Project description:This prospective service evaluation was designed to assess the availability of critical information required in vascular surgical clinics. All the data was collected via a repeated questionnaire, and the outcomes from each cycle were used to highlight where intervention was required to improve the surgical clinic experience. The first audit identified outpatient clinic deficiencies and allowed for problem analysis. Two Plan-Do-Check-Act (PDCA) cycles then were undertaken. Interventions following each cycle included consultant access to online duplex scans and secretarial access to referral letters. Results from the first cycle showed that approximately 20% of clinic appointments were missing information and only 30% of these issues were resolved during the clinic using a work around. Following the first intervention; the numbers of missing patient notes reduced to 4.3% (10.5%), and referral letters to 3.6% (4.6%). Although the numbers of missing duplex scan results increased to 6.5% (3.3%), the new system of online scan results allowed for all scans to be accessed during the clinic. Following results of a second PDCA cycle, vascular surgical secretaries were given access to 'choose and book', a database of GP referral letters. Post intervention, all missing referral letters (2%) could be accessed immediately within the clinic setting. Data driven interventions and repeated PDCA cycles can improve hospital systems for minimal cost. With an annual clinic turnaround of 2500 patients, these interventions can reduce clinic delays and potential harm caused by unavailable records for up to 500 patients a year.
Project description:ObjectiveInfobuttons are message-based content search and retrieval functions embedded within other applications that dynamically return information relevant to the clinical task at hand. The objective of this study was to determine whether infobuttons effectively answer providers' questions about medications or affect patient care decisions.DesignThe authors implemented and evaluated a medication infobutton application called KnowledgeLink. Health care providers at 18 outpatient clinics were randomized to one of two versions of KnowledgeLink, one that linked to information from Micromedex (Thomson Micromedex, Greenwood Village, Co) and the other to material from SkolarMD (Wolters Kluwer Health, Palo Alto, CA).MeasurementsData were collected about the frequency of use and demographics of users, patients, and drugs that were queried. Users were periodically surveyed with short questionnaires and then with a more extensive survey at the end of one year.ResultsDuring the first year, KnowledgeLink was used 7,972 times by 359 users to look up information about 1,723 medications for 4,961 patients. Clinicians used KnowledgeLink twice a month on average, and during an average of 1.2% of patient encounters. KnowledgeLink was used by a wide variety of medical staff, not just physicians and nurse practitioners. The frequency of usage and the questions asked varied with user role (primary care physician, specialist physician, nurse practitioner). Although the median KnowledgeLink session was brief (21 seconds), KnowledgeLink answered users' queries 84% of the time, and altered patient care decisions 15% of the time. Users rated KnowledgeLink favorably on multiple scales, recommended extending KnowledgeLink to other content domains, and suggested enhancing the interface to allow refinement of the query and selection of the target resource.ConclusionAn infobutton can satisfy information needs about medications. Although used infrequently and for brief sessions, KnowledgeLink was positively received, answered most users' questions, and had a significant impact on medical decision making. The next steps would be to broaden the domains that KnowledgeLink covers to more specifically tailor results to the user type, to provide options when queries are not immediately answered, and to implement KnowledgeLink within other electronic clinical applications.
Project description:BACKGROUND:"Digital Partners" is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users' digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. OBJECTIVE:The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. METHODS:Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants' satisfaction. RESULTS:The experience shows a broad satisfaction of both junior and senior users. The project's strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals' free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project's duration, if necessary. CONCLUSIONS:This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion.
Project description:BACKGROUND:We aimed to explore clinicians' communication, including the discussion of diagnosis, cause, prognosis and care planning, in routine post-diagnostic testing consultations with patients with Mild Cognitive Impairment (MCI). METHODS:Thematic content analysis was used to analyze audiotaped consultations in which 10 clinicians (eight neurologists and two geriatricians) from 7 memory clinics, disclosed diagnostic information to 13 MCI patients and their care partners. We assessed clinician-patient communication regarding diagnostic label, cause, prognosis and care planning to identify core findings. RESULTS:Core findings were: clinicians 1) differed in how they informed about the MCI label; 2) tentatively addressed cause of symptoms; 3) (implicitly) steered against further biomarker testing; 4) rarely informed about the patient's risk of developing dementia; 5) often informed about the expected course of symptoms emphasizing potential symptom stabilization and/or improvement, and; 6) did not engage in a conversation on long-term (care) planning. DISCUSSION:Clinicians' information provision about the underlying cause, prognosis and implications for long-term (care) planning in MCI could be more specific. Since most patients and care partners have a strong need to understand the patient's symptoms, and for information on the prognosis and implications for the future, clinicians' current approach may not match with those needs.
Project description:ObjectivesThis research studied hospital administrators' and hospital-based health care providers' (collectively, the target group) perceived value of consumer health information resources and of librarians' roles in promoting health information literacy in their institutions.MethodsA web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group.ResultsA majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support.ConclusionsIt is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources.
