Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians

Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Advancements and Breakthroughs in Ultrasound Imaging

Ultrasonic imaging is a powerful diagnostic tool available to medical practitioners, engineers and researchers today. Due to the relative safety, and the non-invasive nature, ultrasonic imaging has become one of the most rapidly advancing technologies. These rapid advances are directly related to the parallel advancements in electronics, computing, and transducer technology together with sophisticated signal processing techniques. This book focuses on state of the art developments in ultrasonic imaging applications and underlying technologies presented by leading practitioners and researchers from many parts of the world

User Interfaces for Patient-Centered Communication of Health Status and Care Progress

The recent trend toward patients participating in their own healthcare has opened up numerous opportunities for computing research. This dissertation focuses on how technology can foster this participation, through user interfaces to effectively communicate personal health status and care progress to hospital patients. I first characterize the design space for electronic information communication to patients through field studies conducted in multiple hospital settings. These studies utilize a combination of survey instruments, and low- and high-fidelity prototypes, including a document-editing prototype through which users can view and manage clinical data to automatically associate it with progress notes. The prototype, activeNotes, includes the first known techniques supporting clinical information requests directly within a document editor. A usage study with ICU physicians at New York-Presbyterian Hospital (NYP) substantiated our design and revealed how electronic information related to patient status and care progress is derived from a typical Electronic Health Record system. Insights gained from this study informed following studies to understand how to design abstracted, plain-language views suitable for patients. We gauged both patient and physician responses to information display prototypes deployed in patient rooms for a formative study exploring their design. Following my reports on this study, I discuss the design, development and pilot evaluations of a prototype Personal Health Record application providing live, abstracted clinical information for patients at NYP. The portal, evaluated by cardiothoracic surgery patients, is the first of its kind to allow patients to capture and monitor live data related to their care. Patient use of the portal influenced the subsequent design of tools to support users in making sense of online medication information. These tools, designed with nurses and pharmacists and evaluated by cardiothoracic surgery patients at NYP, were developed using topic modeling approaches and text analysis techniques. Embodied in a prototype called Remedy, they enable rapid filtering and comparison of medication-related search results, based on a number of website features and content topics. I conclude by discussing how findings from this series of studies can help shape the ongoing design and development of patient-centered technology

Improving Suturing Skills for Surgical Residents and Advancing Prosthesis Control for Amputees.

Proper suturing technique is one of the most important skills a surgical resident should acquire. However, current methods for teaching it rely on subjective performance evaluations. An instrumented training apparatus for abdominal closure could be used to define objective assessments that directly relate to closure quality. I identify a synthetic material that models abdominal fascia using porcine and cadaveric data and design a means to mount the material so that it mimics abdominal closure. Digital images are used to quantify material deformations and provide real-time objective measures regarding the effect of suture placement and tension in the abdominal tissue. In parallel, I develop a finite element model of abdominal fascia and its closure with suture to deduce stresses in the material and forces in the sutures. I find that despite uniform suture spacing, the forces in suture are unevenly distributed along the closure. These findings motivate the development of a surgical learning tool that objectively relays information about suture placement and tension. In a second body of work, I address the development of a novel interface between an amputee’s peripheral nervous system and a motorized prosthetic device. Conventional myoelectric control cannot produce a sufficient number of independent signals for actuation of modern computerized upper limb prostheses. A compact construct involving grafted muscle surgically prepared at the end of a transected peripheral nerve is envisioned for transducing a nervous signal with fine specificity and sensitivity. Up to 20 such constructs can be prepared in a human arm, and epimysial electrodes on each construct can be used to relay signals encoding 20 independent channels of motor intent. I develop a means of evaluating this construct in awake rats, and demonstrate that the transduced signals suffer minimal crosstalk and are correlated with gait. A decoder is able to reconstruct data produced by motion tracking, and I show that adjacent constructs placed proximal to one another provide the same signals as anatomically intact muscle-nerve antagonist-pair analogs. The correlation between the signals transduced, the walking kinematics, and analogous out of phase activation obtained from adjacent constructs indicates that this technology holds promise for human translation.PHDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/147635/1/danursu_1.pd

