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Unwin, Elizabeth, James Codde, Louise Gill, Suzanne Stevens, and Timothy Nelson. "The WA Hospital Morbidity Data System: An Evaluation of its Performance and the Impact of Electronic Data Transfer." Health Information Management 26, no. 4 (December 1996): 189–92. http://dx.doi.org/10.1177/183335839702600407.
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This paper evaluates the performance of the Hospital Morbidity Data System, maintained by the Health Statistics Branch (HSB) of the Health Department of Western Australia (WA). The time taken to process discharge summaries was compared in the first and second halves of 1995, using the number of weeks taken to process 90% of all discharges and the percentage of records processed within four weeks as indicators of throughput. Both the hospitals and the HSB showed improvements in timeliness during the second half of the year. The paper also examines the impact of a recently introduced electronic data transfer system for WA country public hospitals on the timeliness of morbidity data. The processing time of country hospital records by the HSB was reduced to a similar time as for metropolitan hospitals, but the processing time in the hospitals increased, resulting in little improvement in total processing time.
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Sladek, Ruth M., Malcolm J. Bond, and Paddy A. Phillips. "Do doctors, nurses and managers have different thinking styles?" Australian Health Review 34, no. 3 (2010): 375. http://dx.doi.org/10.1071/ah09791.
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A study of the preferred thinking styles among senior health professionals is reported. A total of 49 medical consultants, 50 senior nurses and 53 health managers from two public teaching hospitals in Adelaide, Australia, were invited via a personal letter to complete a questionnaire comprising measures of thinking style (the Rational Experiential Inventory) and cognitive style (two dimensions of the Myers–Briggs Type Indicator®). Managers reported a higher preference for ‘rational’ reasoning than nurses, whereas medical consultants reported a lower preference for ‘experiential’ reasoning than both managers and nurses. Cognitive style was largely homogenous. Although generalisation of the findings may be limited due to small sample sizes and the self-selection of participants, an understanding of the thinking styles of senior health professionals will likely inform the design and evaluation of future change strategies. What is known about the topic?Research outcomes cannot change population health unless they are adopted, but changing the practices of healthcare workers to reduce ‘know–do’ gaps is not simple. Although there is some evidence to support professionally-oriented strategies such as educational outreach, audit and feedback and reminders, success is sometimes limited, potentially reflecting the limited use of theory in informing the choice of implementation strategies. Non-theoretical approaches may obscure the behavioural determinants of, and mechanisms for, change, making it impossible to generalise lessons learned form one situation to other contexts. What does this paper add?This paper highlights the growing recognition of the need for theory in this important field, and examines a psychological theory for its potential use. Findings provide useful preliminary descriptive data about thinking dispositions within and between three key groups of healthcare decision-makers: senior consultants, senior nurses and managers. It adds to a modest but accumulating research base that explores the tenets of a specified theory among healthcare professionals, reporting reliable differences between individuals in terms of cognitive processing (i.e. how they prefer to think). What are the implications for practitioners?Those faced with implementing change should consider theoretically-driven approaches in their selection of strategies. Based on the theory explored herein, two versions of a message, each targeting a different cognitive processing mode, should be more successful than one version only. This should be true for all three professional groups, and represents a testable strategy for future research.
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Rozova, Vlada, Katrina Witt, Jo Robinson, Yan Li, and Karin Verspoor. "Detection of self-harm and suicidal ideation in emergency department triage notes." Journal of the American Medical Informatics Association 29, no. 3 (December 13, 2021): 472–80. http://dx.doi.org/10.1093/jamia/ocab261.
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Abstract Objective Accurate identification of self-harm presentations to Emergency Departments (ED) can lead to more timely mental health support, aid in understanding the burden of suicidal intent in a population, and support impact evaluation of public health initiatives related to suicide prevention. Given lack of manual self-harm reporting in ED, we aim to develop an automated system for the detection of self-harm presentations directly from ED triage notes. Materials and methods We frame this as supervised classification using natural language processing (NLP), utilizing a large data set of 477 627 free-text triage notes from ED presentations in 2012–2018 to The Royal Melbourne Hospital, Australia. The data were highly imbalanced, with only 1.4% of triage notes relating to self-harm. We explored various preprocessing techniques, including spelling correction, negation detection, bigram replacement, and clinical concept recognition, and several machine learning methods. Results Our results show that machine learning methods dramatically outperform keyword-based methods. We achieved the best results with a calibrated Gradient Boosting model, showing 90% Precision and 90% Recall (PR-AUC 0.87) on blind test data. Prospective validation of the model achieves similar results (88% Precision; 89% Recall). Discussion ED notes are noisy texts, and simple token-based models work best. Negation detection and concept recognition did not change the results while bigram replacement significantly impaired model performance. Conclusion This first NLP-based classifier for self-harm in ED notes has practical value for identifying patients who would benefit from mental health follow-up in ED, and for supporting surveillance of self-harm and suicide prevention efforts in the population.
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Faruquie, Sahrish Sonia, Elizabeth Kumiko Parker, and Peter Talbot. "An evaluation of current home enteral nutrition services at principal referral hospitals in New South Wales, Australia." Australian Health Review 40, no. 1 (2016): 106. http://dx.doi.org/10.1071/ah15029.
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Objective This cross-sectional study investigates the home enteral nutrition (HEN) services of public principal referral hospitals in NSW, Australia, comparing their services to best practice guidelines for HEN. Methods HEN service processes were investigated using an online questionnaire and telephone interview with the dietitian primarily working with HEN at each hospital. Results Participating hospitals reported a total of approximately 3200 HEN patients, 76% required oral nutrition support. Only 69% of hospitals had a dietitian allocated to their HEN service and no hospitals had established multidisciplinary teams to manage HEN patients. Post-discharge follow-up, as recommended for tube fed and oral patients, was achieved by 8% and 15% of hospitals respectively. Forty-six per cent of dietitians were satisfied and 46% of dietitians were dissatisfied with current HEN services provided, and reported the following improvements were required: increased clinical resources allocated to HEN dietitian/coordinator; increased outpatient services (home visits, outpatient clinic, multidisciplinary clinic); and an efficient registration process and database. Conclusions HEN services among participating hospitals are inconsistent, demonstrating gaps in service provision. Baseline assessment scores varied, with an average of 61% of recommendations currently in use. Best practice guidelines are not firmly adhered to due to limited funding and allocated resources for HEN. What is known about the topic? HEN is recognised as a cost-effective and reliable way of treating patients requiring nutrition support post hospital discharge. There are best practice guidelines available to ensure quality care is provided to HEN patients in the community or home setting. As there is no national framework in place for HEN in Australia, currently total patient numbers are unknown and each state and territory provides different levels of service delivery and funding for HEN. It is unknown how guidelines in Australia have been implemented and practiced, as no studies were found that have audited HEN services in Australia. What does this paper add? From the participating hospitals we were able to obtain updated data on HEN patient numbers (~3200). This paper reports on baseline scores in meeting best practice HEN guidelines for tertiary referral hospitals in NSW, Australia and identifies gaps in service provision. It is essential to identify reasons that limit adherence to HEN guidelines, as consequences may include unnecessary re-admissions to emergency departments or hospitals, increasing healthcare costs. Our study found notable differences in service provision ranging from 29% to 86% of recommendations of HEN guidelines achieved, and identified a lack of multidisciplinary teams to manage HEN patients. What are the implications for practitioners? We found HEN services among principal referral hospitals are inconsistent and best practice guidelines are currently not adhered to. National guidelines together with local health policies assist in defining the required standard of care, enhance service delivery and promote clinical excellence. We found the NSW Health Agency for Clinical Innovation HEN Implementation Checklist to be a practical tool for obtaining baseline scores for adherence to best practice guidelines. Regulation of HEN will be positive for HEN users by ensuring a more equitable service is available by introducing consistent funding for HEN nationally. However, it is the responsibility of states and local health districts to implement guidelines, contributing to better health and quality of care provided to patients.
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Zhou, Tian, Bart Nijssen, George J. Huffman, and Dennis P. Lettenmaier. "Evaluation of Real-Time Satellite Precipitation Data for Global Drought Monitoring." Journal of Hydrometeorology 15, no. 4 (July 30, 2014): 1651–60. http://dx.doi.org/10.1175/jhm-d-13-0128.1.
