A tablet-based memory enhancement application for older users: design approach

This paper provides a case study of the design process undertaken in producing a mobile tablet memory assistant solution which was intended for older adults (\u3e65yo) living with early stage memory loss. We adopted an overall design framework consistent with “living laboratory” methodology, for which the associated design principles are: co-creation, multi-stakeholder participation, active user involvement, real-life setting, and multi-method approach. We describe here the detailed steps and provide examples of the application design decisions and outcomes, through successive stages of its evolution. Results of the various user engagements which informed our design choices and for validation of the artefact are presented

Health intelligence: Discovering the process model using process mining by constructing Start-to-End patient journeys

Archived with the publisher's permission. Copyright © 2014, Australian Computer Society, Inc. This paper appeared at the Australasian Workshop on Health Informatics and Knowledge Management (HIKM 2014), Auckland, New Zealand. Conferences in Research and Practice in Information Technology (CRPIT), Vol. 153. J. Warren and K. Gray, Eds. Reproduction for academic, not-for profit purposes permitted provided this text is included.Australian Public Hospitals are continually engaged in various process improvement activities to improve patient care and to improve hospital efficiency as the demand for service intensifies. As a consequence there are many initiatives within the health sector focusing on gaining insight into the underlying health processes which are assessed for compliance with specified Key Performance Indicators (KPIs). Process Mining is classified as a Business Intelligence (BI) tool. The aim of process mining activities is to gain insight into the underlying process or processes. The fundamental element needed for process mining is a historical event log of a process. Generally, these event logs are easily sourced from Process Aware Information Systems (PAIS). Simulation is widely used by hospitals as a tool to study the complex hospital setting and for prediction. Generally, simulation models are constructed by ‘hand’. This paper presents a novel way of deriving event logs for health data in the absence of PAIS. The constructed event log is then used as an input for process mining activities taking advantage of existing process mining algorithms aiding the discovery of knowledge of the underlying processes which leads to Health Intelligence (HI). One such output of process mining activity, presented in this paper, is the discovery of process model for simulation using the derived event log as an input for process mining by constructing start-to-end patient journey. The study was undertaken using data from Flinders Medical Centre to gain insight into patient journeys from the point of admission to the Emergency Department (ED) until the patient is discharged from the hospital.

Gaining insight from patient journey data using process-oriented analysis approach

Hospitals are continually struggling to cater for the increasing demand for inpatient services. This is due to increased population, aging, and the rising incidence of chronic diseases associated with modern life. The high demand for hospital services leads to unpredictable bed availability, longer waiting period for acute admission, difficulties in keeping planned admission, stressed hospital staff, undesirable patient and family experience, as well as unclear long term impact on health care capacity. This study aims to derive some correlation between various factors contributing to ward occupancy rate and operation efficiency. The aim is also to discover the inpatient flow process model proposing to use process mining techniques combined with data analysis to depict the relationships among inpatients, wards and Length of Stay (LOS) in an effort to gain insight into factors that could be focused to relieve access block. Open source process mining software - ProM is used for this study. The study is done in collaboration with Flinders Medical Centre (FMC) using data from their Patient Journey Database as case study

Analysing homogenous patient journeys to assess quality of care for patients admitted outside of their ‘home-ward’

This study is the first to explore the quality of care based on the outlier or the inlier status of patients for a large heterogeneous General Medicine (GM) service at a busy public hospital. The study compared the quality of care between ward outliers and ward inliers based on a homogenous group of patients using Two-step clustering method. Contrary to common perception, ward outliers had overall shorter Length of Stay (LOS) than ward inliers. The study also was unable to support the perception of shorter LOS in the outlier group being associated with higher in-hospital mortality. The study confirmed that overall the outliers received inferior quality of care as discharge summaries for the outliers were delayed and more outliers were re-admitted within 7 days of discharge in comparison to the inliers

Addressing Pain Points: Thinking Outside the Telehealth Box

In this chapter, we present the synthesis of six pain points relating to Australia’s hospital congestion which is under crisis. The COVID-19 pandemic forced health services to respond rapidly to maintain continuity of care through telehealth. Some of these strategies were anticipated to be short-term arrangements, implemented quickly, and haphazardly deployed. While the health emergency accelerated the adoption of telehealth and models of remote care, this implementation was reactive. It is evident that our hospital systems continue to grapple with the issues of an aging population, expanding demand for mental health services, and escalating costs and too few resources. A shift in philosophy to address these and other recurring pain points presents opportunities to embrace virtual care beyond current implementations of telehealth

Effect of zerumbone on scopolamine-induced memory impairment and anxiety-like behaviours in rats

