4,337 research outputs found

    Decision tools in health care: focus on the problem, not the solution

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    BACKGROUND: Systematic reviews or randomised-controlled trials usually help to establish the effectiveness of drugs and other health technologies, but are rarely sufficient by themselves to ensure actual clinical use of the technology. The process from innovation to routine clinical use is complex. Numerous computerised decision support systems (DSS) have been developed, but many fail to be taken up into actual use. Some developers construct technologically advanced systems with little relevance to the real world. Others did not determine whether a clinical need exists. With NHS investing £5 billion in computer systems, also occurring in other countries, there is an urgent need to shift from a technology-driven approach to one that identifies and employs the most cost-effective method to manage knowledge, regardless of the technology. The generic term, 'decision tool' (DT), is therefore suggested to demonstrate that these aids, which seem different technically, are conceptually the same from a clinical viewpoint. DISCUSSION: Many computerised DSSs failed for various reasons, for example, they were not based on best available knowledge; there was insufficient emphasis on their need for high quality clinical data; their development was technology-led; or evaluation methods were misapplied. We argue that DSSs and other computer-based, paper-based and even mechanical decision aids are members of a wider family of decision tools. A DT is an active knowledge resource that uses patient data to generate case specific advice, which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them. The identification of DTs as a consistent and important category of health technology should encourage the sharing of lessons between DT developers and users and reduce the frequency of decision tool projects focusing only on technology. The focus of evaluation should become more clinical, with the impact of computer-based DTs being evaluated against other computer, paper- or mechanical tools, to identify the most cost effective tool for each clinical problem. SUMMARY: We suggested the generic term 'decision tool' to demonstrate that decision-making aids, such as computerised DSSs, paper algorithms, and reminders are conceptually the same, so the methods to evaluate them should be the same

    Consumer Health Informatics: Empowering Healthy-Lifestyle-Seekers Through mHealth

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    People are at risk from noncommunicable diseases (NCD) and poor health habits, with interventions like medications and surgery carrying further risk of adverse effects. This paper addresses ways people are increasingly moving to healthy living medicine (HLM) to mitigate such health threats. HLM-seekers increasingly leverage mobile technologies that enable control of personal health information, collaboration with clinicians/other agents to establish healthy living practices. For example, outcomes from consumer health informatics research include empowering users to take charge of their health through active participation in decision-making about healthcare delivery. Because the success of health technology depends on its alignment/integration with a person's sociotechnical system, we introduce SEIPS 2.0 as a useful conceptual model and analytic tool. SEIPS 2.0 approaches human work (i.e., life's effortful activities) within the complexity of the design and implementation of mHealth technologies and their potential to emerge as consumer-facing NLM products that support NCDs like diabetes

    Role of a digital clinical decision-support system in management of chronic obstructive pulmonary disease

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    Postponed access: the file will be accessible after 2022-05-18M.Phil. in Global Health - ThesisINTH395AMAMD-GLO

    Digital methods to enhance the usefulness of patient experience data in services for long-term conditions: the DEPEND mixed-methods study

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    Background Collecting NHS patient experience data is critical to ensure the delivery of high-quality services. Data are obtained from multiple sources, including service-specific surveys and widely used generic surveys. There are concerns about the timeliness of feedback, that some groups of patients and carers do not give feedback and that free-text feedback may be useful but is difficult to analyse. Objective To understand how to improve the collection and usefulness of patient experience data in services for people with long-term conditions using digital data capture and improved analysis of comments. Design The DEPEND study is a mixed-methods study with four parts: qualitative research to explore the perspectives of patients, carers and staff; use of computer science text-analytics methods to analyse comments; co-design of new tools to improve data collection and usefulness; and implementation and process evaluation to assess use of the tools and any impacts. Setting Services for people with severe mental illness and musculoskeletal conditions at four sites as exemplars to reflect both mental health and physical long-terms conditions: an acute trust (site A), a mental health trust (site B) and two general practices (sites C1 and C2). Participants A total of 100 staff members with diverse roles in patient experience management, clinical practice and information technology; 59 patients and 21 carers participated in the qualitative research components. Interventions The tools comprised a digital survey completed using a tablet device (kiosk) or a pen and paper/online version; guidance and information for patients, carers and staff; text-mining programs; reporting templates; and a process for eliciting and recording verbal feedback in community mental health services. Results We found a lack of understanding and experience of the process of giving feedback. People wanted more meaningful and informal feedback to suit local contexts. Text mining enabled systematic analysis, although challenges remained, and qualitative analysis provided additional insights. All sites managed to collect feedback digitally; however, there was a perceived need for additional resources, and engagement varied. Observation indicated that patients were apprehensive about using kiosks but often would participate with support. The process for collecting and recording verbal feedback in mental health services made sense to participants, but was not successfully adopted, with staff workload and technical problems often highlighted as barriers. Staff thought that new methods were insightful, but observation did not reveal changes in services during the testing period. Conclusions The use of digital methods can produce some improvements in the collection and usefulness of feedback. Context and flexibility are important, and digital methods need to be complemented with alternative methods. Text mining can provide useful analysis for reporting on large data sets within large organisations, but qualitative analysis may be more useful for small data sets and in small organisations. Limitations New practices need time and support to be adopted and this study had limited resources and a limited testing time. Future work Further research is needed to improve text-analysis methods for routine use in services and to evaluate the impact of methods (digital and non-digital) on service improvement in varied contexts and among diverse patients and carers. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 28. See the NIHR Journals Library website for further project information

