Group decision making in oncology: A support through annotation management

International audienceWe propose a software prototype based upon annotations management in palliative ward of an oncology hospital in which dealing with patients' state and evolutions is a complex organizational task. We develop a 5 years empirical investigation that is giving us broad and deep insights to characterize activity and offer an effective support for group decision making and collaborative activity of caregivers. We based our conception of annotation tool on the observations of the rich writing practices of medical professionals. We rely on the innovative strategy of intermediate management to introduce a new technology able to bridge heterogeneous valuable data flows that address both management support and activity support into a single tool

How to Support Coordination Through Annotations? A Longitudinal Case Study of Nurses' Work in an Oncology Hospital

International audienceWe present an ongoing research in the field of healthcare computing and coordination support. We focus on nursing work in an oncology hospital. We use grounded theory methodology to structure this research. After 3 years of work and contributions in the field of communicational approaches of organizations, we are now designing a web mockup in a participative approach. This paper presents to cscw community an original way for improving coordination processes in healthcare through annotations support

Equipement informatique des annotations et des pratiques d'écriture professionnelles : une étude ancrée pour l'organisation des soins en cancérologie

Prenant appui sur une méthodologie d'enquête, de conceptualisation et de développement itérative - la Théorie Ancrée - notre recherche sur l'instrumentation informatique des annotations et des pratiques d'écriture professionnelles nous a permis de développer des concepts, un modèle et un prototype informatique originaux pour le support de l'organisation des soins en cancérologie. Pour mener à bien ce travail itératif de modélisation, nous nous sommes inspirés des pratiques d'écriture des soignants que nous avons observées durant plusieurs années dans un hôpital en cancérologie. Cette étude qualitative a été complétée par un état de l'art pluridisciplinaire. Ce travail d'articulation entre différents domaines scientifiques, enquête et confrontation aux acteurs du terrain nous a permis de développer les concepts de pratique annotative et d'écriture heuristique considérés comme constitutifs du travail d'organisation des soins. Ces pratiques permettent aux soignants d'appréhender leurs environnements de travail complexes, et de gérer efficacement les dynamiques et les variétés de situations et de prise en charge des patients. La caractérisation de ces pratiques nous a permis de développer un modèle informatique simple, robuste et ouvert, mais surtout ancré dans le terrain de recherche et dans les pratiques soignantes. Ce prototype grâce notamment aux contextes d'affichage diversifiés des réseaux d'annotation qu'il autorise, grâce à sa flexibilité et son évolutivité, permet effectivement d'adresser la question du support du travail collectif d'organisation des soins en cancérologie, autant qu'il est prometteur pour d'autres contextes d'exploitation.Our research about computerized equipment of annotations and professional writing practices has articulated Computer Sciences and Communication and Information Sciences in order for us to develop a software prototype for the support of organisation of care in oncology thanks to an empirical and longitudinal study. This articulation has relied on 4 years long of multimodal ethnography, a conceptualization based upon Grounded Theory rules, a model and a software development that we iteratively conduct simultaneously with this qualitative inquiry. This original combination of methodologies from different domains has been remarkably rich to help us build a specific point of view about oncology hospital organizations, and about the accomplishment of care work and about patients' management in these complex professional organizations. The modern medical and hospital rationalizations, including ICT and e-health tools, are in the confluence of various movements that impact upon several elements of hospital organizations, and upon medical and care practices. We focused our study on the situated writing practices of caregivers and specifically on the richness of the materiality of writings that led us to question notions such as information systems, collective and distributed production of knowledge, and the documentary production cycles for the organization of activity. We are making the hypothesis that annotations can be opportunely considered as constitutive elements in the production of "organizational texts" that are in the core of the support of the organization and the realization of collective and individual work. Caregivers rely on these "organizational texts" that they build, actualize and stabilize thanks to what we call the "annotative practice" that enables them to apprehend their complex environments of work, and to handle the dynamics and the variety of situations and to manage patients. We will show how the characterization of this "annotative practice" helped us to develop a simple, robust and open software model. We will detail the iterative process between inquiry, analysis, conceptualizations and developments that led us to stabilize our model and our web prototype that implement this annotative practice. We will conclude our work by showing that this prototype, thanks to the numerous context displays of annotations networks, thanks to its flexibility and evolutivity achieves the support of the collective organization of patients' care in oncology, as much as it seems to be relevant in other exploitation context of collective organization of work

An Interprofessional Public Library-Academic Partnership for Community Outreach on Women\u27s Health

This article describes a collaboration between a branch of the Queens Public Library in NY and an academic medical center that delivered a women’s health educational program with an interprofessional team of faculty, trainees, and students. The team delivered interactive 1-hour long monthly sessions in a Question and Answer format guided by a Powerpoint presentation. The overall goal was to deliver health education workshops on common medical conditions (i.e. diabetes, heart disease) and concerns of interest to women across the lifespan (i.e. infertility, dementia) to improve the health literacy of local community members. We outlined the steps in establishing this collaboration, the process of selecting topics and describe lessons learned from this endeavor, as well as future directions. As we move toward population health management, innovative means such as partnerships with local libraries represent one way to reach the public. This type of programming has potential to improve health literacy and address social determinants of health by providing the community members with timely, trusted health-related information