Project description:The evaluation and selection of novel projects lies at the heart of scientific and technological innovation, and yet there are persistent concerns about bias, such as conservatism. This paper investigates the role that the format of evaluation, specifically information sharing among expert evaluators, plays in generating conservative decisions. We executed two field experiments in two separate grant-funding opportunities at a leading research university, mobilizing 369 evaluators from seven universities to evaluate 97 projects, resulting in 761 proposal-evaluation pairs and more than $250,000 in awards. We exogenously varied the relative valence (positive and negative) of others' scores and measured how exposures to higher and lower scores affect the focal evaluator's propensity to change their initial score. We found causal evidence of a negativity bias, where evaluators lower their scores by more points after seeing scores more critical than their own rather than raise them after seeing more favorable scores. Qualitative coding of the evaluators' justifications for score changes reveals that exposures to lower scores were associated with greater attention to uncovering weaknesses, whereas exposures to neutral or higher scores were associated with increased emphasis on nonevaluation criteria, such as confidence in one's judgment. The greater power of negative information suggests that information sharing among expert evaluators can lead to more conservative allocation decisions that favor protecting against failure rather than maximizing success.
Project description:Abstract This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Main objective: To assess the effectiveness, using evidence from randomised trials, and the association, using evidence from nonrandomised studies, of pharmaceutical industry promotional interactions with prescribers (including receipt of information, payments, gifts and samples), compared to no interactions, on the quality, quantity, cost of prescribed medicines, and on formulary requests. Secondary objectives: To assess whether the effectiveness and association of promotional interactions with the quality, quantity and cost of prescribing differ according to the type of interaction, extent of interaction or exposure level, prescriber type, whether clinicians are trainees or licensed, gender, number of years in practice, prescriber attitude to promotional information and whether the promotional interactions occur in high, middle or low?income settings, according to World Bank classifications of gross national income per capita (World Bank 2018). We will explore whether these listed factors are effect modifiers. Another secondary objective is to assess the effects of prescriptions stimulated by pharmaceutical industry promotional interactions with prescribers on clinical patient outcomes.
Project description:The analysis of questionnaires often involves representing the high-dimensional responses in a low-dimensional space (e.g., PCA, MCA, or t-SNE). However questionnaire data often contains categorical variables and common statistical model assumptions rarely hold. Here we present a non-parametric approach based on Fisher Information which obtains a low-dimensional embedding of a statistical manifold (SM). The SM has deep connections with parametric statistical models and the theory of phase transitions in statistical physics. Firstly we simulate questionnaire responses based on a non-linear SM and validate our method compared to other methods. Secondly we apply our method to two empirical datasets containing largely categorical variables: an anthropological survey of rice farmers in Bali and a cohort study on health inequality in Amsterdam. Compare to previous analysis and known anthropological knowledge we conclude that our method best discriminates between different behaviours, paving the way to dimension reduction as effective as for continuous data.
Project description:Genomic knowledge is being translated into clinical care. To fully realize the value, it is critical to place credible information in the hands of clinicians in time to support clinical decision making. The electronic health record is an essential component of clinician workflow. Utilizing the electronic health record to present information to support the use of genomic medicine in clinical care to improve outcomes represents a tremendous opportunity. However, there are numerous barriers that prevent the effective use of the electronic health record for this purpose. The electronic health record working groups of the Electronic Medical Records and Genomics (eMERGE) Network and the Clinical Genome Resource (ClinGen) project, along with other groups, have been defining these barriers, to allow the development of solutions that can be tested using implementation pilots. In this paper, we present "lessons learned" from these efforts to inform future efforts leading to the development of effective and sustainable solutions that will support the realization of genomic medicine.
Project description:A Quick Response Code (QR Code) aims to provide accurate and traceable information to consumers wanting to verify the quality of agri-food products. This study aimed to investigate the experiences and intentions of scanning QR Code in traditional markets and supermarkets. Furthermore, the types of egg information in the QR Code were explored to identify consumer interests when purchasing eggs. The empirical data were collected from 1112 valid responses throughout Taiwan from July to September, 2020. The Logit, Probit models, and the Bivariate Probit model were used to examine the data. Results showed that shoppers' propensity to scan QR Code revealed a significant difference between traditional markets and supermarkets, i.e., supermarket shoppers having higher a propensity to scan a QR Code. Of the 10 types of potential egg information in the QR Code, over half of respondents said that the production certificate label and inspection information were the top reasons that they would be interested in scanning a QR Code. This was particularly the case for homemakers aged between 51 and 60 years old and those who had scanned QR Code before and would like to pursue more egg information. Since the egg producers have resisted joining the traceability system, the implication of this study provides very practical strategies for government, policy makers, and producers in Taiwan.