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Abstract The Tropical Rainfall Measuring Mission (TRMM) Multi-satellite Precipitation Analysis (TMPA) near-real-time (RT) data are considered less accurate than the TMPA research quality (RP) data because of the simplified data processing algorithm and the lack of gauge adjustments. However, for near-real-time hydrological applications, such as drought nowcasting, the RT data must play a key role given latency considerations and consistency is essential with products like RP, which have a long-term climatology. The authors used a bivariate test to examine the consistency between the monthly RT and RP precipitation estimates for 12 yr (2000–12) and found that, for over 75% of land cells globally, RT and RP were statistically consistent at 0.05 significance level. The inconsistent grid cells are spatially clustered in western North America, northern South America, central Africa, and most of Australia. The authors also show that RT generally increases with time relative to RP in northern South America and western Australia, while in western North America and eastern Australia, RT decreases relative to RP. In other areas such as the eastern part of North America, Eurasia, and southern part of the South America, the RT data are statistically consistent with the RP data and are appropriate for global- or macroscale hydrological applications.
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Saputra, Muhammad Fauzi, Alimin Maidin, Anwar Mallongi, and Syamsuddin Syamsuddin. "Analysis Implementation System Incident Report With Method Realist Evaluation at Siloam Hospitals Balikpapan 2018." Open Access Macedonian Journal of Medical Sciences 8, T2 (September 15, 2020): 152–56. http://dx.doi.org/10.3889/oamjms.2020.5214.
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BACKGROUND: According to Permenkes No. 11 Tahun 2017, patient safety incidents are any unintended or unexpected incident which could have, or did, lead to harm that could be prevented to patient. Incident reporting system which designed to obtain information about patient safety is used for individual and organization learning.
AIM: This study aimed to analyze the increased success of incident report at Siloam Hospitals Balikpapan.
METHODS: Research design which used is qualitative research with the case study research type and the realist evaluation approach.
RESULTS: The data collection is done through observation and profound interview to five officers who’s in charge of incident reporting process at Siloam Hospitals Balikpapan. The data processing uses content analysis. The result shows that incident reporting system’s implementation at Siloam Hospitals Balikpapan which seen from the side of context mechanism outcome has been working well.
CONCLUSION: The conclusion of this research defines that the implementation’s success due to incident reporting program is accorded by reporting guide which has been legitimated by hospital’s directors, human resources who have been equipped with training about reporting program facilitate the reporting process and Head Quality Risk as responsible division to the incident reporting process has high responsibility to the program.
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Shih, S., R. Carter, S. Heward, and C. Sinclair. "Costs Related to Skin Cancer Prevention in Victoria and Australia." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 9s. http://dx.doi.org/10.1200/jgo.18.10800.
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Background: The aim of this presentation is to provide an update on the economic evaluation of the Australian SunSmart program as well as outline the cost of skin cancer treatment to the Victorian public hospital system. This follows the publication of two recently released published economic evaluations that discusses the potential effects of skin cancer prevention inventions. Aim: 1. To highlight the cost effectiveness of skin cancer prevention in Australia 2. To highlight the costs of skin cancer treatment in the Victorian public hospital system 3. To provide strong evidence to inform governments of the value of skin cancer prevention to reduce the costs of treatment in future years. Methods: Program cost was compared with cost savings to determine the investment return of the program. In a separate study, a prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using state service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Results: With additional $AUD 0.16 ($USD 0.12) per capita investment into skin cancer prevention across Australia from 2011 to 2030, an upgraded SunSmart Program would prevent 45,000 melanoma and 95,000 NMSC cases. Potential savings in future healthcare costs were estimated at $200 million, while productivity gains were significant. A future upgraded SunSmart Program was predicted to be cost-saving from the funder perspective, with an investment return of $3.20 for every additional dollar the Australian governments/funding bodies invested into the program. In relation to the costs to the Victorian public hospital system, total annual costs were $48 million to $56 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). Conclusion: The study demonstrates the strong economic credentials of the SunSmart Program, with a strong economic rationale for increased investment. Increased funding for skin cancer prevention must be kept high on the public health agenda. This would also have the dual benefit of enabling hospitals to redirect resources to nonpreventable conditions.
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Ryu, Justine H., and Andrew J. Zimolzak. "Natural Language Processing of Serum Protein Electrophoresis Reports in the Veterans Affairs Health Care System." JCO Clinical Cancer Informatics, no. 4 (September 2020): 749–56. http://dx.doi.org/10.1200/cci.19.00167.
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PURPOSE Serum protein electrophoresis (SPEP) is a clinical tool used to screen for monoclonal gammopathy, thus it is a critical tool in the evaluation of patients with multiple myeloma. However, SPEP laboratory results are usually returned as short text reports, which are not amenable to simple computerized processing for large-scale studies. We applied natural language processing (NLP) to detect monoclonal gammopathy in SPEP laboratory results and compared its performance at multiple hospitals using both a rules-based manual system and a machine-learning algorithm. METHODS We used the data from the VA Corporate Data Warehouse, which comprises data from 20 million unique individuals. SPEP reports were collected from July to December 2015 at 5 Veterans Affairs Medical Centers. Of these reports, we annotated the presence or absence of monoclonal gammopathy in 300 reports. We applied a machine learning–based NLP and a manual rules-based NLP to detect monoclonal gammopathy in SPEP reports at each of the hospitals, then applied the model from 1 hospital to each of the other hospitals. RESULTS The learning system achieved an area under the receiver operating characteristic curve of 0.997, and the rules-based system achieved an accuracy of 0.99. When a model trained on 1 hospital’s data was applied to a different hospital, however, accuracy varied greatly, and the learning-based models performed better than the rules-based model. CONCLUSION Binary classification of short clinical texts such as SPEP reports may be a particularly attractive target on which to train highly accurate NLP systems.
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Nancarrow, Susan A., Alison Roots, Sandra Grace, and Vahid Saberi. "Models of care involving district hospitals: a rapid review to inform the Australian rural and remote context." Australian Health Review 39, no. 5 (2015): 494. http://dx.doi.org/10.1071/ah14137.
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Objectives District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function or models of care of district hospitals in rural and remote Australia. The aim of the present study was to identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context. Methods A systematic, rapid review was conducted of published peer-reviewed and grey literature using CINAHL, Medline, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included ‘rural’, ‘small general and district hospitals’, ‘rural health services organisation & administration’, ‘medically underserved area’, ‘specific conditions, interventions, monitoring and evaluation’, ‘regional, rural and remote communities’, ‘NSW’, ‘Australia’ and ‘other OECD countries’ between 2002 and 2013. Models of teaching and education, multipurpose services centres, recruitment and/or retention were excluded. Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening and full text screening, 24 data sources remained: 21 peer-reviewed publications and three from the grey literature. Identified models of care related specifically to maternal and child health, end-of-life care, cancer care services, Aboriginal health, mental health, surgery and emergency care. Conclusion District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services. What is known about the topic? Little has been published on the function of small-to-medium district hospitals in rural and remote Australia, and almost nothing is known about models of care that are relevant to these settings. What does this paper add? District hospitals form an important part of vertically integrated models of care in Australia. Effective models of care aim to keep health services close to home. There is scope for networked models of care that keep health care within the community supported by hub-and-spoke models of service delivery. What are the implications for practitioners? This review found limited evidence on the skill mix required in district hospitals; however, the skill mix underpins the extent of service and speciality that can be provided locally, particularly with regard to the provision of surgery and emergency services. International evidence suggests that providing surgical services locally can help increase the sustainability of smaller hospitals because they typically provide high return, short episodes of care; however, this depends on the funding model being used. Similarly, the skill mix of staff required to sustain a functioning emergency department brings a skill base that supports a higher level of expertise across the hospital.
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Campbell, Ian C., Gina M. Enierga, Lilian Fuchshuber, and Kim R. James. "An evaluation of the two variable model for stream litter processing using data from southeastern Australia: How important is temperature?" SIL Proceedings, 1922-2010 25, no. 3 (January 1994): 1837–40. http://dx.doi.org/10.1080/03680770.1992.11900503.
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Nugraheni, Reny, and Yoanita Indra Kumalasari. "Evaluasi Sistem Informasi Pendaftaran Pasien Rawat Jalan Di Rumah Sakit X Kota Kediri." Jurnal Kesehatan 8, no. 2 (October 12, 2020): 96–105. http://dx.doi.org/10.25047/j-kes.v8i2.105.
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Hospital information system is an arrangement with data collection, data processing, presentation of information, analysis and inferences of information, is plays a role in supporting quality control, productivity assessment, and program evaluation. X Hospital is one of the most favored hospitals by patients or visitors. Data on the number of visitors of patients for three consecutive years X Hospital highest hospital compared with other hospitals in the city of Kediri. The purpose of this study is to evaluate the implementation of outpatient registration information system information at X Hospital Kediri. Design of this study is quantitative descriptive. Data were collected through questionnaires and observations. The results showed that the information system of outpatient registration is not optimal because the outpatient registration process is not in accordance with the standard operating procedures established. Data completeness and accuracy are in good category. Patient satisfaction on outpatient service is also in good category
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McBryde, Emma S., Judy Brett, Philip L. Russo, Leon J. Worth, Ann L. Bull, and Michael J. Richards. "Validation of Statewide Surveillance System Data on Central Line–Associated Bloodstream Infection in Intensive Care Units in Australia." Infection Control & Hospital Epidemiology 30, no. 11 (November 2009): 1045–49. http://dx.doi.org/10.1086/606168.