The State of the Art of Medical Imaging Technology: from Creation to Archive and Back

Medical imaging has learnt itself well into modern medicine and revolutionized medical industry in the last 30 years. Stemming from the discovery of X-ray by Nobel laureate Wilhelm Roentgen, radiology was born, leading to the creation of large quantities of digital images as opposed to film-based medium. While this rich supply of images provides immeasurable information that would otherwise not be possible to obtain, medical images pose great challenges in archiving them safe from corrupted, lost and misuse, retrievable from databases of huge sizes with varying forms of metadata, and reusable when new tools for data mining and new media for data storing become available. This paper provides a summative account on the creation of medical imaging tomography, the development of image archiving systems and the innovation from the existing acquired image data pools. The focus of this paper is on content-based image retrieval (CBIR), in particular, for 3D images, which is exemplified by our developed online e-learning system, MIRAGE, home to a repository of medical images with variety of domains and different dimensions. In terms of novelties, the facilities of CBIR for 3D images coupled with image annotation in a fully automatic fashion have been developed and implemented in the system, resonating with future versatile, flexible and sustainable medical image databases that can reap new innovations

Quality assurance of rectal cancer diagnosis and treatment - phase 3 : statistical methods to benchmark centres on a set of quality indicators

In 2004, the Belgian Section for Colorectal Surgery, a section of the Royal Belgian Society for Surgery, decided to start PROCARE (PROject on CAncer of the REctum), a multidisciplinary, profession-driven and decentralized project with as main objectives the reduction of diagnostic and therapeutic variability and improvement of outcome in patients with rectal cancer. All medical specialties involved in the care of rectal cancer established a multidisciplinary steering group in 2005. They agreed to approach the stated goal by means of treatment standardization through guidelines, implementation of these guidelines and quality assurance through registration and feedback. In 2007, the PROCARE guidelines were updated (Procare Phase I, KCE report 69). In 2008, a set of 40 process and outcome quality of care indicators (QCI) was developed and organized into 8 domains of care: general, diagnosis/staging, neoadjuvant treatment, surgery, adjuvant treatment, palliative treatment, follow-up and histopathologic examination. These QCIs were tested on the prospective PROCARE database and on an administrative (claims) database (Procare Phase II, KCE report 81). Afterwards, 4 QCIs were added by the PROCARE group. Centres have been receiving feedback from the PROCARE registry on these QCIs with a description of the distribution of the unadjusted centre-averaged observed measures and the centre’s position therein. To optimize this feedback, centres should ideally be informed of their risk-adjusted outcomes and be given some benchmarks. The PROCARE Phase III study is devoted to developing a methodology to achieve this feedback

The state of the art of medical imaging technology: from creation to archive and back.

Medical imaging has learnt itself well into modern medicine and revolutionized medical industry in the last 30 years. Stemming from the discovery of X-ray by Nobel laureate Wilhelm Roentgen, radiology was born, leading to the creation of large quantities of digital images as opposed to film-based medium. While this rich supply of images provides immeasurable information that would otherwise not be possible to obtain, medical images pose great challenges in archiving them safe from corrupted, lost and misuse, retrievable from databases of huge sizes with varying forms of metadata, and reusable when new tools for data mining and new media for data storing become available. This paper provides a summative account on the creation of medical imaging tomography, the development of image archiving systems and the innovation from the existing acquired image data pools. The focus of this paper is on content-based image retrieval (CBIR), in particular, for 3D images, which is exemplified by our developed online e-learning system, MIRAGE, home to a repository of medical images with variety of domains and different dimensions. In terms of novelties, the facilities of CBIR for 3D images coupled with image annotation in a fully automatic fashion have been developed and implemented in the system, resonating with future versatile, flexible and sustainable medical image databases that can reap new innovations

Health management information system (HMIS)

Páginas numeradas: I-VIII, 9-50Tese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 201