Médiations composites de connaissances hétérogènes : entre écrans de papier et manuscrits informatisés

L’hôpital est un terrain de recherche et d’observation qui se caractérise par la montée en puissance de connaissances institutionnalisées et équipées, qui sont au cœur du processus de modernisation du système de santé national. Notre contribution s’intéresse au travail de la connaissance dans le domaine des soins en cancérologie, à partir de l’observation des pratiques d’écriture professionnelles des infirmières. Ces écrits et ces pratiques participent de processus communicationnels complexes, pluriels et hétérogènes de création, de manipulation et de stabilisation de connaissances co-constitutives de l’organisation de l’activité. Cette proposition prend appui sur une étude de cas longitudinale approfondie, basée sur des techniques d’ethnographie multimodale afin de rendre compte de la nature des sociomatérialités, de leur agentivité dans l’activité, et des dynamiques à l’œuvre dans le travail de construction de connaissance qu’elles participent à accomplir. La contribution des SIC en dialogue avec les sciences informatiques permet de mettre en évidence la nécessaire médiation entre connaissances, et l’intérêt d’équipements pluriels et évolutifs pour mener à bien ce travail sur les connaissances pour l’action et pour apprendre de l’action.Healthcare organizations form a research field characterized by an ever-increasing role of the institutionalized knowledge, and its equipment. Our contribution deals with the work of knowledge in the activities of care in oncology wards, through a specific focus on nurse writing practices. These writings and related practices are part of complex, plural and heterogeneous communicational processes of creation, manipulation and stabilization of knowledge that are co-constitutive of the activity organization. This proposal relies on in-depth longitudinal case study based on multimodal ethnography methods, in order to address the nature of socio-materialities, their agentivity, and their contribution to the work dynamics on diverse types of knowledge. The contributions of Information and Communication Sciences conversing with Computer Sciences enlighten the necessary mediation between heterogeneous knowledge, and the interest of plural and evolving equipment in order to support the knowledge work for the action and to sustain the knowledge production resulting from practice

Using highly variable warfarin dosing to identify patients at risk for adverse events

<p>Abstract</p> <p>Background</p> <p>Patients who receive highly variable doses of warfarin may be at risk for poor anticoagulation control and adverse events. However, we lack a system to identify patients with the highest dose variability. Our objectives were to develop a scoring system to identify patients with high dose variability, and to validate this new measure by demonstrating that patients so identified have poor anticoagulation control and higher rates of adverse events (criterion validity).</p> <p>Methods</p> <p>We used a database of over 4, 000 patients who received oral anticoagulation in community practice between 2000-2002. We reviewed the charts of 168 patients with large warfarin dose variation and agreed on 18 risk factor definitions for high dose variability. We identified 109 patients with the highest dose variability (cases), as measured by coefficient of variation (CoV, SD/mean). We matched each case to two controls with low dose variability. Then, we examined all 327 charts, blinded to case/control status, to identify the presence or absence of the 18 risk factors for dose variability. We performed a multivariable analysis to identify independent predictors of high CoV. We also compared anticoagulation control, as measured by percent time in therapeutic range (TTR), and rates of adverse events between groups.</p> <p>Results</p> <p>CoV corresponded with other measures of anticoagulation control. TTR was 53% among cases and 79% among controls (p < 0.001). CoV also predicted adverse events. Six cases experienced a major hemorrhage versus 1 control (p < 0.001) and 3 cases had a thromboembolic event versus 0 control patients (p = 0.04). Independent predictors of high dose variability included hospitalization (OR = 21.3), decreased oral intake (OR = 12.2), use of systemic steroids (OR = 6.1), acetaminophen (OR = 4.0) and antibiotics (OR = 2.7; p < 0.05 for all).</p> <p>Conclusion</p> <p>CoV can be used to identify patients at risk for poor anticoagulation control and adverse events. This new measure has the potential to identify patients at high risk before they suffer adverse events.</p

The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study.

Background and Aims:United States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self-reported URiM from the residency interview process across various specialties. Methods:This was a retrospective cross-sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five-point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non-URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry). Results:The study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non-URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P \u3c .01, two-sample t-test). Non-URiM applicants were younger, and the percentage of male and AOA applicants was greater among non-URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi-Square test; 2.9% vs 1.2%, P \u3c .01, Chi-Square test, respectively). Conclusion:Using a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed

Annotation management: a Group decision support system for nurses tasks

International audienceWe develop a 5-year empirical investigation that is giving us broad and deep insights to characterise activity management in the palliative ward of an oncology hospital, and offer effective support for group decision-making and collaborative activity of caregivers. Following this observation period, we propose a software prototype based upon annotations in which dealing with patients’ state and evolution is a complex organisational task. We based our conception of an annotation tool on the observations of the rich writing practices of medical professionals. We rely on the innovative strategy of intermediate management to introduce a new technology able to bridge heterogeneous, valuable data flows that addresses both management support and activity support in a single tool