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Objective.To measure the interobserver agreement, sensitivity, specificity, positive predictive value, and negative predictive value of data submitted to a statewide surveillance system for identifying central line-associated bloodstream infection (BSI).Design.Retrospective review of hospital medical records comparing reported data with gold standard according to definitions of central line–associated BSI.Setting.Six Victorian public hospitals with more than 100 beds.Methods.Reporting of surveillance outcomes was undertaken by infection control practitioners at the hospital sites. Retrospective evaluation of the surveillance process was carried out by independent infection control practitioners from the Victorian Hospital Acquired Infection Surveillance System (VICNISS). A sample of records of patients reported to have a central line-associated BSI were assessed to determine whether they met the definition of central line–associated BSI. A sample of records of patients with bacteremia in the intensive care unit during the assessment period who were not reported as having central line–associated BSI were also assessed to see whether they met the definition of central line-associated BSI.Results.Records of 108 patients were reviewed; the agreement between surveillance reports and the VICNISS assessment was 67.6% (κ = 0.31). Of the 46 reported central line–associated BSIs, 27 were confirmed to be central line–associated BSIs, for a positive predictive value of 59% (95% confidence interval [CI], 43%–73%). Of the 62 cases of bacteremia reviewed that were not reported as central line–associated BSIs, 45 were not associated with a central line, for a negative predictive value of 73% (95% CI, 60%–83%). Estimated sensitivity was 35%, and specificity was 87%. The positive likelihood ratio was 3.0, and the negative likelihood ratio was 0.72.Discussion.The agreement between the reporting of central line–associated BSI and the gold standard application of definitions was unacceptably low. False-negative results were problematic; more than half of central line–associated BSIs may be missed in Victorian public hospitals.
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Braun, Barbara I., Stephen B. Kritchevsky, Linda Kusek, Edward S. Wong, Steven L. Solomon, Lynn Steele, Cheryl L. Richards, Robert P. Gaynes, and Bryan Simmons. "Comparing Bloodstream Infection Rates: The Effect of Indicator Specifications in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study." Infection Control & Hospital Epidemiology 27, no. 1 (January 2006): 14–22. http://dx.doi.org/10.1086/498966.
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Objective.Bloodstream infection (BSI) rates are used as comparative clinical performance indicators; however, variations in definitions and data-collection approaches make it difficult to compare and interpret rates. To determine the extent to which variation in indicator specifications affected infection rates and hospital performance rankings, we compared absolute rates and relative rankings of hospitals across 5 BSI indicators.Design.Multicenter observational study. BSI rate specifications varied by data source (clinical data, administrative data, or both), scope (hospital wide or intensive care unit specific), and inclusion/exclusion criteria. As appropriate, hospital-specific infection rates and rankings were calculated by processing data from each site according to 2-5 different specifications.Setting.A total of 28 hospitals participating in the EPIC study.Participants.Hospitals submitted deidentified information about all patients with BSIs from January through September 1999.Results.Median BSI rates for 2 indicators based on intensive care unit surveillance data ranged from 2.23 to 2.91 BSIs per 1000 central-line days. In contrast, median rates for indicators based on administrative data varied from 0.046 to 7.03 BSIs per 100 patients. Hospital-specific rates and rankings varied substantially as different specifications were applied; the rates of 8 of 10 hospitals were both greater than and less than the mean. Correlations of hospital rankings among indicator pairs were generally low (rs = 0-0.45), except when both indicators were based on intensive care unit surveillance (rs = 0.83).Conclusions.Although BSI rates seem to be a logical indicator of clinical performance, the use of various indicator specifications can produce remarkably different judgments of absolute and relative performance for a given hospital. Recent national initiatives continue to mix methods for specifying BSI rates; this practice is likely to limit the usefulness of such information for comparing and improving performance.
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Alharbe, Nawaf, Mohamed Ali Rakrouki, and Abeer Aljohani. "A Healthcare Quality Assessment Model Based on Outlier Detection Algorithm." Processes 10, no. 6 (June 16, 2022): 1199. http://dx.doi.org/10.3390/pr10061199.
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With the extremely rapid growth of data in various industries, big data is gradually recognized and valued by people. Medical big data, which can best reflect the significance of big data value, has also received attention from various parties. In Saudi Arabia, healthcare quality assessment is mostly based on human experience and basic statistical methods. In this paper, we proposed a healthcare quality assessment model based on medical big data in a region of Saudi Arabia, which integrated traditional evaluation methods and machine learning based techniques. Healthcare data has been accurate and effective after noise processing, and the outliers could reflect certain medical quality information. An improved k-nearest neighbors (KNN) algorithm has been proposed and its time complexity have been reduced to be more suitable for big data processing. An outlier indicator has been established based on statistical methods and the improved KNN algorithm. Experimental results showed that the proposed approach has good potential for detecting hospitals with financial fraud and poor-quality medical care.
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Perry, Alison R., and Margaret A. Shaw. "Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database." Journal of Laryngology & Otology 114, no. 8 (August 2000): 605–15. http://dx.doi.org/10.1258/0022215001906516.
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Since April 1997, in Melbourne, Australia, speech pathologists have collaborated to establish a prospective database of functional outcomes of speech, swallowing and voice for patients undergoing head and neck cancer treatments.Staff at eight acute care hospitals, all of which offer speech pathology for head and neck cancer services in Victoria, are contributing data, collated centrally, in an agreed pro forma.Early results are given (after 12 months’ data collection). The implications for clinically-based research, and the future potential for benchmarking outcomes – by expansion of the rehabilitation database beyond the current participating sites – is discussed.This paper outlines the rationale of establishing the database is multicentred, and explores some of the complexities involved, including the challenges inherent in long-term accurate data collection in the head and neck cancer patient population. This work represents the development of an appropriate, usable tool for data collection on functional outcomes.
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Thayabaranathan, Tharshanah, Nadine E. Andrew, Rohan Grimley, Enna Stroil-Salama, Brenda Grabsch, Kelvin Hill, Greg Cadigan, et al. "Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals." Healthcare 9, no. 9 (August 25, 2021): 1095. http://dx.doi.org/10.3390/healthcare9091095.
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The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI.
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Noor, Kawsar, Lukasz Roguski, Xi Bai, Alex Handy, Roman Klapaukh, Amos Folarin, Luis Romao, et al. "Deployment of a Free-Text Analytics Platform at a UK National Health Service Research Hospital: CogStack at University College London Hospitals." JMIR Medical Informatics 10, no. 8 (August 24, 2022): e38122. http://dx.doi.org/10.2196/38122.
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Background As more health care organizations transition to using electronic health record (EHR) systems, it is important for these organizations to maximize the secondary use of their data to support service improvement and clinical research. These organizations will find it challenging to have systems capable of harnessing the unstructured data fields in the record (clinical notes, letters, etc) and more practically have such systems interact with all of the hospital data systems (legacy and current). Objective We describe the deployment of the EHR interfacing information extraction and retrieval platform CogStack at University College London Hospitals (UCLH). Methods At UCLH, we have deployed the CogStack platform, an information retrieval platform with natural language processing capabilities. The platform addresses the problem of data ingestion and harmonization from multiple data sources using the Apache NiFi module for managing complex data flows. The platform also facilitates the extraction of structured data from free-text records through use of the MedCAT natural language processing library. Finally, data science tools are made available to support data scientists and the development of downstream applications dependent upon data ingested and analyzed by CogStack. Results The platform has been deployed at the hospital, and in particular, it has facilitated a number of research and service evaluation projects. To date, we have processed over 30 million records, and the insights produced from CogStack have informed a number of clinical research use cases at the hospital. Conclusions The CogStack platform can be configured to handle the data ingestion and harmonization challenges faced by a hospital. More importantly, the platform enables the hospital to unlock important clinical information from the unstructured portion of the record using natural language processing technology.
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Pallikathekathil, Z. J., and M. Wilson. "APPLICATIONS OF SPECTROLITH MINERALOGY FROM NEUTRON CAPTURE SPECTROSCOPY TOOLS FOR FORMATION EVALUATION." APPEA Journal 43, no. 1 (2003): 555. http://dx.doi.org/10.1071/aj02029.