Introduction: We investigated the effects of zerumbone (1 and 10 mg/kg) against hyperactivity, anxiety and memory impairment in scopolamine-induced dementia in Sprague-Dawley rats. Methods: Open field tests, elevated plus maze and Morris water maze were performed to assess general locomotor activity, anxiety-like behaviours and learning and memory processes respectively in rats pre treated with scopolamine. Results: Scopolamine-treated rats showed high total activity, stereotype, and total distance travelled in the open field arena, reduced number of entries to open arms, decreased the percentage of time spent in open arms and higher escape latency time in the Morris water maze test. Interestingly, single administration of zerumbone (1 and 10 mg/kg) reversed the hyperactivity, anxiety-like behaviours, and learning impairment effects of scopolamine in the three experimental model studied respectively. Discussion: Our findings demonstrated that the scopolamine-induced impairment of learning and memory was reversed by the administration of zerumbone. As a conclusion, our findings presented the positive effects of zerumbone on dementia-like behaviours in the animal model used and could possibly contribute for future research to manage hyperactivity, anxiety, and learning disabilities

Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review

Background: Tuberculosis (TB) is a major global public health problem and one of the leading causes of death among infectious diseases. Although TB can be cured with first-line antibiotics treatment of 6 months regimen, non-adherence to the treatment remains the main challenge for TB prevention and control. Interventions to promote adherence need to address multiple underlying factors linked to non-adherence, which requires a synthesis of studies to understand these factors in the local context. Our review accordingly examines these factors for TB treatment in Ethiopia. Methods: Articles were searched from PubMed and ScienceDirect databases, as well as manual searches through Google and Google Scholar search engines. Both quantitative and qualitative studies that showed factors associated with or reasons for non-adherence, default or loss to follow up from TB treatment were included. A total of 276 articles were screened, and 29 articles were ultimately included in the review. Findings: The extracted factors were synthesized thematically into seven dimensions of patient-centred, social, economic, health system, therapy, lifestyle, and geographic access factors. More than 20 distinct factors were identified under these headings. Some of these factors may also apply quite widely in other settings, with greater or lesser influence, but some are particularly applicable to the Ethiopian setting. Conclusion: Helping patients to achieve full adherence to TB medication is a complex problem as it is influenced by interplay between many factors. Healthcare managers, providers, and researchers need to consider and address multiple underlying factors when designing adherence interventions. This work provides a reference set of such factors for Ethiopian interventions

The relationship between in-hospital location and outcomes of care in patients diagnosed with dementia and/or delirium diagnoses: analysis of patient journey

Abstract Background The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted to hospital can be placed in units or wards other than that which specialise in the patient’s primary health issue (home-ward). These patients are called ‘outlier’ patients. Risk factors and health system outcomes of hospital care for ‘outlier’ patients diagnosed with dementia and/or delirium are unknown. Therefore, the aim of this research was to examine patient journeys of people with dementia and/or delirium diagnoses, to identify risk factors for ‘inlier’ or ‘outlier’ status and patient or health system outcomes (consequences) of this status. Methods A retrospective, descriptive study compared patients who had dementia and/or delirium according to the proportion of time spent on the home ward i.e. ‘inliers’ or ‘outliers’. Data from the patient journey database at Flinders Medical Centre (FMC), a public hospital in South Australia from 2007 and 2014 were extracted and analysed. The analysis was carried out on the patient journeys of people with a dementia and/or delirium diagnosis. Results When 6367 inpatient journeys with dementia and/or delirium within FMC were examined, the Emergency Department (ED) Length of Stay (LOS) after being admitted as inpatient was prolonged for ‘outlier’ patients compared to ‘inlier’ patients (OR: 1.068, 95% CI: 1.057–1.079, p = 0.000). However, the inpatient LOS for’outlier’ patients was only marginally shorter than that of the ‘inlier’ patients (OR: 0.998, 95% CI: 0.998–0.998, p = 0.000). The chances of dying within 48 h of admission increased for ‘outlier’ patients (OR: 1.973, 95% CI: 1.158–3.359, p = 0.012) and their Charlson co-morbidity Index was higher (OR: 1.059, 95% CI: 1.021–1.10, p = 0.002). Completion of discharge summaries within 2 days post-discharge for ‘outlier’ patients was compromised (OR: 1.754, 95% CI: 1.492–2.061, p = 0.000).Additionally, ‘outlier’ patients were more likely to be discharged to another hospital for other care types not offered at FMC (OR: 1.931, 95% CI: 1.559–2.391, p = 0.000). Conclusion An examination of the patient journeys at FMC has determined that the health system outcomes for patients with dementia and/or delirium who are admitted outside of their home-ward are affected by in-hospital location despite the homogenous nature of the study population