An ontology for formal representation of medication adherence-related knowledge : case study in breast cancer

Indiana University-Purdue University Indianapolis (IUPUI)Medication non-adherence is a major healthcare problem that negatively impacts the health and productivity of individuals and society as a whole. Reasons for medication non-adherence are multi-faced, with no clear-cut solution. Adherence to medication remains a difficult area to study, due to inconsistencies in representing medicationadherence behavior data that poses a challenge to humans and today’s computer technology related to interpreting and synthesizing such complex information. Developing a consistent conceptual framework to medication adherence is needed to facilitate domain understanding, sharing, and communicating, as well as enabling researchers to formally compare the findings of studies in systematic reviews. The goal of this research is to create a common language that bridges human and computer technology by developing a controlled structured vocabulary of medication adherence behavior—“Medication Adherence Behavior Ontology” (MAB-Ontology) using breast cancer as a case study to inform and evaluate the proposed ontology and demonstrating its application to real-world situation. The intention is for MAB-Ontology to be developed against the background of a philosophical analysis of terms, such as belief, and desire to be human, computer-understandable, and interoperable with other systems that support scientific research. The design process for MAB-Ontology carried out using the METHONTOLOGY method incorporated with the Basic Formal Ontology (BFO) principles of best practice. This approach introduces a novel knowledge acquisition step that guides capturing medication-adherence-related data from different knowledge sources, including adherence assessment, adherence determinants, adherence theories, adherence taxonomies, and tacit knowledge source types. These sources were analyzed using a systematic approach that involved some questions applied to all source types to guide data extraction and inform domain conceptualization. A set of intermediate representations involving tables and graphs was used to allow for domain evaluation before implementation. The resulting ontology included 629 classes, 529 individuals, 51 object property, and 2 data property. The intermediate representation was formalized into OWL using Protégé. The MAB-Ontology was evaluated through competency questions, use-case scenario, face validity and was found to satisfy the requirement specification. This study provides a unified method for developing a computerized-based adherence model that can be applied among various disease groups and different drug categories

Using conceptual graphs for clinical guidelines representation and knowledge visualization

The intrinsic complexity of the medical domain requires the building of some tools to assist the clinician and improve the patient’s health care. Clinical practice guidelines and protocols (CGPs) are documents with the aim of guiding decisions and criteria in specific areas of healthcare and they have been represented using several languages, but these are difficult to understand without a formal background. This paper uses conceptual graph formalism to represent CGPs. The originality here is the use of a graph-based approach in which reasoning is based on graph-theory operations to support sound logical reasoning in a visual manner. It allows users to have a maximal understanding and control over each step of the knowledge reasoning process in the CGPs exploitation. The application example concentrates on a protocol for the management of adult patients with hyperosmolar hyperglycemic state in the Intensive Care Unit

Exploring compassion, shame and the healthcare system in relation to self-care in type 2 diabetes

This portfolio thesis is comprised of three parts: 1) a systematic literature review, 2) an empirical report and, 3) supporting appendices.Part one is a systematic literature review which aimed to explore healthcare system factors that are related to self-care in individuals with Type 2 Diabetes. A systematic search of four key databases identified nineteen empirical papers for review. A narrative analysis of the evidence is provided and key factors relating to self-care are identified and summarised. A review of methodological quality and standard of reporting of reviewed studies is also provided. Implications for the field of research and for clinical practice are discussed.Part two is an empirical report of an original piece of research exploring compassion and shame in relation to self-care in individuals with Type 2 Diabetes. Quantitative analysis aimed to investigate whether shame has a negative effect on self-care, and whether compassion has a role in buffering the impact of shame. In an additional qualitative element, experiences of shame in individuals with Type 2 Diabetes were explored. The findings of the study are discussed in relation to previous literature and theory, and implications for future research and clinical practice are considered.Part three contains the appendices relating to the systematic literature review and the empirical report. It additionally includes an epistemological statement, and a reflective statement focussing on the research process

Type 2 diabetes mellitus and online learning : a patient-centred approach

Type 2 diabetes mellitus is one of the most pressing global health problems. It is often considered to be a ‘lifestyle condition’ associated with distinct patterns of nutritional and physical activity. Treatment options can be biomedical or a combination of educational and biomedical approaches. Treatment strategies that focus on educational interventions in a health context tend to focus on psychological constructs (self-efficacy, for example) but are often under-theorised in terms of learning theory. Technology-based interventions are also similarly lacking in their employment of learning theory as they often tend to focus on the transactional nature of information flow between the user and adopted technology platform. This project, on the other hand, places learning theory at the core of the design of an online-based, patient-centred learning community for people with type 2 diabetes. The project adopted a design-based research approach and the objective was to provide an environment conducive to the development of a community of practice and learning for participants with type 2 diabetes and to explore if the characteristics of transformative learning could be identified. Interviews, self-efficacy surveys and focus groups were conducted during various stages of the design. The analytical approach included activity theory and the community of inquiry framework. The results demonstrate that a design-based research process can be effectively utilised for the development of an online patient-centred learning environment in the context of type 2 diabetes. It was shown that the adoption of the theory of transformative learning can help to frame the various types of learning that take place during the process associated with self-management of a chronic disease such as diabetes. Analysis of the engagement with the learning community Type 2 diabetes mellitus and online learning: a patient-centred approach indicates that the characteristics of transformative learning were partially realised although a community of practice was not established. The study illustrates the role that a theory-rich patient-centred learning environment can play in the ongoing process of patient care in the context of type 2 diabetes. Interventions in other chronic disease contexts may also benefit from the results of this study

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

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

Conceptual graph-based knowledge representation for supporting reasoning in African traditional medicine

Although African patients use both conventional or modern and traditional healthcare simultaneously, it has been proven that 80% of people rely on African traditional medicine (ATM). ATM includes medical activities stemming from practices, customs and traditions which were integral to the distinctive African cultures. It is based mainly on the oral transfer of knowledge, with the risk of losing critical knowledge. Moreover, practices differ according to the regions and the availability of medicinal plants. Therefore, it is necessary to compile tacit, disseminated and complex knowledge from various Tradi-Practitioners (TP) in order to determine interesting patterns for treating a given disease. Knowledge engineering methods for traditional medicine are useful to model suitably complex information needs, formalize knowledge of domain experts and highlight the effective practices for their integration to conventional medicine. The work described in this paper presents an approach which addresses two issues. First it aims at proposing a formal representation model of ATM knowledge and practices to facilitate their sharing and reusing. Then, it aims at providing a visual reasoning mechanism for selecting best available procedures and medicinal plants to treat diseases. The approach is based on the use of the Delphi method for capturing knowledge from various experts which necessitate reaching a consensus. Conceptual graph formalism is used to model ATM knowledge with visual reasoning capabilities and processes. The nested conceptual graphs are used to visually express the semantic meaning of Computational Tree Logic (CTL) constructs that are useful for formal specification of temporal properties of ATM domain knowledge. Our approach presents the advantage of mitigating knowledge loss with conceptual development assistance to improve the quality of ATM care (medical diagnosis and therapeutics), but also patient safety (drug monitoring)