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When performing a petrophysical analysis, an accurate understanding of the mineralogy of the formations of interest is important for two main reasons. Firstly, the mineralogy of the formations controls the matrix density, which is fundamental in the evaluation of porosity using conventional methods. Secondly, an accurate estimate of the fraction of clay minerals present in the formation is essential in accurately correcting resistivity-based saturation estimates for the effects of excess clay conductivity.Accurately evaluating the mineralogy in formations containing both gas and radioactive minerals such as feldspars can be a challenge. Traditional clay indicators such as gamma ray estimate clay volumes which are too high due to the radioactivity coming from matrix grains such as potassium feldspars, feldspar rich volcanolithic grains and muscovite. In formations having light hydrocarbon such as gas or condensate, density-neutron logs under-estimate the volume of clays due to the light hydrocarbon effects on the density and neutron logs. Moreover, if the logs are to be acquired in a borehole with gas, air or foam, only a limited number of tools sensitive to mineralogy may be run. Using the SpectroLith technique, data from neutron capture spectroscopy tools such as the Reservoir Saturation Tool (RST) or Elemental Capture Spectroscopy Sonde (ECS) can be used to provide answers in these challenging situations.The RST is normally logged in cased hole for the sigma or carbon/oxygen ratio logs useful for determining formation saturation. The SpectroLith processing extracts lithology information, and in turn the weight proportion of clay, quartz-feldspar-mica, carbonate, pyrite, anhydrite and coal. The ECS tool is optimised for providing SpectroLith results at faster logging speeds in larger boreholes.This paper demonstrates, through examples from Australia, the applications of SpectroLith results derived from RST and ECS measurements. Two examples with the RST and one with the ECS are presented. In one example, the only available source of mineralogical information was from the results of SpectroLith processing applied to RST data. The second example shows how SpectroLith results can complement a through casing petrophysical evaluation. The example using ECS compares the mineralogy from a traditional analysis with that from SpectroLith processing and demonstrates the improvements to the petrophysical evaluation through a more accurate mineralogical description. Although no complete examples are available in gas wells in Australia at present, SpectroLith provides a promising way for accurately estimating mineralogy in gas wells.
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To, Kato, Imai, Taninobu, Kohriyama, and Ito. "Developing a Time-Based Evaluation Method for Functional Exercises of Emergency Medical Operations." Safety 5, no. 3 (August 7, 2019): 49. http://dx.doi.org/10.3390/safety5030049.
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Public health service is one of the most important sectors in terms of saving lives. During a disaster, hospitals and medical groups implement extension tasks from their daily activities. Enhancing coordination across organizations contributes to the removal of communication barriers. Functional exercises are simulated trainings for emergency responders that aim to enhance coordination capabilities. The application of time elements in exercise evaluation methods is a significant area of potential research. We develop methods to quantitatively analyze time spent on completing unit tasks in functional exercises. This study focuses on analyzing observed time data in two functional exercises of the Disaster Medical Operation Center in Kitakyushu, which were repeated in October and November 2015. We employed a censored regression method to analyze the time spent on both complete and incomplete unit tasks together. Differences in processing time for 39 tasks, which were repeated in the two exercises, are visually inspected. Benefits of time study in the evaluation of exercises are presented.
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Mundy, Linda, Sarah Howard, Liam McQueen, Jacqui Thomson, and Kaye Hewson. "Fostering healthcare innovation in public hospitals: the Queensland experience." Australian Health Review 43, no. 6 (2019): 672. http://dx.doi.org/10.1071/ah18055.
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Faced with scarce resources and a demand for health care that exceeds supply, health policy makers at all levels of government need to adopt some form of rationing when deciding which health services should be funded in the public health system. With a relatively small investment, programs such as Queensland Health’s New Technology Funding Evaluation Program (NTFEP) fosters innovation by providing funding and pilot studies for new and innovative healthcare technologies. The NTFEP assists policy makers to make informed decisions regarding investments in new safe and effective technologies based on available evidence gathered from real-world settings relevant to Queensland patients and clinicians. In addition, the NTFEP allows appropriate patient access, especially in rural and remote locations, to potentially beneficial technologies and acts a gatekeeper, protecting them from technologies that may be detrimental or harmful. What is known about the topic? Jurisdictions have struggled to identify ways to manage the introduction of new and innovative health technologies into clinical practice. The 2009 review of health technology in Australia recommended better assessment and appraisal by ensuring real-life practices in hospitals and community settings were considered, with a consumer and patient focus. What does this paper add? Queensland Health’s NTFEP provides a robust and transparent mechanism to manage the introduction of innovative healthcare technologies into clinical practice, providing an opportunity to collect real-world data outside of formal clinical trials. These data can not only be used to inform clinical, but also purchasing, decision-making within the public health system. This model of investment and innovation has the potential to be implemented in other jurisdictions and provide opportunities to share learnings. What are the implications for practitioners? Programs such as the NTFEP provide reassurance to practitioners and patients alike that innovative healthcare technologies are adopted in public hospitals using an evidence-based approach after demonstrating that they are not only safe and clinically effective, but represent value for money and improved patient outcomes in a public health system.
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Harten, Sabine M. van, Joost J. L. M. Bierens, Lieke Welling, Peter Patka, Robert W. Kreis, and Maarten Boers. "The Volendam Fire: Lessons Learned from Disaster Research." Prehospital and Disaster Medicine 21, no. 5 (October 2006): 303–9. http://dx.doi.org/10.1017/s1049023x00003927.
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AbstractIntroduction:After the Volendam fire, a multidisciplinary, integral evaluation, called the Medical Evaluation of the Disaster in Volendam (MERV), was established. This article is a discussion of disaster research methodology. It describes the organizational framework of this project and the methodological problems.Methods:A scientific steering group consisting of members from three hospitals prepared and guided the project. A research team wrote the final study protocol and performed the study. The project was funded by the Ministry of Health. The study protocol had a modular design in which each of the modules focused on one specific area or location. The main questions for each location were: (1) which treatment protocols were used; (2)what was the condition of the patient; and (3) was medical care provided according to existing protocols. After the fire, 241 victims were treated in hospitals; they all were included in the study. Most of the victims had burn injuries, and approximately one-third suffered from inhalation injury. All hospitals and ambulance services involved were visited in order to collect data, and interviewers obtained additional information. The government helped obtain permission for data-collection in three of the hospitals. Over 1,200 items of information about each patient and >200,000 total items were collected. During data processing, the data were re-organized, categorized, and presented in a uniform and consistent style. A cross-sectional site analysis and a longitudinal patient analysis were conducted. This was facilitated by the use of several sub-data-bases. The modular approach made it possible to obtain a complete overview of the medical care provided. The project team was guided by a multidisciplinary steering group and the research was performed by a research team. This enabled the research team to focus on the scientific aspects.Conclusion:The evaluation of the Volendam fire indicates that a project approach with a modular design is effective for the analysis of complex incidents. The use of several sub-databases makes it easy to combine findings and conduct cross-sectional and longitudinal analyses. The government played an important role in the funding and support of the project. To limit and structure data collection and analysis, a pilot study based on several predefined main questions should be conducted. The questions then can be specified further based on the availability of data.
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Gardner, C., J. M. Rankin, E. Geelhoed, M. Nguyen, M. Newman, D. Cutlip, M. W. Knuiman, T. G. Briffa, M. S. T. Hobbs, and F. M. Sanfilippo. "Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol." BMJ Open 4, no. 10 (October 2014): e006337. http://dx.doi.org/10.1136/bmjopen-2014-006337.
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IntroductionCoronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or both. Although the efficacy of both procedures at the individual level has been established, the impact of advances in coronary artery revascularisation procedures (CARP) on long-term outcomes and cost-effectiveness at the population level are yet to be assessed. Our aim is to evaluate a minimum of 6-year outcomes and costs for the total population of patients who had CARP in Western Australia (WA) in 2000–2005.Methods and analysisThis retrospective population cohort study will link clinical and administrative health data for a previously defined cohort including all patients in WA who had a CARP in the period 2000–2005. The cohort consists of 19 014 patients who had 21 175 procedures (15 429 PCI and 5746 CABG). We are now collecting a minimum of 6 years follow-up of morbidity and mortality data for the cohort using the WA Data Linkage System, clinical registries and hospital records, with 12 years follow-up for cases in the year 2000. Comparison of long-term outcomes for different CARP will be reported (PCI vs CABG; bare metal stents vs drug-eluting stents vs CABG). Cost-effectiveness analysis of CARP from the perspective of the healthcare sector will be performed using individual level cost data and average costs from Australian Refined Diagnosis Related Groups.Ethics and disseminationThis study has received ethics approval from the University of Western Australia, the Western Australian Department of Health and all participating hospitals. Being a large population cohort study, approval included a waiver of informed consent. All findings will be presented at local, national and international healthcare/academic conferences and published in peer-reviewed journals.
