Clinical guidelines as plans: An ontological theory

Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. The framework we propose allows us to represent in formal terms how clinical guidelines are realized through the actions of are realized through the actions of individuals organized into teams. We provide various levels of implementation representing different levels of conformity on the part of health care organizations. Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons. The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation

Consolidated List of Requirements

This document is a consolidated catalogue of requirements for the Electronic Health Care Record (EHCR) and Electronic Health Care Record Architecture (EHCRA), gleaned largely from work done in the EU Framework III and IV programmes and CEN, but also including input from other sources including world-wide standardisation initiatives. The document brings together the relevant work done into a classified inventory of requirements to inform the on-going standardisation process as well as act as a guide to future implementation of EHCRA-based systems. It is meant as a contribution both to understanding of the standard and to the work that is being considered to improve the standard. Major features include the classification into issues affecting the Health Care Record, the EHCR, EHCR processing, EHCR interchange and the sharing of health care information and EHCR systems. The principal information sources are described briefly. It is offered as documentation that is complementary to the four documents of the ENV 13606 Parts I-IV produced by CEN Pts 26,27,28,29. The requirements identified and classified in this deliverable are referenced in other deliverables

Experts and Decision Making: First Steps Towards a Unifying Theory of Decision Making in Novices, Intermediates and Experts

Expertise research shows quite ambiguous results on the abilities of experts in judgment and decision making (JDM) classic models cannot account for. This problem becomes even more accentuated if different levels of expertise are considered. We argue that parallel constraint satisfaction models (PCS) might be a useful base to understand the processes underlying expert JDM and the hitherto existing, differentiated results from expertise research. It is outlined how expertise might influence model parameters and mental representations according to PCS. It is discussed how this differential impact of expertise on model parameters relates to empirical results showing quite different courses in the development of expertise; allowing, for example, to predict under which conditions intermediates might outperform experts. Methodological requirements for testing the proposed unifying theory under complex real-world conditions are discussed.Judgment and Decision Making, Expertise, Intermediate Effects, Parallel Constraint Satisfaction, Mental Representation

Doctor of Philosophy

dissertationDomain adaptation of natural language processing systems is challenging because it requires human expertise. While manual e ort is e ective in creating a high quality knowledge base, it is expensive and time consuming. Clinical text adds another layer of complexity to the task due to privacy and con dentiality restrictions that hinder the ability to share training corpora among di erent research groups. Semantic ambiguity is a major barrier for e ective and accurate concept recognition by natural language processing systems. In my research I propose an automated domain adaptation method that utilizes sublanguage semantic schema for all-word word sense disambiguation of clinical narrative. According to the sublanguage theory developed by Zellig Harris, domain-speci c language is characterized by a relatively small set of semantic classes that combine into a small number of sentence types. Previous research relied on manual analysis to create language models that could be used for more e ective natural language processing. Building on previous semantic type disambiguation research, I propose a method of resolving semantic ambiguity utilizing automatically acquired semantic type disambiguation rules applied on clinical text ambiguously mapped to a standard set of concepts. This research aims to provide an automatic method to acquire Sublanguage Semantic Schema (S3) and apply this model to disambiguate terms that map to more than one concept with di erent semantic types. The research is conducted using unmodi ed MetaMap version 2009, a concept recognition system provided by the National Library of Medicine, applied on a large set of clinical text. The project includes creating and comparing models, which are based on unambiguous concept mappings found in seventeen clinical note types. The e ectiveness of the nal application was validated through a manual review of a subset of processed clinical notes using recall, precision and F-score metrics

Heidegger and nurse education.

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN023515 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study

The need for mental health clinicians to practice cultural safety is vital in ensuring meaningful care and in moving towards improving the mental health outcomes for Aboriginal people. The concept of cultural safety is particularly relevant to mental health professionals as it seeks to promote cultural integrity and the promotion of social justice, equity and respect. A substantive theory that explained the experience of providing cultural safety in mental health care to Aboriginal patients was developed using grounded theory methodology. Mental health professionals engaged in a social psychological process, called seeking solutions by navigating the labyrinth to overcome the experience of being unprepared. During this process participants moved from a state of being unprepared to one where they began to navigate the pathway of cultural safety. The findings of this research suggest health professionals have a limited understanding of the concept of cultural safety. The experience of providing cultural safety has not been adequately addressed by organizations, health services, governments, educational providers and policy makers. Health services, organizations and government agencies must work with Aboriginal people to progress strategies that inform and empower staff to practice cultural safety

The role of interprofessional education within the medical undergraduate palliative care curriculum : a systematic review

INTRODUCTION:In the near future, population changes will impact on palliative care provision. We have to evolve to meet patients’ changing needs. Part of this evolution is to develop the role of the multidisciplinary team to provide patient-centred care. This highlights a learning need within medical education which can be achieved through the development of collaboration skills. Interprofessional education (IPE) has been utilised as a pedagogic tool by health professions in order to enhancing such skills. OBJECTIVES:To identify and synthesis evidence on the use of IPE as a method of delivering palliative care teaching to undergraduate medical students.METHOD:Primary studies were identified by searching bibliographic databases; MEDLINE, EMBASE, AMED, CINAHL, ERIC, BEI, BNI, PsychINFO, CENTRAL and the index of thesis and dissertations (UK) from January 1993 to February 2015. This was augmented by searching references from the preliminary search and key conference proceedings. Studies were included if the educational initiative was attended by two or more professions, including undergraduate medical students. A narrative synthesis of identified studies was performed with Kirkpatrick’s hierarchy of evaluation as a framework to assess learning outcomes. Data-driven thematic analysis was performed and a thematic schema created to illustrate the factors underpinning IPE. RESULTS:Eleven studies were identified. Significant variability in study quality was observed. Overall IPE was generally well received by students and facilitators. A positive response to educational initiatives was influenced by the perceived relevance and benefit of content to later clinical practice. Recruitment and educational setting were found to influence student satisfaction and motivation. Barriers to the implementation of IPE included; cultural differences and participant background. The consideration of learning outcomes in accordance with kirkpatrick’s hierarchy highlighted a paucity of data relating to societal and patient impact, with a lack of longterm follow-up.CONCLUSION:There is potential value in the use of IPE within the medical undergraduate palliative care curriculum, however there is need for more robust research with longterm follow-up