The development of a video retrieval system using a clinician-led approach

Patient video taken at home can provide valuable insights into the recovery progress during a programme of physical therapy, but is very time consuming for clinician review. Our work focussed on (i) enabling any patient to share information about progress at home, simply by sharing video and (ii) building intelligent systems to support Physical Therapists (PTs) in reviewing this video data and extracting the necessary detail. This paper reports the development of the system, appropriate for future clinical use without reliance on a technical team, and the clinician involvement in that development. We contribute an interactive content-based video retrieval system that significantly reduces the time taken for clinicians to review videos, using human head movement as an example. The system supports query-by-movement (clinicians move their own body to define search queries) and retrieves the essential fine-grained movements needed for clinical interpretation. This is done by comparing sequences of image-based pose estimates (here head rotations) through a distance metric (here Fréchet distance) and presenting a ranked list of similar movements to clinicians for review. In contrast to existing intelligent systems for retrospective review of human movement, the system supports a flexible analysis where clinicians can look for any movement that interests them. Evaluation by a group of PTs with expertise in training movement control showed that 96% of all relevant movements were identified with time savings of as much as 99.1% compared to reviewing target videos in full. The novelty of this contribution includes retrospective progress monitoring that preserves context through video, and content-based video retrieval that supports both fine-grained human actions and query-by-movement. Future research, including large clinician-led studies, will refine the technical aspects and explore the benefits in terms of patient outcomes, PT time, and financial savings over the course of a programme of therapy. It is anticipated that this clinician-led approach will mitigate the reported slow clinical uptake of technology with resulting patient benefit

Communication interventions to promote the public's awareness of antibiotics: a systematic review.

BackgroundInappropriate antibiotic use is implicated in antibiotic resistance and resultant morbidity and mortality. Overuse is particularly prevalent for outpatient respiratory infections, and perceived patient expectations likely contribute. Thus, various educational programs have been implemented to educate the public.MethodsWe systematically identified public-directed interventions to promote antibiotic awareness in the United States. PubMed, Google Scholar, Embase, CINAHL, and Scopus were queried for articles published from January 1996 through January 2016. Two investigators independently assessed titles and abstracts of retrieved articles for subsequent full-text review. References of selected articles and three review articles were likewise screened for inclusion. Identified educational interventions were coded for target audience, content, distribution site, communication method, and major outcomes.ResultsOur search yielded 1,106 articles; 34 met inclusion criteria. Due to overlap in interventions studied, 29 distinct educational interventions were identified. Messages were primarily delivered in outpatient clinics (N = 24, 83%) and community sites (N = 12, 41%). The majority included clinician education. Antibiotic prescription rates were assessed for 22 interventions (76%). Patient knowledge, attitudes, and beliefs (KAB) were assessed for 10 interventions (34%). Similar rates of success between antibiotic prescription rates and patient KAB were reported (73 and 70%, respectively). Patient interventions that did not include clinician education were successful to increase KAB but were not shown to decrease antibiotic prescribing. Three interventions targeted reductions in Streptococcus pneumoniae resistance; none were successful.ConclusionsMessaging programs varied in their designs, and many were multifaceted in their approach. These interventions can change patient perspectives regarding antibiotic use, though it is unclear if clinician education is also necessary to reduce antibiotic prescribing. Further investigations are needed to determine the relative influence of interventions focusing on patients and physicians and to determine whether these changes can influence rates of antibiotic resistance long-term

Doctor of Philosophy

dissertationThe verb plays a critical role in sentence production, but verb production is commonly impaired in aphasia. The verb is therefore an important treatment target for aphasia treatments. The verb appears to have a network structure of meaning within the mental lexicon, and existing treatments, such as Verb Network Strengthening Treatment (VNeST) and “verb is core” treatment approach naming rehabilitation theoretically by expanding this network structure. However, these and other verb naming treatments have focused nearly exclusively on verbs with high concreteness ratings. While high concreteness verbs are useful and common, recent evidence highlights the utility and frequency of low concreteness verbs in spoken language also. Thus the focus of current verb treatments on verbs with high concreteness omits a set of verbs that are potentially useful for persons with aphasia. Therefore, a treatment was designed to improve the accuracy of low concreteness verb naming in persons with aphasia. The novel treatment was largely based on VNeST and emphasized the network structure of the mental representation of target verbs by pairing them with common subjects and objects. Three adult persons with nonfluent aphasia participated in a single-subject research design study examining the feasibility of the treatment for improving verbal naming of low concreteness verbs. Results from the study indicated possible changes associated with the treatment for two of the three participants, though these changes were limited in magnitude. Treatment performance data suggested possible improvements in verb processing that were not reflected in the primary outcome measure. Thus, future research is warranted and should focus on further enriching the mental verb network representations of target verbs with low concreteness and on refining relevant outcome measures