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Rahman, Herdani, and Ni Ketut Sutariniasih. "IMPLEMENTASI PEMANFAATAN PACS DALAM PROSES MANAJEMEN DOSIS RADIASI PASIEN DI SILOAM HOSPITALS LIPPO VILLAGE." Prosiding Seminar Si-INTAN 2, no. 1 (July 13, 2022): 1–7. http://dx.doi.org/10.53862/ssi.v2.072022.001.
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PACS IMPLEMENTATION ON PATIENT DOSE MANAGEMENT PROCESS AT SILOAM HOSPITALS LIPPO VILLAGE. In order to provide services that prioritize patient safety, radiology department of Siloam Hospitals Lippo Village is committed to manage patient dose radiation. Radiation dose management applications is one of three principles of radiation protection, namely optimization. The determination of DRL (diagnostic reference level) is the application of the optimization principle. Radiation management includes several stages, starting from documentation of data inspection, data processing, data analysis, evaluation of local DRL. Consistent and systematic monitoring of radiation dose is needed to improve the quality of radiology services. Siloam Hospitals Lippo Village using PACS (Picture archiving communication system) in the process of documentation data. The documentation process utilizes the technote feature in the INFINITT PACS Software. By using an agreed writing format, the radiographer as a user writes a technote on the PACS which contains information including name, medical record number, weight, type of examination, estimated exposure factor (kV, mA etc.) and dose information (DAP, CTDI, DLP), KERMA water etc.). The patient dose data information has been adjusted to the BAPETEN Si-INTAN application. All of this stages require collaboration and consistency between radiology specialists, radiographers, medical physicists and the IT team. Through this method, dose management process can be made easier. This is because technote can be processed on excel worksheet. So that it can be said that using PACS technote has been proven to be able to make the radiation dose management process more effective and efficient. Keywords: PACS, DRL, Radiology, SI-INTAN, Technote
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van den Hurk, Corina, Martin W. Dercksen, J. W. R. Nortier, and Wim Breed. "Learning from best scalp cooling practices in a registry: Differences in results from n>7000 patients with solid tumors." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 11610. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11610.
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11610 Background: Hair loss is a frequently occurring and stigmatizing side effect of chemotherapy. Worldwide scalp cooling is being introduced to prevent chemotherapy-induced alopecia (CIA). In the Netherlands scalp cooling is implemented in many hospitals since 2005. FDA clearance has been approved for scalp cooling among breast cancer patients in the USA in 2016. Recently approval has been expended for solid tumors. Methods: In a prospective, longitudinal registry data have been collected between 2006 and 2017. Patients could be included if they received chemotherapy that induced severe alopecia, regardless type of solid tumor, stage of disease, age, gender or receiving adjuvant or palliative treatment. Patients were eligible for evaluation of hair loss after they received at least 2 cycles of chemotherapy or if they ceased scalp cooling because of severe hair loss after the first cycle. Failure was defined as feeling the need to use a wig or head cover. Data will be presented using descriptive statistics and multivariate regression analysis to explore determinants of scalp cooling efficacy per largest groups of chemotherapy regimen, and evaluate variety between hospitals. Results: Preliminary results show data of 7378 patients from 68 hospital locations of whom 75% had breast cancer and 8% prostate cancer. Overall 57% of patients did not feel the need to wear a wig or head cover. Variation was observed between hospitals in scalp cooling procedures: e.g. wetting the hair (0-100% of patient) and cooling- and infusion times that varied per type of chemotherapy. Also results varied between hospitals per type and dose of chemotherapy (n > 10 patients), e.g. minimal 37% and maximal 86% success rates between hospitals for paclitaxel-carboplatin (n = 498), 17-54% success for irinotecan monotherapy (n = 275), 25-79% success for 5FU/epirubicin/cyclophosphamide-docetaxel (n = 843) and 79-94% for docetaxel monotherapy (n = 824). Also variation in satisfaction with information about scalp cooling and nursing expertise was observed. Results from the regression analyses will be presented at the conference. Conclusions: Scalp cooling efficacy varied enormously between hospitals. A registry is a useful tool to identify best practices and to provide guidance to further improve results. An international registry has been set up to also collect data on CIA among scalp cooled and non-scalp cooled patients in the USA, Australia and the UK.
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Hanesya, Arini Farihatul, Ancah Caesarina Novi Marchianti, and Saiful Bukhori. "Evaluation of the Hospital Information System (HIS ) using EUCS and PIECES Methods on the Medical Record Section of RSUD dr. Haryoto Lumajang." IJCONSIST JOURNALS 3, no. 1 (December 28, 2021): 13–20. http://dx.doi.org/10.33005/ijconsist.v3i1.57.
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The use of HIS itself in Indonesia is 82.21% of hospitals have adopted HIS and only 15.79% have not adopted HIS. However, the use of SIMRS still uses paperless medical records because there are still several aspects of SIMRS that need to be developed according to user needs. The purpose of this study was to evaluate HIS using the PIECES and EUSC methods. The PIECES method is used to evaluate based on system performance consisting of performance, information, economy, control, efficiency and service variables. The EUSC method is used to evaluate user satisfaction using content, format, acurancy, timeliness and easy of use variables. This type of research is quantitative descriptive and analytic with a sample of 45 people. Descriptive data processing using scoring and analytical using chi square test. Descriptive data processing using scoring and analytical using chi square test. The results of descriptive research using the PIECES method: the performance variable is 69.0%, the information variable is 70.18%, the economy variable is 67.3%, the control variable is 71.4%, the efficiency variable is 72.3%, the service variable is 73. ,2% and all variables included in the good category. The results of analytical research using the End User Computing Satisfaction method found that there are 4 variables that affect user satisfaction, namely content, format, timeliness and easy of use, while the acurancy variable does not affect HIS user satisfaction.
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Scowen, Craig, Nasir Wabe, Alex Eigenstetter, Robert Lindeman, Melissa Miao, Johanna I. Westbrook, and Andrew Georgiou. "Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation." BMJ Open 10, no. 10 (October 2020): e039437. http://dx.doi.org/10.1136/bmjopen-2020-039437.
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IntroductionVariation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation; (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations.Methods and analysisThis is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017–2018) and 2 years post Atlas (2021–2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter).Ethics and disseminationThe study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.
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Ali, Yousaf, Muhammad Waseem Khan, UbaidUllah Mumtaz, Aneel Salman, Noor Muhammad, and Muhammad Sabir. "Identification of factors influencing the rise of cesarean sections rates in Pakistan, using MCDM." International Journal of Health Care Quality Assurance 31, no. 8 (October 8, 2018): 1058–69. http://dx.doi.org/10.1108/ijhcqa-04-2018-0087.
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PurposeThe rate of cesarean sections has been rapidly increased in the last few decades in all the developing as well as developed countries. The rate of cesarean sections determined by the World Health Organization has been crossed by many countries, like Brazil, India, China, USA, Australia, etc. Similarly, this rate has also increased in Pakistan. The purpose of this paper is to explore and identify the factors that are responsible for the rising rate of cesarean sections in Pakistan.Design/methodology/approachThese factors are categorized under medical and non-medical factors. The medical factors include the obesity of mother, age of mother, weight of the baby, umbilical cord prolapse, fetal distress, abnormal presentation, dystocia and failure to progress. The non-medical factors include financial incentives of doctors, time convenience for doctors, high tolerance to surgery, patient’s preference toward cesarean section, private hospitals, public hospitals, income status of patients, rural areas, urban areas and the education of patients. To identify the critical factors, data have been collected and a multi-criteria decision-making technique, called Decision Making Trial and Evaluation Laboratory, is used.FindingsThe result shows that the medical factors that are responsible for the rise in the rate of cesarean sections are umbilical cord prolapse, age of mother and obesity of mother. On the other hand, the non-medical factors that are the reasons for the increase in cesarean sections are the large number of private hospitals and the unethical acts of the doctors in these hospitals, preference of patients, and either the unavailability of doctors or poor conditions of hospitals in rural areas.Originality/valueCesarean section is an important surgical intervention and is considered to be very essential in the cases of existing as well as potential medical problems to the mother or the baby. Cesarean section is also performed for non-medical reasons. In Pakistan, the number of private hospitals has increased and these hospitals provide good health care. However, these hospitals do not work under the rules and regulations set by the government. The doctors in private hospitals perform unnecessary cesarean sections in order to fulfill the demands of private hospital’s owners. In addition to this, it is also found that, nowadays, most women prefer to give birth through cesarean section in order to eliminate the pain of normal vaginal delivery.
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Eagar, Kathy. "Defining an episode of care: A study of five Case Types." Australian Health Review 20, no. 3 (1997): 105. http://dx.doi.org/10.1071/ah970105.
