Interpretation of an international terminology standard in the development of a logic-based compositional terminology

Purpose: Version 1.0 of the International Classification for Nursing Practice (ICNP®) is a logic-based compositional terminology. International Organization for Standardization (ISO) 18104:2003 Health Informatics¿Integration of a reference terminology model for nursing is an international standard to support the development, testing and implementation of nursing terminologies. Methods: This study examines how ISO 18104:2003 has been interpreted in the development of ICNP® Version 1.0 by identifying mappings between ICNP® and the ISO standard. Representations of diagnostic and interventional statements within ICNP® are also analyzed according to the requirements mandated by the ISO standard. Results: All structural components of ISO 18104:2003 i.e. semantic categories, semantic domains, qualifiers and semantic links are represented either directly or in interpreted form within ICNP®. The formal representations within ICNP® of diagnostic and interventional statements meet the requirement of the ISO standard. Conclusions: The findings of this study demonstrate that ICNP® Version 1.0 conforms to ISO 18104:2003. More importantly perhaps, this study provides practical examples of how components of a terminology standard might be interpreted and it examines how such a standard might be used to support the definition of high-level schemata in developing logic-based compositional terminologies

Formal nursing terminology systems: a means to an end

In response to the need to support diverse and complex information requirements, nursing has developed a number of different terminology systems. The two main kinds of systems that have emerged are enumerative systems and combinatorial systems, although some systems have characteristics of both approaches. Differences in the structure and content of terminology systems, while useful at a local level, prevent effective wider communication, information sharing, integration of record systems, and comparison of nursing elements of healthcare information at a more global level. Formal nursing terminology systems present an alternative approach. This paper describes a number of recent initiatives and explains how these emerging approaches may help to augment existing nursing terminology systems and overcome their limitations through mediation. The development of formal nursing terminology systems is not an end in itself and there remains a great deal of work to be done before success can be claimed. This paper presents an overview of the key issues outstanding and provides recommendations for a way forward

A norma ISO 18.104: 2003 como modelo integrador de terminologias de enfermagem

This paper presents the ISO 18.104:2003 as an integrative model of nursing terminology. It describes the standard, studies and experiences with its use and discusses possibilities to develop knowledge in the field. The standard has been shown to be effective in developing reference terminologies, and as a standard method for interoperability and reuse. Studies have internal limitations such as language and notations unknown to nursing. Correspondence of the model with classifications used in health services and practice is incipient, which hinders its applicability and development due to the lack of examples to be analyzed and discussed.Este estudio tiene como objetivo presentar la ISO 18.104:2003 como modelo integrador de terminologías de enfermería; él describe la norma, investigaciones y experiencias de su uso y discute las posibilidades del desarrollo de conocimiento en el área. La norma se muestra efectiva para la composición de terminologías de referencia y como método estándar para la interoperabilidad y uso. Se verificó que las investigaciones poseen limitaciones internas, como lenguaje y notaciones desconocidas por la enfermería. Es incipiente la correspondencia del modelo con las clasificaciones utilizadas en los servicios y en la práctica, lo que impide su análisis. Se considera que hay poca correspondencia del modelo con las clasificaciones utilizadas en los servicios y en la práctica profesional, lo que impide su aplicabilidad y su evolución, por la ausencia de ejemplos a ser analizados y discutidos.Este estudo teve como objetivo apresentar a ISO 18.104:2003 como modelo integrador de terminologias de enfermagem, descrevendo a norma, pesquisas e experiências de seu uso e discutindo as possibilidades de desenvolvimento do conhecimento na área. A norma se mostra efetiva para a composição de terminologias de referência e como método padrão para a interoperabilidade e reuso. Verificou-se que as pesquisas possuem limitações internas, como linguagem e notações desconhecidas pela enfermagem. É incipiente a correspondência do modelo às classificações utilizadas nos serviços e na prática, o que impede sua análise. Considera-se que há pouca correspondência do modelo às classificações utilizadas nos serviços e na prática profissional, impedindo sua aplicabilidade e evolução, pela ausência de exemplos a serem analisados e discutidos

Development and Psychometric Analysis of the Patient Preferences for Engagement Tool

