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Analysis of Search on Clinical Narrative within the EHR
Electronic Health Records (EHRs) are used increasingly in the hospital and outpatient set- tings, and patients are amassing digitized clinical information. On one hand, aggregating all the patient's clinical information can greatly assist health care workers in making sound decisions. On the other hand, it can result in information overload, making it difficult to browse for information within the health record. Considering the time constraints clinicians face, one way to reduce information overload is through a search utility. However, traditional, free-text search engines within the EHR can potentially miss documents that do not contain the query but that are relevant to the clinical user's search. This dissertation aims at addressing this gap by analyzing within-patient search of the EHR and examining various semantic search approaches on clinical narrative. Our work consists of three studies where clinical users' search needs are examined, traditional string-matching is analyzed, and semantic search approaches on clinical narrative are evaluated. The first study applied a mixed method approach in order to provide a better understanding of clinical users' search needs within the EHR. It is comprised of a retrospective log analysis of search log files and a survey that was administered to clinical professionals within our institution. The log analysis attempts to categorize how users of a search system query for information, and the survey tries to understand users' search preferences. This study showed that clinical users were very interested in search functionality within the EHR and that various types of users utilize a search utility differently. Overall, most users searched for specific laboratory tests and diseases within the health record. The last two studies rely on a gold standard, which was developed specifically for this dissertation. The gold standard contained a document collection, a set of queries, and for each document/query pair, a relevance judgment. This gold standard was used to evaluate and compare different search models on clinical narrative. The second study conducted was an error analysis of the traditional, vector-space model search approach. The study examined the false positives and false negatives of this approach and categorized the errors in order to identify gaps that semantic approaches may fill. The last study was a systematic evaluation of five different semantic search approaches. These search methods consisted of distributional semantic approaches and an ontology-based approach. The study identified that a mixed topic modeling and vector-space model approach was the best performing search algorithm on our gold standard. All of these studies lay the foundation for us to gain a deeper understanding of information retrieval methods within the electronic health record. Ultimately, this will allow health care professionals to easily access pertinent patient information, which could result in better health care delivery
Planning families in Zaria: an investigation into the information-behaviours and favoured advice-givers of parents in northern Nigeria.
The availability of precise, impartial and credible information is crucial to building knowledge and empowering citizens to make rational individual and collective decisions. For this reason, the usefulness of information for satisfying identified needs is strongly dependent on the appropriateness of its presentation (language, format, and consideration of cultural and religious sensitivities) and its accessibility (cost of acquiring, mode of dissemination, location of distribution). Nigeria is a country characterised by wide-scale poverty, unemployment, crime, high maternal and infant mortality rates, and high fertility rates - especially in the North-West. Despite the concerted efforts of government agencies, non-government organisations (NGOs), charities and international organisations to reduce fertility and promote family planning (FP), utilisation remains low. Culture, religion, fear of medical side-effects and the dominant decision-making influence of men have repeatedly been identified by researchers as barriers to the adoption of FP by parents and prospective parents in the region. Information-seeking behaviour (ISB) has consistently been recognised as pivotal to developing effective initiatives for promoting sustainable and healthy populations, yet take-up of FP remains low in developing countries, including Nigeria, especially in rural communities. This thesis uses the Information Seeking and Communication Model (ISCM) to analyse the ISB of men and women in the rural Local Government Area of Zaria, northern Nigeria. Thematic analysis of 12 semi-structured interviews revealed evident disparities in the behaviours and choices of favoured advice-givers. While married couples' ISB and major FP sources were more informal than formal β privileging anecdote, received wisdom and personal experience over 'official' advice from government or health professionals - men favoured the authority of religious leaders or community-based sources (e.g. village heads), while women preferred to rely on informal advice sources. However, single men and women's ISB and information sources were majorly semi-formal, in avoidance of being described as deviants in the society. Distrust for government and practical barriers to accessing information (e.g. distance from health centres or problems with understanding the formats of pamphlets and translating literature written in non-native languages) were revealed to be the most significant barriers to the uptake of more formal FP advice. The study ends by recommending a series of possible improvements to the FP communication process, by making information more accessible to the critical sub-groups identified, while also being sensitive to cultural and religious values, so as to better engage with 'hard to reach' individuals and communities