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This is the first study in Australia to test definitions of various types of episodes of care. The definitions reported here are those used in the 1996 National Sub-Acuteand Non-Acute Patient (SNAP) Casemix Classification Study.The study collected data on a total of 683 patients at 10 hospitals and two communityhealth services providing a range of rehabilitation, aged care and community careservices. The kappa statistic (k) was used to determine the significance of the level ofagreement between raters. The value of kappa was 0.838 with a 95per cent confidence interval of 0.801 to 0.975.The results of this study are encouraging and support the use of the five Case Types? Palliative Care, Rehabilitation, Psychogeriatric, Geriatric Evaluation and Management, and Maintenance Care. All five Case Types proved to have good inter-raterreliability, there was a good fit for most patients, and staff found the definitionseasy to use.
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ALONSO, JOSE, W. BYGRAVE, and L. M. GILLIN. "MATHEMATICAL VISUALIZATION AND ANALYSIS TECHNIQUES FOR ENTREPRENEURSHIP STUDIES: IMAGE PROCESSING IN THE UNITED STATES, EUROPE, JAPAN AND AUSTRALIA." Journal of Enterprising Culture 02, no. 01 (March 1994): 509–33. http://dx.doi.org/10.1142/s0218495894000136.
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Statistics and computer graphics, using linear and non-linear techniques, have been applied to entrepreneurial survey data in a study of the image analysis industry. Chief Executive Officers and Directors of Research have been interviewed in the United States, Europe, Japan and Australia. During the interview, a long questionnaire was completed. A mathematical model in terms of motivation, resources and performance measures has been developed to evaluate company positioning, and for future implementation as an expert system for high technology investment evaluation. A set of indices, derived using cluster and principal component analyses, describes groupings of variables which can be used to find the locus of a company position in an n-dimensional space. This position helps to establish whether the requisite technical, knowledge, marketing and financial infrastructures of the company are in keeping with the n-dimensional surfaces established by other companies in the field. These surfaces are then visualized using polynomial and Fourier parametric methods. Stratifications of the database by culture (as determined by geographical location), manufacturer-user-integrator classification, measures of innovation, and modes of deployment of financial resources are studied in terms of their taxonomic and performance characterisation abilities. Preliminary analyses reveal noticeable clustering of motivational variables by culture.
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Dai, Yun, and Hao Liu. "Application of the R-Tree Clustering Model in Medical Information Retrieval." Mobile Information Systems 2022 (August 11, 2022): 1–9. http://dx.doi.org/10.1155/2022/2887395.
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Hospitals produce a large amount of medical information every day. In the face of medical big data, the existing data processing methods cannot meet expectations and need to be continuously optimized. In the database system, when the stored objects are very large, and then the efficiency of data retrieval is a major bottleneck, therefore restricting the application of medical information. For that reason and to improve the efficiency of information retrieval, it is necessary to add an index to the information object and filter the dataset participating in the connection retrieval through the index. In this paper, an information retrieval technique grounded on the R-tree clustering model index is proposed for massive hospital information. The R-tree clustering model is constructed in massive hospital information by using the dynamic determination clustering center (DCC) algorithm. Finally, the superiority of the method is proved by simulations. The experiments and empirical evaluation show that the proposed R-tree clustering model index significantly improves data retrieval efficiency.
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Nghiem, Son, Jonathan Williams, Clifford Afoakwah, Quan Huynh, Shu-kay Ng, and Joshua Byrnes. "Can Administrative Health Data Improve the Gold Standard? Evidence from a Model of the Progression of Myocardial Infarction." International Journal of Environmental Research and Public Health 18, no. 14 (July 10, 2021): 7385. http://dx.doi.org/10.3390/ijerph18147385.
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Background: Myocardial infarction (MI), remains one of the leading causes of death and disability globally but publications on the progression of MI using data from the real world are limited. Multistate models have been widely used to estimate transition rates between disease states to evaluate the cost-effectiveness of healthcare interventions. We apply a Bayesian multistate hidden Markov model to investigate the progression of MI using a longitudinal dataset from Queensland, Australia. Objective: To apply a new model to investigate the progression of myocardial infarction (MI) and to show the potential to use administrative data for economic evaluation and modeling disease progression. Methods: The cohort includes 135,399 patients admitted to public hospitals in Queensland, Australia, in 2010 treatment of cardiovascular diseases. Any subsequent hospitalizations of these patients were followed until 2015. This study focused on the sub-cohort of 8705 patients hospitalized for MI. We apply a Bayesian multistate hidden Markov model to estimate transition rates between health states of MI patients and adjust for delayed enrolment biases and misclassification errors. We also estimate the association between age, sex, and ethnicity with the progression of MI. Results: On average, the risk of developing Non-ST segment elevation myocardial infarction (NSTEMI) was 8.7%, and ST-segment elevation myocardial infarction (STEMI) was 4.3%. The risk varied with age, sex, and ethnicity. The progression rates to STEMI or NSTEMI were higher among males, Indigenous, or elderly patients. For example, the risk of STEMI among males was 4.35%, while the corresponding figure for females was 3.71%. After adjustment for misclassification, the probability of STEMI increased by 1.2%, while NSTEMI increased by 1.4%. Conclusions: This study shows that administrative health data were useful to estimate factors determining the risk of MI and the progression of this health condition. It also shows that misclassification may cause the incidence of MI to be under-estimated.
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Benuriadi, Benuriadi, Osman Sianipar, and Guardian Yoki Sanjaya. "SISTEM INFORMASI DALAM PELAYANAN LABORATORIUM." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 19, no. 1 (October 14, 2016): 56. http://dx.doi.org/10.24293/ijcpml.v19i1.391.
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The development of information technology has altered the conventional type of hospital laboratoryservices, from mostly paper based into computerized system. In term of quicker and easier, the output of computer-based information is useful for the improving healthcare services management. Laboratory services in the public hospitals mostly used paper-based laboratory data processing, leading to problems of accessibility, usability, clarity and completeness of the information. This study aims to to know how to develop a computer-based laboratory information system for a supporting laboratory management in the hospital toward in depth and systematic assessment among relevant stakeholders. The study was conducted at Praya Public Hospital Central District of Lombok, Nusa Tenggara Barat. Five stages of prototyping method were used for the system development, namely: planning, designing, systems testing, pilot implementation and system evaluation. Data and information obtained to observe in this study were in-depth interviews and questionnaire dissemination. During the planning phase, there were four groups of information should be identified, which should be required by the hospital management, laboratory staff, physicians and other health providers and information for the patient as well. Following the need assessment, a context diagram, Data Flow Diagram (DFD), structure of database, Entity Relationship Diagram (ERD), input and output designs were created. A prototype of computer-based laboratory information system was developed according to these systematic analysis and design. Evaluation on user’s perception demonstrated that the prototype could provide laboratory information easily, understandable, as well as complete and useful for all group of users. In conclusion, developing information system that involved potential users in hospital laboratory unit demonstrated its usefulness and this encouraged that public hospitals should adopt computerized laboratory information systems.
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Lynch, Elizabeth, Kate Laver, Tamina Levy, and Timothy Schultz. "‘The way that we are collecting and using data has evolved’ evaluating the Australian National Stroke Audit programme to inform strategic direction." BMJ Open Quality 12, no. 1 (January 2023): e002136. http://dx.doi.org/10.1136/bmjoq-2022-002136.
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BackgroundThe National Stroke Audit has been used to audit and provide feedback to health professionals and stroke care services in Australia since 2007. The Australian Stroke Clinical Registry was piloted in 2009 and numbers of hospitals participating in the registry are increasing. Considering the changing data landscape in Australia, we designed this study to evaluate the stroke audit and to inform strategic direction.MethodsWe conducted a rapid review of published literature to map features of successful data programmes, followed by a mixed-methods study, comprising national surveys and interviews with clinicians and administrators about the stroke audit. We analysed quantitative data descriptively and analysed open-ended survey responses and interview data using qualitative content analysis. We integrated data from the two sources.ResultsWe identified 47 Australian data programs, successful programs were usually funded by government sources or professional associations and typically provided twice yearly or yearly reports.106 survey participants, 14 clinician and 5 health administrator interview participants were included in the evaluation. The Stroke Audit was consistently perceived as useful for benchmarking, but there were mixed views about its value for local quality improvement. Time to enter data was the most frequently reported barrier to participation (88% of survey participants), due to the large number of datapoints and features of the audit software.Opportunities to improve the Stroke Audit included refining Audit questions, developing ways to automatically export data from electronic medical records and capturing accurate data for patients who transferred between hospitals.ConclusionWhile the Stroke Audit was not perceived by all users to be beneficial for traditional quality improvement purposes, the ability to benchmark national stroke services and use these data in advocacy activities was a consistently reported benefit. Modifications were suggested to improve usability and usefulness for participating sites.
