages 3-5: Qualitative study of family and professional preferences

Background: There is a lack of online, evidence-based information and resources to support home-based care of childhood CKD stages 3-5. Methods. Qualitative interviews were undertaken with parents, patients and professionals to explore their views on content of the proposed online parent information and support (OPIS) web-application. Data were analysed using Framework Analysis, guided by the concept of Self-efficacy. Results: 32 parents, 26 patients and 12 professionals were interviewed. All groups wanted an application that explains, demonstrates, and enables parental clinical care-giving, with condition-specific, continously available, reliable, accessible material and a closed communication system to enable contact between families living with CKD. Professionals advocated a regularly updated application to empower parents to make informed health-care decisions. To address these requirements, key web-application components were defined as: (i) Clinical care-giving support (information on treatment regimens, video-learning tools, condition-specific cartoons/puzzles, and a question and answer area) and (ii) Psychosocial support for care-giving (social-networking, case studies, managing stress, and enhancing families' health-care experiences). Conclusions: Developing a web-application that meets parents' information and support needs will maximise its utility, thereby augmenting parents' self-efficacy for CKD caregiving, and optimising outcomes. Self-efficacy theory provides a schema for how parents' self-efficacy beliefs about management of their child's CKD could potentially be promoted by OPIS. © 2014 Swallow et al.; licensee BioMed Central Ltd

Reasoning by analogy in the generation of domain acceptable ontology refinements

Refinements generated for a knowledge base often involve the learning of new knowledge to be added to or replace existing parts of a knowledge base. However, the justifiability of the refinement in the context of the domain (domain acceptability) is often overlooked. The work reported in this paper describes an approach to the generation of domain acceptable refinements for incomplete and incorrect ontology individuals through reasoning by analogy using existing domain knowledge. To illustrate this approach, individuals for refinement are identified during the application of a knowledge-based system, EIRA; when EIRA fails in its task, areas of its domain ontology are identified as requiring refinement. Refinements are subsequently generated by identifying and reasoning with similar individuals from the domain ontology. To evaluate this approach EIRA has been applied to the Intensive Care Unit (ICU) domain. An evaluation (by a domain expert) of the refinements generated by EIRA has indicated that this approach successfully produces domain acceptable refinements

Emergent Frameworks for Decision Support Systems

Knowledge is generated and accessed from heterogeneous spaces. The recent advances in in-formation technologies provide enhanced tools for improving the efficiency of knowledge-based decision support systems. The purpose of this paper is to present the frameworks for developing the optimal blend of technologies required in order to better the knowledge acquisition and reuse in large scale decision making environments. The authors present a case study in the field of clinical decision support systems based on emerging technologies. They consider the changes generated by the upraising social technologies and the challenges brought by the interactive knowledge building within vast online communities.Knowledge Acquisition, CDDSS, 2D Barcodes, Mobile Interface

Proceedings ICPW'07: 2nd International Conference on the Pragmatic Web, 22-23 Oct. 2007, Tilburg: NL

Proceedings ICPW'07: 2nd International Conference on the Pragmatic Web, 22-23 Oct. 2007, Tilburg: N

Display Enhanced Testing For Concussions And Mild Traumatic Brain Injury

Cognitive assessment systems and methods that provide an integrated solution for evaluating the presence or absence of cognitive impairment. The present invention is used to test cognitive functions of an individual including information processing speed, working memory, work list learning and recall, along with variations of these tasks. Immersive and non-immersive systems and methods are disclosed. Testing and results feedback using the present invention may be completed in real time, typically in less than 15 minutes.Emory UniversityGeorgia Tech Research Corporatio

Knowledge will Propel Machine Understanding of Content: Extrapolating from Current Examples

Machine Learning has been a big success story during the AI resurgence. One particular stand out success relates to learning from a massive amount of data. In spite of early assertions of the unreasonable effectiveness of data, there is increasing recognition for utilizing knowledge whenever it is available or can be created purposefully. In this paper, we discuss the indispensable role of knowledge for deeper understanding of content where (i) large amounts of training data are unavailable, (ii) the objects to be recognized are complex, (e.g., implicit entities and highly subjective content), and (iii) applications need to use complementary or related data in multiple modalities/media. What brings us to the cusp of rapid progress is our ability to (a) create relevant and reliable knowledge and (b) carefully exploit knowledge to enhance ML/NLP techniques. Using diverse examples, we seek to foretell unprecedented progress in our ability for deeper understanding and exploitation of multimodal data and continued incorporation of knowledge in learning techniques.Comment: Pre-print of the paper accepted at 2017 IEEE/WIC/ACM International Conference on Web Intelligence (WI). arXiv admin note: substantial text overlap with arXiv:1610.0770