A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

Work stress and cancer researchers : an exploration of the challenges, experiences and training needs of UK cancer researchers.

Work stress is a significant issue for many UK healthcare professionals, in particular those working in the field of oncology. However, there have been very few attempts to explore the challenges, experiences or training needs of researchers working in cancer research. In doing so, we will be better positioned to support and develop these researchers. 18 UK oncology researchers from a variety of backgrounds took part in a semi-structured interview. Interviews were transcribed and analysed using thematic analysis. The analysis identified two overarching themes: logistical research issues (workload, accessing/ recruiting participants, finances) and sensitive research issues (emotional demands, professional boundaries, sensitivity around recruitment). One cross-cutting theme, supportive strategies (support and training, coping mechanisms), was seen to influence both logistical and sensitive research issues. While further research is needed to fully understand the causes and impact of work stress on cancer researchers, three specific issues were highlighted: emotional demands are relevant to quantitative and mixed methods researchers as well as those engaged in qualitative research; the researchers’ background (experience; clinical/non-clinical) was influential and an exploration of effective coping strategies is required; and there is a clear need for adequate support systems and training to be available, particularly for early career researchers.</p

Jefferson Digital Commons quarterly report: October-December 2018

This quarterly report includes: Articles Dissertations From the Archives Grand Rounds and Lectures Industrial Design Capstones Journals and Newsletters LabArchives Launch Masters of Public Health Capstones Posters Reports Videos What People are Saying About the Jefferson Digital Common

Engineering simulations for cancer systems biology

Computer simulation can be used to inform in vivo and in vitro experimentation, enabling rapid, low-cost hypothesis generation and directing experimental design in order to test those hypotheses. In this way, in silico models become a scientific instrument for investigation, and so should be developed to high standards, be carefully calibrated and their findings presented in such that they may be reproduced. Here, we outline a framework that supports developing simulations as scientific instruments, and we select cancer systems biology as an exemplar domain, with a particular focus on cellular signalling models. We consider the challenges of lack of data, incomplete knowledge and modelling in the context of a rapidly changing knowledge base. Our framework comprises a process to clearly separate scientific and engineering concerns in model and simulation development, and an argumentation approach to documenting models for rigorous way of recording assumptions and knowledge gaps. We propose interactive, dynamic visualisation tools to enable the biological community to interact with cellular signalling models directly for experimental design. There is a mismatch in scale between these cellular models and tissue structures that are affected by tumours, and bridging this gap requires substantial computational resource. We present concurrent programming as a technology to link scales without losing important details through model simplification. We discuss the value of combining this technology, interactive visualisation, argumentation and model separation to support development of multi-scale models that represent biologically plausible cells arranged in biologically plausible structures that model cell behaviour, interactions and response to therapeutic interventions

One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations

Proposes a framework for meeting patients' cultural and linguistic needs: policies and procedures that support cultural competence, data collection, population-tailored services, and internal and external collaborations. Includes a self-assessment tool

Include 2011 : The role of inclusive design in making social innovation happen.

Include is the biennial conference held at the RCA and hosted by the Helen Hamlyn Centre for Design. The event is directed by Jo-Anne Bichard and attracts an international delegation

Framing quality improvement tools and techniques in healthcare: the case of Improvement Leaders' Guides

The paper presents a study of how quality improvement tools are framed within healthcare settings.\ud \ud The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated using a case study of the NHS Modernisation Agency Improvement Leaders’ Guides.\ud \ud Improvement Leaders’ Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobililsation of tools and techniques, the experience also illustrated the challenges in distributing such approaches.\ud \ud The paper provides a contribution to our understanding of framing the 'social act' of quality improvement. Given the ongoing emphasis on quality improvement and the persistent challenges involved, it also provides information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.\ud \ud \u

It is Time to Stop Talking and Start Doing: The Views of People with Learning Disability on Future Research

There is a need for people with learning disabilities to be involved in directing research to ensure that the research is meaningful to those it concerns. This paper describes a scoping exercise to determine the research priorities for the field of learning disabilities for the next ten years. It focuses specifically on the role of people with learning disabilities in setting this research agenda and describes the methodology used, which involved a series of consultation workshops. Analysis of the data from these generated six priority themes: access to health care; getting good support; the right to relationships; housing options; work and personal finance; inclusion in the community. The findings showed that it is possible for people with learning disabilities to participate in setting a research agenda and there was agreement between the different stakeholders on the fundamental priorities. Moreover, the inclusion of people with learning disabilities provided a perspective that could not be adequately represented by other stakeholder groups. People with learning disabilities were concerned that research has a meaningful impact and can lead to demonstrable improvements in care. In order for this to happen there is a need for widespread dissemination of accessible outputs that reach the relevant stakeholders