Multidisciplinary oncology care pathways, evaluation of organisational interventions

In het proefschrift van Van Huizen worden de reorganisatie van multidisciplinaire medische overleggen (MDO’s) en video-confereren (VC) geëvalueerd. Het bleek dat door de invoering van een multidisciplinair eerste-dag spreekuur voor hoofd-hals-kanker en de reorganisatie van het gastro-intestinale oncologische MDO, de efficiëntie van de zorgtrajecten, vooral de wachttijd tot behandeling, verbeterde. Daarnaast bleek dat bij multidisciplinaire behandelingen het informeren van de patiënt extra aandacht verdient en wensen steeds moeten worden meegewogen.Zes verschillende vormen van VC in oncologische netwerken werden geïdentificeerd. De toepassingen van VC varieerde van ad hoc overleg met experts over behandeling van complexe casussen of zeer zeldzame tumoren, tot regulier overleg tussen zorgprofessionals, bijvoorbeeld in de palliatieve zorg. Voordelen van VC voor patiënten waren minder reizen voor diagnostisch onderzoek, betere coördinatie van zorg, betere toegang tot schaarse voorzieningen en behandeling in de eigen regio. Voordelen voor zorgmedewerkers waren optimalisatie van behandelplannen door multidisciplinaire discussies van complexe cases, tegelijkertijd informeren van zorgmedewerkers over wijzigingen in het zorgplan voor individuele patiënten en medische ontwikkelingen, verbeterde zorgcoördinatie en minder reizen.Het reguliere VC-MDO Hoofd-Hals Oncologie tussen een Universitair Medisch Centrum Groningen en haar partner Medisch Centrum Leeuwarden bleek vooral van waarde voor het bespreken van complexe casussen, omdat het andere team er met een ‘frisse blik’ naar keek, en voor het afstemmen van medisch beleid. Voor de aansturing van een zorgtraject bleek er behoefte te zijn aan een ‘real-time dashboard’ betreffende diagnostische procedures en behandelplannen. De meerwaarde van zo’n dashboard zou in toekomstig onderzoek geëvalueerd moeten worden.Van Huizen's dissertation evaluates the reorganisation of multidisciplinary meetings (MDTMs) and video-conferencing (VC). It turned out that introduction of a multidisciplinary first-day consultation for head-and-neck cancer and reorganisation of the gastrointestinal oncological MDTM improved the efficiency of the care pathway, particularly waiting times to start treatment. It was shown that in case of multidisciplinary treatment, extra attention should be paid to informing the patient and that wishes should always be taken into consideration.Six different types of VC in oncology networks were identified. Applications ranged from ad hoc consultation with experts about complex cases or very rare tumours to regular meetings about e.g. palliative care. Benefits for patients were, less travel, better coordination of care, better access to scarce facilities and treatment in their own community. Benefits for healthcare professionals involved optimised treatment plans through multidisciplinary discussion of complex cases, the ability to inform all healthcare professionals simultaneously on developments in the care of individual patients, enhanced care coordination, less travel and continued medical education.The regular VC-MDTM Head-and-Neck Oncology between Groningen University Medical Centre and its partner Leeuwarden Medical Centre added value in discussing complex cases, because the other team offered a fresh perspective by hearing it ‘as new’ and in in keeping their medical viewpoints aligned.For management of a care pathway, there was a need for real-time information regarding diagnostic procedures and treatment plans in the form of a ‘real time dashboard’. The added value of such a dashboard should evaluated in future research

Digital diffusion in the clinical trenches : findings from a Telemedicine Needs Assessment

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Architecture, 2002.Includes bibliographical references (leaves 105-110).Broadly stated, this dissertation focuses on how practitioners and provider organizations integrate the computer and web into healthcare delivery. The opportunity that afforded this research was a Telemedicine Needs Assessment commissioned by a Massachusetts-based provider organization, consisting of two hospitals and 29 community group practices (CGP). The Telemedicine Needs Assessment incorporated qualitative and quantitative research programs to include: 1. cross-sectional, institution-wide, in-depth interviews; 2. participant observation at administrative and clinical day-to-day operations, and lastly, 3. a 68 item, closed-ended survey distributed to all 586 clinical practitioners to assess the access, use, and perceived needs of current computer, web, and telemedicine technologies. Data from the survey, (72% response rate), established a computer and web enablement baseline against which the success, failure, or potential usefulness of any future medical informatics implementation would be evaluated. Findings included: 1. Computer and web enablement within the organization is not ubiquitous. Access is high, use is low; 2. Practitioner status, practice location, and gender affect enablement. Non-MDs, CGP-based practitioners, and female practitioners report lowest access and use. 3. No differences were reported specific to home access to computers and use of e-mail. 4. Hospital-based practitioners report greater access and use. CGP-based practitioners report greater perceived needs for teletechnologies.(cont.) 5. Hospital-based and CGP-based male MDs emerge as the most polarized subgroups due to differences in computer and web use and perceived needs. 6. Female practitioners are more successful than male practitioners securing tech support at home and at work. 7. With regard to technology uptake, female MDs constitute a more homogeneous group than male MDs. Also, four products emerged from the Telemedicine Needs Assessment: 1. a needs assessment theory and methodology derived from Process Architecture which promulgates that discussions specific to the end users' work must always be inextricably linked with their work practice; 2. a typology of barriers to the integration of computer and web-based technologies into healthcare delivery stratified by practitioner, administration, organization, and industry; 3. a framework which defines and integrates real and virtual healthcare delivery services, products, and technologies, and finally; 4. a systems-based model of clinical and telecommunications integrated delivery networks providing IS, IT, and administrative infrastructure support for the framework.by Verlé Margaret Harrop.Ph.D