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De Brouwer, Mathias, Femke Ongenae, Pieter Bonte, and Filip De Turck. "Towards a Cascading Reasoning Framework to Support Responsive Ambient-Intelligent Healthcare Interventions." Sensors 18, no. 10 (October 18, 2018): 3514. http://dx.doi.org/10.3390/s18103514.
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In hospitals and smart nursing homes, ambient-intelligent care rooms are equipped with many sensors. They can monitor environmental and body parameters, and detect wearable devices of patients and nurses. Hence, they continuously produce data streams. This offers the opportunity to collect, integrate and interpret this data in a context-aware manner, with a focus on reactivity and autonomy. However, doing this in real time on huge data streams is a challenging task. In this context, cascading reasoning is an emerging research approach that exploits the trade-off between reasoning complexity and data velocity by constructing a processing hierarchy of reasoners. Therefore, a cascading reasoning framework is proposed in this paper. A generic architecture is presented allowing to create a pipeline of reasoning components hosted locally, in the edge of the network, and in the cloud. The architecture is implemented on a pervasive health use case, where medically diagnosed patients are constantly monitored, and alarming situations can be detected and reacted upon in a context-aware manner. A performance evaluation shows that the total system latency is mostly lower than 5 s, allowing for responsive intervention by a nurse in alarming situations. Using the evaluation results, the benefits of cascading reasoning for healthcare are analyzed.
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Zhang, Y., and H. A. Salisch. "APPLICATION OF NEURAL NETWORKS TO THE EVALUATION OF RESERVOIR QUALITY IN A LITHOLOGICALLY COMPLEX FORMATION." APPEA Journal 38, no. 1 (1998): 776. http://dx.doi.org/10.1071/aj97051.
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Neural networks are non-algorithmic, analog, distributive and massively parallel information processing systems that have a number of performance characteristics in common with biological neural networks or the human brain. Neural networks can simulate the nervous systems of living animals which work differently from conventional computing, to analyse, compute and solve some complex practical problems making use of computers. Neural networks are able to discover highly complex relationships between several variables that are presented to the network. Studies show that neural networks can be used to solve a great number of practical problems which occur in modeling, predictions, assessments, recognition and image processing. In particular, neural networks are suitable for application to problems where some results are known but the manner in which these results can be achieved are not known (or are difficult to implement) or the results themselves are not known. An important challenge for geologists, geophysicists and reservoir engineers is to accurately determine petrophysical parameters and to improve reservoir evaluation and description. It is important to be able to obtain realistic values of petrophysical parameters from well logs because core data are often not available either because of bore hole conditions or due to the high cost of coring. In lithologically complex formations conventional petrophysical evaluation methods cannot be used because of the lithological heterogeneity. This paper presents an application of neural networking to estimate petrophysical parameters from well logs and to evaluate reservoir quality in the Mardie Greensand in the Carnarvon Basin in Western Australia.
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Fiks, D. О. "The results of the assessment of the condition at the time of admission to the hospital, the functional result at the time of discharge and planning of the outpatient stage in stroke patients according to the register of hospitals in Vinnytsia for 2017-20." Reports of Vinnytsia National Medical University 24, no. 1 (May 18, 2020): 175–84. http://dx.doi.org/10.31393/reports-vnmedical-2020-24(1)-33.
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Annotation. Improving approaches to the diagnosis, treatment and rehabilitation of stroke is a priority, as this disease is not only a medical but also a social problem. The purpose of the work is to assess the dynamics of the indicators at the time of admission to the hospital, the functional result at the time of discharge and planning of the outpatient stage in stroke patients of hospitals in Vinnytsia for the period 2017–2019. The stroke register is formed on the basis of medical documentation of medical institutions, which are the most typical for this region of Ukraine. Statistical processing of the results was performed using the licensed statistical package “Statistica 5.5” using parametric evaluation methods. Significant differences in the indicators of the effectiveness of the organization of medical care for stroke at the pre-hospital and hospital stage between the two medical institutions of Vinnytsia, as well as in the dynamics of observation time. The positive and negative aspects of medical and diagnostic work of these hospitals are analyzed. A number of factors influencing the success of treatment outcome and comprehensive rehabilitation of stroke patients are analyzed. Modern views on the problem of analysis of clinical data using the method of register and medical statistics are presented.
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Fiks, D. O. "Analysis of risk factors and stroke structure according to the hospital register of clinics in Vinnytsia for 2017-2019." Reports of Morphology 26, no. 1 (May 22, 2020): 24–31. http://dx.doi.org/10.31393/morphology-journal-2020-26(1)-04.
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Due to the analysis of a whole set of indicators of the quality of medical care for acute cerebrovascular accident (ACA), and above all, the identification of major shortcomings in the maintenance of stroke register, it is possible to reduce morbidity, mortality and disability from this nosology. The purpose of the work is to study and compare the structure and risk factors of stroke according to the hospitals of Vinnytsia for the period 2017-2019. The stroke register was created on the basis of medical documentation of hospitals of the municipal non-profit enterprise “Vinnytsia Regional Clinical Psychoneurological Hospital named after Academician O.I. Yushchenko of Vinnytsia Regional Council” (VRCPNH) and Vinnytsia City Clinical Hospital of Emergency Medical Services (VCCHEMS), which are the most typical for this region of Ukraine. Statistical processing of the results was performed using the licensed statistical package “Statistica 5.5” using parametric evaluation methods. Between the two medical institutions in Vinnytsia and in the dynamics of time there were significant differences in different age, sex, type of stroke contingent of patients. When comparing the data of the territorial-population register of stroke in hospitals in Vinnytsia in 2017-2019, it was found that in both studied institutions the percentage of young and middle-aged patients, especially men, increased. The percentage of young and middle-aged patients in VRCPNH is higher than in VCCHEMS. Modified risk factors, which are currently the most important medical and social problem, are analyzed. There were no significant differences in the dynamics of stroke in both hospitals. The percentage of patients who had a stroke in hospital has decreased over time. The meteorological dependence of stroke has been proved, which points to the importance of preventive measures for people at risk. The main shortcomings in the collection of anamnestic data are analyzed. Analysis of risk factors for stroke suggests that the disease is based on various causes.
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Wu, Guosong, Cathy Eastwood, Yong Zeng, Hude Quan, Quan Long, Zilong Zhang, William A. Ghali, et al. "Developing EMR-based algorithms to Identify hospital adverse events for health system performance evaluation and improvement: Study protocol." PLOS ONE 17, no. 10 (October 5, 2022): e0275250. http://dx.doi.org/10.1371/journal.pone.0275250.
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Background Measurement of care quality and safety mainly relies on abstracted administrative data. However, it is well studied that administrative data-based adverse event (AE) detection methods are suboptimal due to lack of clinical information. Electronic medical records (EMR) have been widely implemented and contain detailed and comprehensive information regarding all aspects of patient care, offering a valuable complement to administrative data. Harnessing the rich clinical data in EMRs offers a unique opportunity to improve detection, identify possible risk factors of AE and enhance surveillance. However, the methodological tools for detection of AEs within EMR need to be developed and validated. The objectives of this study are to develop EMR-based AE algorithms from hospital EMR data and assess AE algorithm’s validity in Canadian EMR data. Methods Patient EMR structured and text data from acute care hospitals in Calgary, Alberta, Canada will be linked with discharge abstract data (DAD) between 2010 and 2020 (n~1.5 million). AE algorithms development. First, a comprehensive list of AEs will be generated through a systematic literature review and expert recommendations. Second, these AEs will be mapped to EMR free texts using Natural Language Processing (NLP) technologies. Finally, an expert panel will assess the clinical relevance of the developed NLP algorithms. AE algorithms validation: We will test the newly developed AE algorithms on 10,000 randomly selected EMRs between 2010 to 2020 from Calgary, Alberta. Trained reviewers will review the selected 10,000 EMR charts to identify AEs that had occurred during hospitalization. Performance indicators (e.g., sensitivity, specificity, positive predictive value, negative predictive value, F1 score, etc.) of the developed AE algorithms will be assessed using chart review data as the reference standard. Discussion The results of this project can be widely implemented in EMR based healthcare system to accurately and timely detect in-hospital AEs.
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O’Connor, Siobhán, Peta L. Hitchens, and Lauren V. Fortington. "Hospital-treated injuries from horse riding in Victoria, Australia: time to refocus on injury prevention?" BMJ Open Sport & Exercise Medicine 4, no. 1 (February 2018): e000321. http://dx.doi.org/10.1136/bmjsem-2017-000321.
