Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.</p> <p>Methods</p> <p>Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.</p> <p>Results</p> <p>The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.</p> <p>Conclusions</p> <p>These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.</p

Emergence and Evolution of Cooperation Under Resource Pressure

We study the influence that resource availability has on cooperation in the context of hunter-gatherer societies. This paper proposes a model based on archaeological and ethnographic research on resource stress episodes, which exposes three different cooperative regimes according to the relationship between resource availability in the environment and population size. The most interesting regime represents moderate survival stress in which individuals coordinate in an evolutionary way to increase the probabilities of survival and reduce the risk of failing to meet the minimum needs for survival. Populations self-organise in an indirect reciprocity system in which the norm that emerges is to share the part of the resource that is not strictly necessary for survival, thereby collectively lowering the chances of starving. Our findings shed further light on the emergence and evolution of cooperation in hunter-gatherer societies.Spanish Ministry of Science and Innovation Project CSD2010-00034 (SimulPast CONSOLIDER-INGENIO 2010) and HAR2009-06996; from the Argentine National Scientific and Technical Research Council (CONICET): Project PIP-0706; from the Wenner-Gren Foundation for Anthropological Research: Project GR7846; and from the project H2020 FET OPEN RIA IBSEN/66272

'Siting' voice in stories of conflict: Bounding conflict in place and time through social memory and acts of remembering

This chapter takes the idea of ‘voice’ as it communicates stories of conflict and trauma, and reimages place as the ‘site’ from which voice emanates: a complex entanglement of social, political, material, human and non-human forces that differs across the voice of history, the collective voice of a community and voice as emerging from the site of an individual life. Focusing specifically on conflict stories obtained from fieldwork in Aceh, Indonesia, the chapter argues that history and collective remembering may function as Mazzei’s (2016) ‘voice without subject.’ However, in listening to individuals’ stories, ethnographers and oral historians participate in the formation of a voice that is localized at the site of the individual’s life and constructs a new ethical-political relation between storyteller and listener