Background Assessing patients’ preferences for engaging in healthcare is needed to inform the planning and delivery of individualized healthcare. Unfortunately, patients are often not engaged in their care to the extent that they would like, leading to patient feelings of disempowerment and frustration. Objectives The purpose of this study was to (a) develop and (b) psychometrically test the Patient Preferences for Engagement Tool (PPET), a clinical assessment tool that can be used by nursing staff to identify patient preferences for engagement in healthcare. The usability of the PPET was also examined for both nurses and patients participating in the study. Methods The psychometric evaluation design used content and construct validity testing (exploratory and confirmatory factor analysis, known groups comparisons) and reliability estimation using Cronbach’s alpha coefficient. The sample consisted of 308 adult patients aged 18–101 years from a Midwestern U.S. Magnet-designated academic medical center. Results Content validity index was at least 0.8 for all but one item. Using a split sample, a six-factor solution was first identified using exploratory factor analysis and then confirmed using confirmatory factor analysis. Demographic and illness factors were not significant predictors of factor scores. Cronbach’s alpha coefficients of all six factors were \u3e0.7. Both patients and nurses gave high ratings to the tool on effectiveness, efficiency, and satisfaction with use. Discussion The PPET demonstrated acceptable validity and reliability estimates. Assessing patient preferences for engagement gives value to the patient voice and provides an opportunity to have discussions with patients about various ways they can engage in their healthcare. Future research will focus on reducing the number of items on the PPET to construct a clinically useful resource for providers to use to assess patient preferences for healthcare engagement, leading to the development of more personalized care delivery methods

Music Therapy for Patients Who Have Undergone Hematopoietic Stem Cell Transplant

Objectives. This study examines the short- and long-term QOL benefits of a music therapy intervention for patients recovering from hematopoietic stem cell transplantation (HSCT). Methods. Ninety allogeneic HSCT patients, after transplant, were randomized to receive ISO-principle (i.e., mood matching) based music therapy (MT; n = 29), unstructured music (UM; n = 30), or usual care (UC; n = 31) for four weeks. The ISO principle posits that patients may shift their mood from one state to another by listening to music that is equal to the individual\u27s initial mood state and subsequently listening to music selections that gradually shift in tempo and mood to match the patient\u27s desired disposition. Participants in MT and UM groups developed two audio CDs to help them feel more relaxed and energized and were instructed to use the CDs to improve their mood as needed. Short-term effects on mood and long-term effects on QOL were examined. Results. MT and UM participants reported improved mood immediately after listening to CDs; the within-group effect was greater for UM participants compared to MT participants. Participant group was not associated with long-term QOL outcomes. Conclusions. Music listening improves mood acutely but was not associated with long-term benefits in this study

Music Therapy for Patients Who Have Undergone Hematopoietic Stem Cell Transplant

Objectives. This study examines the short- and long-term QOL benefits of a music therapy intervention for patients recovering from hematopoietic stem cell transplantation (HSCT). Methods. Ninety allogeneic HSCT patients, after transplant, were randomized to receive ISO-principle (i.e., mood matching) based music therapy (MT; n = 29), unstructured music (UM; n = 30), or usual care (UC; n = 31) for four weeks. The ISO principle posits that patients may shift their mood from one state to another by listening to music that is equal to the individual\u27s initial mood state and subsequently listening to music selections that gradually shift in tempo and mood to match the patient\u27s desired disposition. Participants in MT and UM groups developed two audio CDs to help them feel more relaxed and energized and were instructed to use the CDs to improve their mood as needed. Short-term effects on mood and long-term effects on QOL were examined. Results. MT and UM participants reported improved mood immediately after listening to CDs; the within-group effect was greater for UM participants compared to MT participants. Participant group was not associated with long-term QOL outcomes. Conclusions. Music listening improves mood acutely but was not associated with long-term benefits in this study

Persons who frequently visit the psychiatric emergency room. Who are they and what are their needs?

Persons who frequently visit psychiatric emergency rooms (PERs) account for a disproportionately high number of total visits to PERs. They have needs just as any other human beings do. Yet in addition, they also have specific daily function needs, service needs, and needs for professional healthcare.The overall aim of this thesis was to investigate who persons frequently visiting PERs in Sweden are and what needs they have. Both studies I and II were conducted in southern Sweden. Study I is a quantitative mapping study describing who persons who frequently visit PERs are, what characterizes them, and what characterizes their visits, while study II investigates their self-expressed and self-assessed needs using a mixed-methods design.For data collection, a large-scale registry was used in study I, while in study II an interviewer-administered manual was applied consisting of open-ended questions and validated instruments covering the person-in-care’s needs assessment, alcohol and drug use, exposure to violence, and social network. Quantitative data were analysed using descriptive statistics and non-parametric tests (I, II) and qualitative data were analysed using qualitative content analysis (II).The results indicate that persons who frequently visit PERs represented 8.1% of the total number of PER visitors but accounted for 38.3% of the total number of PER visits (I). They differed significantly from the rest of the PER visitors in terms of gender, diagnoses, hospital admissions, and temporal patterns of visits. Differences were also found in the distance between the PERs and the home municipalities of the visitors (I). In addition, they reported problems in many need areas in life, involving physical and psychiatric health problems as well as financial, emotional, and social problems (II). Results also indicate that they are often subject to violence and have limited social networks (II).The results may be used for planning, developing, and evaluating interventions targeting the needs of persons who frequently visit PERs, which is in line with a person-centred approach. Such an approach might eventually address their needs better, reduce their suffering, and consequently result in fewer PER visits