Lean Thinking: Theory, Application and Dissemination

This book was written and compiled by the University of Huddersfield to share the learnings and experiences of seven years of Knowledge Transfer Partnership (KTP) and Economic and Social Research Council (ESRC) funded projects with the National Health Service (NHS). The focus of these projects was the implementation of Lean thinking and optimising strategic decision making processes. Each of these projects led to major local improvements and this book explains how they were achieved and compiles the lessons learnt. The book is split into three chapters; Lean Thinking Theory, Lean Thinking Applied and Lean Thinking Dissemination

Clinical Simulations in Academic Courses: Four Case Studies Across the Medical SLP Graduate Curriculum

Simulation practices are growing in both popularity and necessity within speech pathology programs. Simulation use can serve to not only minimize client risk but to increase student confidence and competence prior to patient contact, particularly with low incidence or medically fragile patients. This paper describes and reflects on four individual simulation experiences within one graduate speech language pathology program and their outcomes. The use of both simulated patients and mannequin training resulted in an increase in students\u27 perception of knowledge and confidence in their clinical skills with medical patients

Treatment integrity of elaborated semantic feature analysis aphasia therapydelivered in individual and group settings

Background & Aims This study ran within the framework of the Thales Aphasia Project that investigated the efficacy of elaborated semantic feature analysis (ESFA). We evaluated the treatment integrity (TI) of ESFA, i.e., the degree to which therapists implemented treatment as intended by the treatment protocol, in two different formats: individual and group therapy. Methods & Procedures Based on the ESFA manual, observation of therapy videos and TI literature, we developed two ESFA integrity checklists, for individual and group therapy, and used them to rate 15 videos of therapy sessions, delivered by three speech–language therapists (SLTs). Thirteen people with aphasia (PwA) were involved in this study. Reliability of the checklists was checked using Kappa statistics. Each session's TI was calculated. Differences in TI scores between the two therapy approaches were calculated using independent sample t-tests. Treating SLTs’ views on what facilitates TI were also explored through a survey. Outcomes & Results Inter- and intra-rater reliability were excellent (.75 ≤ κ ≤ 1.00) for all but one video (κ = .63). Overall, a high TI level (91.4%) was achieved. Although both approaches’ TI was high, TI for individual therapy sessions was significantly higher than for group sessions (94.6% and 86.7% respectively), t(13) = 2.68, p = .019. SLTs found training, use of the treatment manual, supervision and peer support useful in implementing ESFA therapy accurately. Conclusions & Implications ESFA therapy as delivered in Thales is well described and therapists can implement it as intended. The high TI scores found enhance the internal validity of the main research project and facilitate its replication. The need for more emphasis on the methodological quality of TI studies is discussed

A range of memory possibilities: The challenge of the false memory debate for clinicians and researchers

The aim of this article is to present a succinct review and evaluation of the main areas of contention in the false memory debate and, from this basis, to suggest ways in which the best from both sides can be utilised. We examine the potential pitfalls of therapy in terms of the fallibility and suggestibility of autobiographical memory and therapists and therapeutic techniques as the architects of false memories. We then evaluate the case for false memory formation examining if some researchers hold misconceived views of psychotherapy, if experimental studies lack ecological validity, and the effect of trauma on memory. Finally, we explore how the potential pitfalls of therapy can be avoided in practice, reflecting on the usefulness of British Psychological Society guidelines, how clinicians can implement research findings, and how research on the false memory debate can be improved. We conclude that the way forward is researcher-clinician collaboration in the development of ecologically valid research paradigms

A practical design and implementation of a low cost platform for remote monitoring of lower limb health of amputees in the developing world

In many areas of the world accessing professional physicians ‘when needed/as needed’ might not be always possible for a variety of reasons. Therefore, in such cases a targeted e-Health solution to safeguard patient long-term health could be a meaningful approach. Today’s modern healthcare technologies, often built around electronic and computer-based equipment, require an access to a reliable electricity supply. Many healthcare technologies and products also presume access to the high speed internet is available, making them unsuitable for use in areas where there is no fixed-line internet connectivity, access is slow, unreliable and expensive, yet where the most benefit to patients may be gained. In this paper a full mobile sensor platform is presented, based around readily-purchased consumer components, to facilitate a low cost and efficient means of monitoring the health of patients with prosthetic lower limbs. This platform is designed such that it can also be operated in a standalone mode i.e. in the absence of internet connectivity, thereby making it suitable to the developing world. Also, to counter the challenge of power supply issues in e-Health monitoring, a self-contained rechargeable solution to the platform is proposed and demonstrated. The platform works with an Android mobile device, in order to allow for the capture of data from a wireless sensor unit, and to give the clinician access to results from the sensors. The results from the analysis, carried out within the platform’s Raspberry Pi Zero, are demonstrated to be of use for remote monitoring. This is specifically targeted for monitoring the tissue health of lower limb amputees. The monitoring of residual limb temperature and gait can be a useful indicator of tissue viability in lower limb amputees especially those suffering from diabetes. We describe a route wherein non-invasive monitoring of tissue health is achievable using the Gaussian process technique. This knowledge will be useful in establishing biomarkers related to a possible deterioration in a patient’s health or for assessing the impact of clinical interventions