I Used to be Fat : A Qualitative Analysis of Bariatric Surgery Patients

A thesis presented to the faculty of the Caudill College of Arts, Humanities, and Social Sciences at Morehead State University in Partial fulfillment of the requirements for the Degree of Master of Arts by Steven W. Fife on June 22, 2019

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today

Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services

Background: Crohn’s disease (CD) is a long-term condition which requires repeated disease monitoring via medical imaging, where repeated burdensome medical investigations negatively impact on patients quality of life. Small bowel ultrasound scanning (SBUS) has been shown to be similar in accuracy when compared to magnetic resonance enterography (MRE), has the potential to be quicker, less costly and improve patient experience of care, but it is not routinely used in NHS IBD care. Objectives: This thesis aims to provide insight on how best to support the implementation of SBUS in practice by collecting information about current national usage and appetite for SBUS uptake, stakeholder perceptions of the adoption of the intervention by health services and the potential impact of use of SBUS on care pathways in routine CD care. Findings from this work will contribute to the production of an implementation package to facilitate national uptake of SBUS in NHS IBD services. Methods: A scoping literature review and three research studies were undertaken throughout this programme of work. The scoping literature review was undertaken to explore clinical utility of SBUS in IBD settings. A national survey was undertaken to uncover current usage and appetite for use of SBUS in IBD settings. A qualitative semi structured interview study was undertaken to explore stakeholder perceptions of SBUS use and implementation of ultrasound in IBD settings. A care pathway analysis and cost implications analysis were undertaken to gauge the impact of the introduction of SBUS into an NHS IBD service. The quantitative data were analysed using descriptive statistics. Qualitative data were analysed using template analysis. Results: Ultrasound is reported as quicker, more acceptable to patients and safer when compared to MRE and has been shown to be similarly accurate in detecting presence and extent of small bowel CD. Ultrasound is used widely in central Europe and Canada but has not yet been embraced in the UK. Survey responses indicated that there is an appetite for the uptake of SBUS in NHS services. There is disparity in confidence levels when using ultrasound to make clinical decisions, compared to MRE. The interview study revealed that stakeholders believe that the introduction of SBUS into clinical services would be beneficial to patient experience, outcomes and cost reduction. There are concerns in relation to the availability of training for health care professionals and the belief that there are still concerns relating to accuracy of SBUS compared to MRE. Interview participants believed that the largest barriers to implementation of SBUS in the NHS were the existing practices, beliefs and behaviours of healthcare professionals which are likely to be difficult to amend. Care pathway and costs implications analysis’ showed that there are significant potential cost saving and waiting time reduction implications to the introduction of SBUS into NHS IBD services. Conclusions: Recommendations from this work which will contribute to the generation of an implementation package for SBUS include the need for well-structured and supported training for health care professionals, tools for identifying and fostering leadership roles in promoting and sustaining change and mechanisms for reviewing and adapting SBUS over time to ensure it meets the needs of stakeholders and IBD services

Repeatable and reusable research - Exploring the needs of users for a Data Portal for Disease Phenotyping

Background: Big data research in the field of health sciences is hindered by a lack of agreement on how to identify and define different conditions and their medications. This means that researchers and health professionals often have different phenotype definitions for the same condition. This lack of agreement makes it hard to compare different study findings and hinders the ability to conduct repeatable and reusable research. Objective: This thesis aims to examine the requirements of various users, such as researchers, clinicians, machine learning experts, and managers, for both new and existing data portals for phenotypes (concept libraries). Methods: Exploratory sequential mixed methods were used in this thesis to look at which concept libraries are available, how they are used, what their characteristics are, where there are gaps, and what needs to be done in the future from the point of view of the people who use them. This thesis consists of three phases: 1) two qualitative studies, including one-to-one interviews with researchers, clinicians, machine learning experts, and senior research managers in health data science, as well as focus group discussions with researchers working with the Secured Anonymized Information Linkage databank, 2) the creation of an email survey (i.e., the Concept Library Usability Scale), and 3) a quantitative study with researchers, health professionals, and clinicians. Results: Most of the participants thought that the prototype concept library would be a very helpful resource for conducting repeatable research, but they specified that many requirements are needed before its development. Although all the participants stated that they were aware of some existing concept libraries, most of them expressed negative perceptions about them. The participants mentioned several facilitators that would encourage them to: 1) share their work, such as receiving citations from other researchers; and 2) reuse the work of others, such as saving a lot of time and effort, which they frequently spend on creating new code lists from scratch. They also pointed out several barriers that could inhibit them from: 1) sharing their work, such as concerns about intellectual property (e.g., if they shared their methods before publication, other researchers would use them as their own); and 2) reusing others' work, such as a lack of confidence in the quality and validity of their code lists. Participants suggested some developments that they would like to see happen in order to make research that is done with routine data more reproducible, such as the availability of a drive for more transparency in research methods documentation, such as publishing complete phenotype definitions and clear code lists. Conclusions: The findings of this thesis indicated that most participants valued a concept library for phenotypes. However, only half of the participants felt that they would contribute by providing definitions for the concept library, and they reported many barriers regarding sharing their work on a publicly accessible platform such as the CALIBER research platform. Analysis of interviews, focus group discussions, and qualitative studies revealed that different users have different requirements, facilitators, barriers, and concerns about concept libraries. This work was to investigate if we should develop concept libraries in Kuwait to facilitate the development of improved data sharing. However, at the end of this thesis the recommendation is this would be unlikely to be cost effective or highly valued by users and investment in open access research publications may be of more value to the Kuwait research/academic community