The conceptual and practical ethical dilemmas of using health discussion board posts as research data.

Increasing numbers of people living with a long-term health condition are putting personal health information online, including on discussion boards. Many discussion boards contain material of potential use to researchers; however, it is unclear how this information can and should be used by researchers. To date there has been no evaluation of the views of those individuals sharing health information online regarding the use of their shared information for research purposes

Determinants for successful deployment of clinical prediction models : a design science research in the Dutch healthcare sector

Whereas the promises of (predictive) analytics in healthcare are clear and extensively reported, the executive practicalities are not. Mapping the factors that have a hand in the implementation and continuation (i.e. deployment) of such projects improves the execution of prediction models and hence improves diagnostic and prognostic healthcare for patients. This research takes a design science approach to create an artifact aimed at successful deployment of clinical prediction models (CPMs). Through a literature review, various factors that play a role in the deployment of CPMs are categorized. Interviews with an extensive expert panel lead to the development of the CRISP-DM Deployment Extension for CPMs. Next to opinions on the importance of each factor, new in-sights are collected on related topics. A case study at a Dutch hospital allows for the testing of the artifact. A gap analysis is conducted, leading to a practical advice in terms of successful deployment. The research concludes with a proposed deployment strategy and a list of eight recommendations that can be considered the determinants for successful deployment of clinical prediction models

A precision medicine initiative for Alzheimer's disease: the road ahead to biomarker-guided integrative disease modeling

After intense scientific exploration and more than a decade of failed trials, Alzheimer’s disease (AD) remains a fatal global epidemic. A traditional research and drug development paradigm continues to target heterogeneous late-stage clinically phenotyped patients with single 'magic bullet' drugs. Here, we propose that it is time for a paradigm shift towards the implementation of precision medicine (PM) for enhanced risk screening, detection, treatment, and prevention of AD. The overarching structure of how PM for AD can be achieved will be provided through the convergence of breakthrough technological advances, including big data science, systems biology, genomic sequencing, blood-based biomarkers, integrated disease modeling and P4 medicine. It is hypothesized that deconstructing AD into multiple genetic and biological subsets existing within this heterogeneous target population will provide an effective PM strategy for treating individual patients with the specific agent(s) that are likely to work best based on the specific individual biological make-up. The Alzheimer’s Precision Medicine Initiative (APMI) is an international collaboration of leading interdisciplinary clinicians and scientists devoted towards the implementation of PM in Neurology, Psychiatry and Neuroscience. It is hypothesized that successful realization of PM in AD and other neurodegenerative diseases will result in breakthrough therapies, such as in oncology, with optimized safety profiles, better responder rates and treatment responses, particularly through biomarker-guided early preclinical disease-stage clinical trials

From P4 medicine to P5 medicine: transitional times for a more human-centric approach to AI-based tools for hospitals of tomorrow

Within the debate on shaping future clinical services, where different robotics and artificial intelligence (AI) based technologies are integrated to perform tasks, the authors take the chance to provide an interdisciplinary analysis required to validate a tool aiming at supporting the melanoma cancer diagnosis. In particular, they focus on the ethical-legal and technical requirements needed to address the Assessment List on Trustworthy AI (ALTAI), highlighting some pros and cons of the adopted self-assessment checklist. The dialogue stimulates additionally remarks on the EU regulatory initiatives on AI in the healthcare systems

Data, Data Everywhere, and Still Too Hard to Link: Insights from User Interactions with Diabetes Apps

For those with chronic conditions, such as Type 1 diabetes, smartphone apps offer the promise of an affordable, convenient, and personalized disease management tool. How- ever, despite significant academic research and commercial development in this area, diabetes apps still show low adoption rates and underwhelming clinical outcomes. Through user-interaction sessions with 16 people with Type 1 diabetes, we provide evidence that commonly used interfaces for diabetes self-management apps, while providing certain benefits, can fail to explicitly address the cognitive and emotional requirements of users. From analysis of these sessions with eight such user interface designs, we report on user requirements, as well as interface benefits, limitations, and then discuss the implications of these findings. Finally, with the goal of improving these apps, we identify 3 questions for designers, and review for each in turn: current shortcomings, relevant approaches, exposed challenges, and potential solutions

Strategies in Mitigating Medicare/Medicaid Fraud Risk

In the fiscal year 2014, approximately 1,337 health care providers lost their provider license to Medicare/Medicaid fraud. Out of the 1,318 criminal convictions reported by the U.S. Medicaid Fraud Control Units (MFCU), 395 (30%) were home health care aides who claimed to have rendered services not provided. The purpose of this multiple case study was to explore licensed and certified home health care business managers\u27 strategies to mitigate Medicare/Medicaid fraud risk. A purposive sampling of 9 business managers and chief executive officers from 3 licensed and certified home health care businesses in Franklin County, Ohio participated in semistructured face-to-face interviews. Data from the interviews were transcribed, coded, and analyzed to identify themes regarding Medicare/Medicaid fraud risk management strategies. Drawing from the Committee of Sponsoring Organization\u27s internal control framework and fraud management lifecycle theory, 5 themes emerged: the control environment, risk assessment, control activities, information and communication, and monitoring activities. Findings from this study included maintenance of integrity and culture, training and educating both staff and clients about fraud reporting processes and the consequences of fraud, rotating staff on a regular basis, performing fraud risk assessments, implementing remote timekeeping and monitoring system, and compensating shift leaders to coordinate activities in the clients\u27 residences. The implication for positive social change includes reducing healthcare cost for all taxpayers through Medicare/Medicaid fraud reduction

Balancing cultural and workplace values: Perceptions of Aboriginal and Torres Strait Islander employee wellbeing and best practice in the workplace.

This item is only available electronically.Significant disparities exist between Indigenous people’s wellbeing and employment rates, and that of non-Indigenous people. Indigenous people are 2.6 times more likely to experience severe psychological distress and have an unemployment rate 4.2 times that of non-Indigenous people. Despite significant effort in the last decade, employment statistics have only improved minimally, and the wellbeing of Indigenous populations is of continued concern. Cultural competency training is considered a useful tool to improve employee wellbeing and retention rates, and is a common practice in many workplaces. Literature that explores Indigenous and non-Indigenous perceptions of wellbeing in the workplace and cultural competency training in the same context is limited. The aim of this study is to explore remote and urban, Indigenous and non-Indigenous perceptions of wellbeing, employment related issues, and cultural competency, and how these three concepts interact. Eight semi-structured interviews were conducted with Indigenous and non-Indigenous professionals; the data was analysed using thematic analysis. The main themes identified were: ‘implications of family, community, and culture’; ‘support’; ‘appropriate work’; ‘discrimination’; ‘confidence in the system; ‘competency versus awareness; and ‘practical barriers’. The findings of this study provide insight into the types of environments perceived to be most conducive to positive wellbeing and retention outcomes in the workplace, and how cultural competency training is perceived.Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 201