    Telemedicine

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    Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

    Comprehensive Physical Function Measure for the Intensive Care Unit: The use of Rasch Analysis and Item Response Theory

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    Introduction: This dissertation study provides an in-depth examination of current intensive care unit (ICU) physical function assessment measures and synthesizes these into one comprehensive measurement tool that addresses multiple areas of function. Background: A recent systematic review identified 26 measures being used in ICU clinical research, although a subsequent systematic review revealed only 14 of those physical function assessment measures have psychometric properties evaluated specifically for the ICU setting. A robust physical function assessment measure for use in the ICU, allows for determination of efficacy of treatment, comparison of studies across settings, and broader interpretation of results. Specific Aims: Aim 1: Identify physical-function measures currently utilized in the ICU that have been psychometrically tested. Aim 2: Analyze all measure constructs to determine redundancies and appropriateness for use in the ICU setting according to Rasch analysisand item response theory. Aim 3: Create a comprehensive, robust functional measurement tool for use with patients in the intensive care unit. Methodology: Rasch analysis was used for individual activity task evaluation, ranking of task difficulty, and removal of duplicate tasks. IRT Rasch analysisincluded: item fit, hierarchy, reliability, dimensionality, DIF, and probability. Receiver operating characteristics curve was conducted for predictive validity. Results: Fifteen items out of a total of 53 met the requirements for an optimal rating scale. The items were ranked according to difficulty and there was no misfit. The reliability indexes were 5.13, α = .96 and 21.52, α = 1.00 for person and item scores respectively confirming scale hierarchy. The Cronbach Alpha (KR-20) person raw score test reliability was 0.96 with SEM 2.72. DIF was deemed non-significant and the probability curves were well delineated and ordered. The comprehensive physical function measure was found to have predictive validity for discharge to home with an optimal ICU admission cut-off score of 42 raw & 51 equal-interval, (sensitivity 71.7%, specificity 67.7%), and an optimal ICU discharge cut-off score of 54 raw & 61 equal-interval, (sensitivity 81.6%, specificity 82.0%). Summary: A robust, reliable, and valid 15-item comprehensive physical function measure for use in the ICU was developed through Rasch analysisand item response theory

    Co-designing patient-centred technology for chronic kidney disease : supporting the patient journey

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    Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids.Chronic kidney disease (CKD) patients endure their chronic condition, in addition to complicated treatment pathways and trajectories, high treatment burden and great volumes of information which is not always applicable to their individual situations. There are calls for more patient-centred care, with greater patient involvement in treatment decisions and routine collection of patient outcomes. Digital health innovations have the potential to address these points, but poorly designed or implemented interventions can increase treatment burden, and many fail to reach implementation, described as “pilotitis” in the literature. This thesis explores the use of a Participatory Action Research approach to designing CKD interventions, involving multidisciplinary stakeholders and patients in the design process. First a scoping review on implemented technology-based and patient-centred interventions for high treatment burden populations was conducted, with results providing factors for promoting patient-centredness in technological interventions. A multidisciplinary group of domain experts from academia and medicine was then formed, to identify issues within the community, provide initial design requirements and guide development of a prototype intervention. This prototype would be implemented and evaluated after 6 weeks use by CKD patients in routine care, as part of a vascular access-specific quality-of-life measure (VASQoL) validation study. This resulted in a System Usability Scale (SUS) evaluation and qualitative feedback from 26 CKD patients as well the feedback and observations of a clinical researcher. This evaluation identifies further design requirements as well as the idiosyncratic needs of dialysing CKD patients, such as situational impairment and perceived value of technology. The focus then shifted to patient education, with iterative design and feedback on prototype designs with the MDG, clinical stakeholders and CKD patients in online and in-person workshops, and an interactive symposium. Through multidisciplinary co-design and iterative development, the research produced extensive design requirements and prototype systems for CKD patient education and decision-making aids

    Wireless remote patient monitoring on general hospital wards.

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    A novel approach which has potential to improve quality of patient care on general hospital wards is proposed. Patient care is a labour-intensive task that requires high input of human resources. A Remote Patient Monitoring (RPM) system is proposed which can go some way towards improving patient monitoring on general hospital wards. In this system vital signs are gathered from patients and sent to a control unit for centralized monitoring. The RPM system can complement the role of nurses in monitoring patients’ vital signs. They will be able to focus on holistic needs of patients thereby providing better personal care. Wireless network technologies, ZigBee and Wi-Fi, are utilized for transmission of vital signs in the proposed RPM system. They provide flexibility and mobility to patients. A prototype system for RPM is designed and simulated. The results illustrated the capability, suitability and limitation of the chosen technology
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