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

Structured patient information management for efficient treatment and healthcare quality assurance in oncology

Die Behandlung von Patienten mit Tumoren im Kopf-Hals-Bereich gestaltet sich als komplexer und herausfordernder Prozess sowohl für den Patienten als auch für die behandelnden Ärzte und Chirurgen. Zur Gewährleistung der bestmöglichen individuellen Therapie werden vor Beginn der Behandlung zahlreiche diagnostische Verfahren durchgeführt. Hierzu zählen unter anderem medizinische bildgebende Verfahren wie z.B. Computertomographie (CT) oder Magnetresonanztomographie (MRT) sowie die Entnahme von tumorverdächtigem Gewebe während einer Panendoskopie zur exakten Bestimmung der Tumorart (Histologie, Grading, TNM-Klassifikation nach UICC, genaue Lokalisation des Primärtumors, der lokoregionären Metastasen und ggf. Fernmetastasen). Die gewonnenen Informationen bilden anschließend die Grundlage für die Entscheidung über die durchzuführende Therapie und stehen in unterschiedlichen klinischen Informationssystemen sowie auf Papierakten zur Verfügung. Leider werden die Daten im klinischen Alltag häufig nur unstrukturiert und schwer auffindbar präsentiert, da die führenden Informationssysteme nur unzureichend in den klinischen Arbeitsprozess integriert und untereinander schlecht vernetzt sind. Die präzise und erschöpfende Darstellung der jeweiligen individuellen Situation und die darauf aufbauende Therapieentscheidung sind aber entscheidend für die Prognose des Patienten, da der erste, gut geplante \"Schuss\" entscheidend für den weiteren Verlauf ist und nicht mehr korrigiert werden kann. In dieser Arbeit werden neue Konzepte zur Verbesserung des Informationsmanagements im Bereich der Kopf-Hals-Tumorbehandlung entwickelt, als prototypische Software implementiert und im klinischen Alltag in verschiedenen Studien wissenschaftlich evaluiert. Die Erlangung eines tiefgreifenden Verständnisses über die klinischen Abläufe sowie über beteiligte Informationssysteme und Datenflüsse stellte den ersten Teil der Arbeit dar. Aufbauend auf den Erkenntnissen wurde ein klinisches Informationssystem oncoflow entwickelt. Oncoflow importiert vollautomatisch relevante Patientendaten von verschiedenen klinischen Informationssystemen, restrukturiert die Daten und unterstützt Ärzte und Chirurgen im gesamten Therapieprozess. Das System wurde anschließend in unterschiedlichen Studien evaluiert und der klinische Nutzen in Bezug auf effizientere Arbeitsabläufe und eine verbesserte Informationsqualität gezeigt. Im folgenden Teil der Arbeit wurden Machine Learning Methoden genutzt um von Daten in der elektronischen Patientenakte auf den aktuellen Prozessschritt im Therapieprozess zu schließen. Der letzte Teil der Arbeit zeigt Möglichkeiten zur Erweiterung des Systems zur Nutzung in weiteren klinischen Fachdisziplinen auf

Health ManagementInformation Systems for Resource Allocation and Purchasing in Developing Countries

World Bank, Health Nutrition and Population, Discussion Paper: The paper begins with the premise that it is not possible to implement an efficient, modern RAP strategy today without the effective use of information technology. The paper then leads the architect through the functionality of the systems components and environment needed to support RAP, pausing to justify them at each step. The paper can be used as a long-term guide through the systems development process as it is not necessary (and likely not possible) to implement all functions at once. The paper’s intended audience is those members of a planning and strategy body, working in conjunction with technical experts, who are charged with designing and implementing a RAP strategy in a developing country

Where can teens find health information? A survey of web portals designed for teen health information seekers