Doctor of Philosophy

dissertationThe problem of information transfer between healthcare sectors and across the continuum of care was examined using a mixed methods approach. These methods include qualitative interviews, retrospective case reviews and an informatic gap analysis. Findings and conclusions are reported for each study. Qualitative interviews were conducted with 16 healthcare representatives from 4 disciplines (medicine, pharmacy, nursing, and social work) and 3 healthcare sectors (hospital, skilled nursing care and community care). Three key themes from a Joint Cognitive Systems theoretical model were used to examine qualitative findings. Agreement on cross-sector care goals is neither defined nor made explicit and in some instances working at cross purposes. Care goals and information paradigms change as patients move from hospitalbased crisis stabilization, diagnosis and treatment to a postdischarge care to home or skilled nursing recovery, function restoration, or end of life support. Control of the transfer process is variable across institutions with little feedback and feed-forward. Lack of knowledge, competency and information tracking threatens sector interdependencies with suspicion and distrust. Sixty-three patients discharged between 2006 and 2008 from hospitals to skilled nursing facilities were randomly selected and reviewed. Most notably missing are discharge summaries (30%), nursing assessments or notes (17%), and social work documents (25%). Advanced directives or living wills necessary for end of life support were present in only 6% of the cases. The presence of information on activities of daily living (ADLs), other disabling conditions, and nutrition was associated with positive outcomes at the 0.001, 0.04 and 0.08levels. Consistent geriatric information transfer across the continuum is needed for relevant care management. An interoperability gap analysis conducted on the LINC (Linking Information Necessary for Care) transfer form determined its interoperability to be the semantic level 0. Detailed Clinical Models representing care management processes are challenged by the lack of consensus in terminology standards across sectors. Construction of information transfer solutions compliant with the Centers of Medicare and Medicaid Services (CMS) Stage 2 meaningful use criteria must address syntactic and semantic standards, map sector terminologies within care management processes, and account for the lack of standard terminologies in allied health domains

Usability and Technology Acceptance of an Electronic Child Abuse Screening Tool in a Pediatric Emergency Department

Up to half of all child physical abuse victims with major abuse injuries seen in hospitals had sentinel injuries assessed by medical providers. Universal screening for child abuse and neglect in the emergency department can potentially increase detection at lower levels of injury. However, we must consider usability for the electronic health record embedded child abuse and neglect-screening tool to be most effective. The user most likely to interact with the screening tool is the bedside nurse. The interface of the initial screening tool and the process of inputting information must be perceived as useful, usable, and satisfying to the bedside nurse. The alert for a positive screen needs to achieve the right balance in visual hierarchy and workflow while avoiding alert fatigue and information overload in an already busy space. This project addresses the lack of robust universal child abuse and neglect screening in the Texas Children’s Hospitals’ emergency department. It also aims to address the gap in the literature on electronic health record-embedded child abuse and neglect screening tool usability. In addition, it seeks to address the gap in the literature on child abuse, neglect screening, and response protocols, as well as expand those protocols so they encompass support services for families affected by the sequela of poverty to avoid future states of neglect

Standardizing New Diagnostic Tests to Facilitate Rapid Responses to The Covid-19 Pandemic

In order to enhance the data interoperability, an expeditious and accurate standardization solution is highly desirable for naming rapidly emerging novel lab tests, and thus diminishes confusion in early responses to pandemic outbreaks. This is a preliminary study to explore the roles and implementation of medical informatics technology, especially natural language processing and ontology methods, in standardizing information about emerging lab tests during a pandemic, thereby facilitating rapid responses to the pandemic. The ultimate goal of this study is to develop an informatics framework for rapid standardization of lab testing names during a pandemic to better prepare for future public health threats. We first constructed an information model for lab tests approved during the COVID-19 pandemic and built a named entity recognition tool that can automatically extract lab test information specified in the information model from the Emergency Use Authorization(EUA)documents of the U.S. Food and Drug Administration (FDA), thus creating a catalog of approved lab tests with detailed information. To facilitate the standardization of lab testing data in electronic health records, we further developed the COVID-19 TestNorm, a tool that normalizes the names of various COVID-19 lab testing used by different healthcare facilities into standard Logical Observation Identifiers Names and Codes (LOINC). The overall accuracy of COVID-19 TestNorm on the development set was 98.9%, and on the independent test set was 97.4%. Lastly, we conducted a clinical study on COVID-19 re-positivity to demonstrate the utility of standardized lab test information in supporting clinical research. We believe that the result of my study indicates great a potential of medical informatics technologies for facilitating rapid responses to both current and future pandemics