A framework for decision making on teleexpertise with traceability of the reasoning

This paper provides a methodological framework for decision making process to ensure its traceability generally in the context of telemedicine and particularly in the act of teleexpertise. This act permits to medical professionals and/or health professionals to collaborate in order to take suitable decisions for a patient diagnosis or treatment. The main problem dealing with teleexpertise is the following: How to ensure the traceability of the decisions making process? This problem is solved in this paper through a conceptualisation of a rigorous framework coupling semantic modelling and explicit reasoning which permits to fully support the analysis and rationale for decisions made. The logical semantic underlying this framework is the argumentative logicto provide adequate management of information with traceability of the reasoning including options and constraints. Thus our proposal will permit to formally ensure the traceability of reasoning in telemedicine and particularly in teleexpertise in order to favour the quality of telemedicine’s procedure checking. This traceability is to guarantee equitable access to the benefits of the collective knowledge and experience and to provide remote collaborative practices with a sufficient safety margin to guard against the legal requirements. An illustrative case study is provided by the modelling of a decision making process applied to teleexpertise for chronic diseases such as diabetes mellitus type2

Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study

Abstract Background Ward rounds are an important and ubiquitous element of hospital care with a history extending well over a century. Although originally intended as a means of educating medical trainees and junior doctors, over time they have become focused on supporting clinical practice. Surprisingly, given their ubiquity and importance, they are under-researched and inadequately understood. This study aims to contribute knowledge in human reasoning within medical teams, meeting a pressing need for research concerning the reasoning occurring in rounds. Methods The research reported here aimed to improve the understanding of ward round reasoning by conducting a critical realist case study exploring the collaborative group reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia. The data collection involved observing rounds, interviewing medical practitioners and holding focus group meetings. Results Nine group reasoning mechanisms concerning sharing, agreeing and recording information in the categories of information accumulation, sense-making and decision-making were identified, together forming a program theory of ward round reasoning. In addition, themes spanning across mechanisms were identified, further explaining ward round reasoning and suggesting avenues for future exploration. Themes included the use of various criteria, tensions involving mechanisms, time factors, medical roles and hierarchies. Conclusions This paper contributes to the literature by representing rounds in a manner that strengthens understanding of the form of the group reasoning occurring within, thus supporting theory-based evaluation strategies, redesigned practices and training enhancements

Medical versus social egg freezing: the importance of future choice for women's decision-making

While the literature on oncofertility decision-making was central to the bioethics debate on social egg freezing when the practice emerged in the late 2000s, there has been little discussion juxtaposing the two forms of egg freezing since. This article offers a new perspective on this debate by comparing empirical qualitative data of two previously conducted studies on medical and social egg freezing. We re-analysed the interview data of the two studies and did a thematic analysis combined with interdisciplinary collaborative auditing for empirical ethics projects. Despite their different contexts, major similarities in women's decision-making and reasoning were found. We developed two main common themes. Firstly, women felt a clear need to plan for future options. Secondly, they manipulated decision-times by postponing definitive decisions and making micro-decisions. The comparison highlights that the passage of time and the preservation of future choice seems to permeate all aspects of the patient experiences in both studies. As a result of considering real-world lived experiences, we suggest that there are many overlaps in women's reasoning about egg freezing regardless of why they are making a decision to freeze. These overlaps are morally relevant and thus need to be further integrated into the existing arguments that have been canvassed in the flourishing egg freezing and fertility preservation debates across the field, and in policy and practice globally

Integration of decision support systems to improve decision support performance

Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward.

INTRODUCTION Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds. METHODS Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations. RESULTS A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4). DISCUSSION The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team

Intelligent multimedia communication for enhanced medical e-collaboration in back pain treatment

This is the post-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2004 SAGE PublicationsRemote, multimedia-based, collaboration in back pain treatment is an option which only recently has come to the attention of clinicians and IT providers. The take-up of such applications will inevitably depend on their ability to produce an acceptable level of service over congested and unreliable public networks. However, although the problem of multimedia application-level performance is closely linked to both the user perspective of the experience as well as to the service provided by the underlying network, it is rarely studied from an integrated viewpoint. To alleviate this problem, we propose an intelligent mechanism that integrates user-related requirements with the more technical characterization of quality of service, obtaining a priority order of low-level quality of service parameters, which would ensure that user-centred quality of perception is maintained at an optimum level. We show how our framework is capable of suggesting appropriately tailored transmission protocols, by incorporating user requirements in the remote delivery of e-health solutions

Baseline data of a longitudinal assessment of a Bachelor of Science in Health Science (BSHS) Program based on the core competencies for Interprofessional Collaborative Practice (IPCP)

Background: IPCP has been identified as essential to provide quality healthcare: so, IPE is being integrated to professional programs. While IPE is being researched in professional programs, not much is known about IPE at the pre-professional level. Purpose: Stockton’s BSHS program was built based upon the Core Competencies for IPCP. The current study assessed the following IPE-related constructs: Health Science Reasoning, Ethical Decision Making for Health, Attitude Towards Health Care Teams, and Readiness for IP Learning. Description: A cohort of students was recruited during the introductory course to the program. The following measures were administered at baseline: Health Science Reasoning Test (HSRT), Ethical Decision Making (EDM) Measure for Health Science, The Attitudes Toward Health Care Teams Scale (ATHCTS), Readiness for Interprofessional Learning (RIPLS) and demographic questions. Results: A cohort (N = 483) of students was recruited; N = 464 participated of the baseline. Results of main measures are: HSRT (M = 17.2, SD = 4.7), EDM (M = 2.18, SD = 0.20), ATHCTS (M = 4.1, SD = 0.47), RIPLS (M = 3.68, SD = 0.91). Results for subscales and demographic data will be included in the presentation. Conclusions: Results from EDM, ATHCTS and RIPLS suggest undergraduate pre-professional students’ Ethicality is at expected levels, they have positive attitudes toward healthcare teams and are prepared to receive IPE. However, the sample performed significantly below the expected level of critical thinking. Relevance: This suggests that students in an undergraduate health science program can receive interprofessional education, at least at the attitudinal and awareness level. IPE at this level can effectively foster positive attitudes towards working interprofessionally

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Therapists’ experiences and perceptions of teamwork in neurological rehabilitation: Critical happenings in effective and ineffective teamwork

This article reports the second part of an exploratory study into occupational therapists` and physiotherapists` perceptions and experiences of team-work in neurological rehabilitation: the factors that were thought to influence effective and ineffective team-work, and the meaning behind effective and ineffective team work in neurological rehabilitation. The study was undertaken through semi-structured interviews of 10 therapists from three different neurological rehabilitation teams based in the United Kingdom, and used the critical incident technique. Through analysis of the data, several main themes emerged regarding the perceived critical happenings in effective and ineffective team work. These were: team events and characteristics, team members` characteristics, shared and collaborative working practices, communication, specific organisational structures, environmental, external, and patient and family related factors. Effective and ineffective team-work was perceived to impact on a number of levels: having implications for the team, the patient, individual team members, and the neurological rehabilitation service. The study supported the perceived value of team work within neurological rehabilitation. It also indicated the extensive and variable factors that may influence the team working process as well as the complex and diverse nature of the process