The Web is an important source for health information for most teens with access to the Web (Gray et al, 2005a; Kaiser, 2001). While teens are likely to turn to the Web for health information, research has indicated that their skills in locating, evaluating and using health information are weak (Hansen et al, 2003; Skinner et al, 2003, Gray et al, 2005b). This behaviour suggests that the targeted approach to finding health information that is offered by web portals would be useful to teens. A web portal is the entry point for information on the Web. It is the front end, and often the filter, that users must pass through in order to link to actual content. Unlike general search engines such as Google, content that is linked to a portal has usually been pre-selected and even created by the organization that hosts the portal, assuring some level of quality control. The underlying architecture of the portal is structured and thus offers an organized approach to exploring a specific health topic. This paper reports on an environmental scan of the Web, the purpose of which was to identify and describe portals to general health information, in English and French, designed specifically for teens. It answers two key questions. First of all, what portals exist? And secondly, what are their characteristics? The portals were analyzed through the lens of four attributes: Usability, interactivity, reliability and findability. Usability is a term that incorporates concepts of navigation, layout and design, clarity of concept and purpose, underlying architecture, in-site assistance and, for web content with text, readability. Interactivity relates to the type of interactions and level of engagement required by the user to access health information on a portal. Interaction can come in the form of a game, a quiz, a creative experience, or a communication tool such as an instant messaging board, a forum or blog. Reliability reflects the traditional values of accuracy, currency, credibility and bias, and in the web-based world, durabililty. Findability is simply the ease with which a portal can be discovered by a searcher using the search engine that is most commonly associated with the Web by young people - Google - and using terms related to teen health. Findability is an important consideration since the majority of teens begin their search for health information using search engines (CIBER, 2008; Hansen et al, 2003). The content linked to by the portals was not evaluated, nor was the portals’ efficacy as a health intervention. Teens looking for health information on the Web in English have a wide range of choices available but French-language portals are much rarer and harder to find. A majority of the portals found and reviewed originated from hospitals, associations specializing in a particular disease, and governmental agencies, suggesting that portals for teens on health related topics are generally reliable. However, only a handful of the portals reviewed were easy to find, suggesting that valuable resources for teens remain buried in the Web

A Guide to Authentic e-Learning

Part of the groundbreaking Connecting with e-Learning series, A Guide to Authentic e-Learning provides effective, working examples to engage learners with authentic tasks in online settings. As technology continues to open up possibilities for innovative and effective teaching and learning opportunities, students and teachers are no longer content to accept familiar classroom or lecture-based pedagogies that rely on information delivery and little else. Situated and constructivist theories advocate that learning is best achieved in circumstances resembling the real-life application of knowledge. While there are multiple learning design models that share similar foundations, authentic e-learning tasks go beyond process to become complex, sustained activities that draw on realistic situations to produce realistic outcomes

Pivot to online learning for adapting or continuing workplace-based clinical learning in medical education following the COVID-19 pandemic: A BEME systematic review

BackgroundThe novel coronavirus disease (COVID-19) was declared a pandemic in March 2020, which necessitated adaptations to medical education. This systematic review synthesises published reports of medical educational developments and innovations that pivot to online learning from workplace-based clinical learning in response to the pandemic. The objectives were to synthesise what adaptations / innovation were implemented (description), their impact (justification), and ‘how’ and ‘why’ these were selected (explanation and rationale).MethodsThe authors systematically searched four online databases and hand-searched MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full-texts, performed data extraction, and assessed the risk of bias. Our findings are reported in alignment with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.ResultsFifty-five articles were included. Most studies (n=40) were from North America, and nearly 70% focused on undergraduate medical education (UGME). Key developments were rapid shifts from workplace-based learning to virtual spaces, including online electives, telesimulation, telehealth, radiology, and pathology image repositories, live-streaming or pre-recorded videos of surgical procedures, stepping up of medical students to support clinical services, remote adaptations for clinical visits, multidisciplinary team meetings and ward rounds. Challenges or barriers included lack of personal interactions, lack of standardised telemedicine curricula and need for faculty time, technical resources and devices. Assessment of risk of bias revealed poor reporting of underpinning theory, resources, setting, educational methods, and content. ConclusionsThis review highlights the response of medical educators in deploying adaptations and innovations from workplace-based to online learning during the COVID-19 pandemic in clinical settings. Whilst innovations and adaptations have ensured learning across the continuum, explicit reporting of operationalisation of education interventions requires additional focus. We would encourage future work to fully evaluate all outcomes and move towards reporting at Kirkpatrick levels 3 or 4

Air Force Institute of Technology Research Report 1997

This report summarizes the research activities of the Air Force Institute of Technology\u27s Graduate School of Engineering and the Graduate School of Logistics and Acquisition Management. It describes research interests and faculty expertise; list student theses/dissertations; identifies research sponsors and contributions; and outlines the procedure for contacting either school