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BackgroundThe most recent report on hospital-treated horse-riding injuries in Victoria was published 20 years ago. Since then, injury countermeasures and new technology have aimed to make horse riding safer for participants. This study provides an update of horse-riding injuries that required hospital treatment in Victoria and examines changes in injury patterns compared with the earlier study.MethodsHorse-riding injuries that required hospital treatment (hospital admission (HA) or emergency department (ED) presentations) were extracted from routinely collected data from public and private hospitals in Victoria from 2002–2003 to 2015–2016. Injury incidence rates per 100 000 Victorian population per financial year and age-stratified and sex-stratified injury incidence rates are presented. Poisson regression was used to examine trends in injury rates over the study period.ResultsED presentation and HA rates were 31.1 and 6.6 per 100 000 person-years, increasing by 28.8% and 47.6% from 2002 to 2016, respectively. Female riders (47.3 ED and 10.1 HA per 100 000 person-years) and those aged between 10 and 14 years (87.8 ED and 15.7 HA per 100 000 person-years) had the highest incidence rates. Fractures (ED 29.4%; HA 56.5%) and head injuries (ED 15.4%; HA 18.9%) were the most common injuries. HA had a mean stay of 2.6±4.1 days, and the mean cost per HA was $A5096±8345.ConclusionHorse-riding injuries have remained similar in their pattern (eg, types of injuries) since last reported in Victoria. HA and ED incidence rates have increased over the last 14 years. Refocusing on injury prevention countermeasures is recommended along with a clear plan for implementation and evaluation of their effectiveness in reducing injury.
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Lisiak-Felicka, Dominika, Pawel Nowak, and Maciej Szmit. "Selected Aspects of Information Security Management in Entities Performing Medical Activity." International Journal of Operations Management 1, no. 2 (2021): 30–37. http://dx.doi.org/10.18775/ijom.2757-0509.2020.12.4004.
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The article is devoted to the issues related to an information security management in medical entities. The healthcare entities have been amongst the prime targets for hackers for several years. According to the IBM report “The 2016 X-Force Cyber Security Intelligence Index” in 2015 most of the attacks were carried out against these entities. The years 2016 and 2017 also witnessed spectacular cyberattacks, for example: medical records breach of 3.3 million people because of an unauthorized access to a server in the US, some WannaCry ransomware attacks on the UK hospitals, some MongoDB Database Leaks in the US or NotPetya ransomware attacks in the US hospitals. Entities performing medical activity are processing personal data concerning health that is classified as a “sensitive data” and needs a special protection. The article presents the results of the survey – interviews with IT managers (or designated persons) in entities performing medical activity in Lodz Voivodeship in Poland. The aim of the research was analysis and evaluation of information security management in these entities. The interviews had been performed between December, 2017 and January, 2018. As the results of the research, the ways of information security management were identified (in particular such aspects as: characteristics of the information security teams, information security management system auditing, risk management, information security incidents, budgets for information security, training and the General Data Protection Regulation implementation). The paper also describes the types of information that should be protected in healthcare entities and characteristic of surveyed entities that subordinate to the local government of Lodz Voivodeship in Poland.
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Peiris, David, Lachlan Wright, Madeline News, and Katherine Corcoran. "Community-Based Chronic Disease Prevention and Management for Aboriginal People in New South Wales, Australia: Mixed Methods Evaluation of the 1 Deadly Step Program." JMIR mHealth and uHealth 7, no. 10 (October 21, 2019): e14259. http://dx.doi.org/10.2196/14259.
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Background Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden.
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Rawlings, Deb, Kim Devery, and Naomi Poole. "Improving quality in hospital end-of-life care: honest communication, compassion and empathy." BMJ Open Quality 8, no. 2 (May 2019): e000669. http://dx.doi.org/10.1136/bmjoq-2019-000669.
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BackgroundWith over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: ‘Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…’MethodsThe modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated.FindingsFive themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice.ConclusionLearners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention—behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
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Franseda, Afrilio, Wawan Kurniawan, Sita Anggraeni, and Windu Gata. "Integrasi Metode Decision Tree dan SMOTE untuk Klasifikasi Data Kecelakaan Lalu Lintas." Jurnal Sistem dan Teknologi Informasi (Justin) 8, no. 3 (July 31, 2020): 282. http://dx.doi.org/10.26418/justin.v8i3.40982.
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Kecelakaan lalu lintas merupakan suatu peristiwa yang tidak dapat diprediksi dengan pasti dan dapat mengakibatkan korban jiwa, korban luka ringan, korban luka berat atau kerugian materil seperti benda berharga. Permasalahan ini terjadi di seluruh dunia, tidak terkecuali Australia Selatan yang merupakan salah satu wilayah di Australia. Tercatat bahwa wilayah tersebut memiliki total kecelakaan yang memakan korban 4.953 pada tahun 2018. Oleh karena itu, dibutuhkan analisis untuk mengantisipasi kecelakaan agar tidak terulang kembali kejadian dengan faktor yang sama. Salah satu solusi untuk permasalahan ini yaitu diperlukan metode klasifikasi untuk mengelompokkan faktor-faktor yang mempengaruhi kecelakaan lalu lintas. Metode klasifikasi yang digunakan sebagai pengolah data adalah metode Decision Tree. Metode pada permasalahan ketidakseimbangan kelas menggunakan metode Synthetic MinorityOver-sampling Technique (SMOTE). Untuk proses dalam meningkatkan evaluasi pada penelitian ini menggunakan proses Knowledge Discovery in Database (KDD). Pengujian dilakukan dengan tiga desain model yaitu Split Validation Decision Tree dan SMOTE diperoleh akurasi 69.23%. Pengujian menggunakan Cross Validation Decision Tree dan SMOTE diperoleh akurasi 63.56%. Pengujian menggunakan Decision Tree dan SMOTE Split Data diperoleh akurasi 71.12% dengan perbandingan 1:9. Sehingga, setelah ketiga desain model tersebut dibandingkan, maka Decision Tree dan SMOTE Split Data mendapatkan akurasi yang paling baik. Selain itu diperoleh pula presisi 89.71% (3:7) dan area under curve (AUC) sebesar 0.773 (1:9). Penelitian ini masuk kedalam kategori fair classification (cukup).Traffic accidents are events that cannot be predicted with certainty and can result in casualties, minor injuries, serious injuries, or material losses such as valuable objects. This problem occurs throughout the world, including South Australia which is one of the regions in Australia. It is recorded that the area had a total of 4,953 casualties in 2018. Therefore an analysis is needed to anticipate the accident so that it does not happen again with the same factors. One solution to this problem is the classification method needed to classify the factors that affect traffic accidents. The classification method used for data processing is the Decision Tree method. The method for class imbalance problems uses the method of Synthetic Minority Over-sampling Technique (SMOTE). For the process of increasing evaluation in this study using the Knowledge Discovery in Database (KDD) process. The test was carried out with three model designs namely Split Validation Decision Tree and SMOTE model design obtained an accuracy of 69.23%. Testing using Cross Validation Decision Tree and SMOTE obtained an accuracy of 63.56%. Testing using the Decision Tree and SMOTE Split Data obtained an accuracy 71.12% with ratio of 1:9. So, after the three design models are compared, the split Decision Tree and SMOTE Split Data gets the best accuracy. Also, a precision of 89.71% (3:7) and area under curve (AUC) were obtained of 0.773 (1:9). This research belongs to the fair classification category.
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Sreerangappa, M., M. Suresh, and D. Jayadevappa. "Segmentation of Brain Tumor and Performance Evaluation Using Spatial FCM and Level Set Evolution." Open Biomedical Engineering Journal 13, no. 1 (December 17, 2019): 134–41. http://dx.doi.org/10.2174/1874120701913010134.
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Background: In recent years, brain tumor is one of the major causes of death in human beings. The survival rate can be increased if the tumor is diagnosed accurately in the early stage. Hence, medical image segmentation is always a challenging task of any problem in computer guided medical procedures in hospitals. The main objective of the segmentation process is to obtain object of interest from the given image so that it can be represented in a meaningful way for further analysis. Methods: To improve the segmentation accuracy, an efficient segmentation method which combines a spatial fuzzy c-means and level sets is proposed in this paper. Results: The experiment is conducted using brain web and DICOM database. After pre-processing of an MR image, a spatial FCM algorithm is applied. The SFCM utilizes spatial data from the neighbourhood of each pixel to represent clusters. Finally, these clusters are segmented using level set active contour model for the tumor boundary. The performance of the proposed algorithm is evaluated using various performance metrics. Conclusion: In this technique, wavelets and spatial FCM are applied before segmenting the brain tumor by level sets. The qualitative results show more accurate detection of tumor boundary and better convergence rate of the contour as compared to other segmentation techniques. The proposed segmentation frame work is also compared with two automatic segmentation techniques developed recently. The quantitative results of the proposed method summarize the improvements in segmentation accuracy, sensitivity and specificity.
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Hillis, James M., Bernardo C. Bizzo, Sarah Mercaldo, John K. Chin, Isabella Newbury-Chaet, Subba R. Digumarthy, Matthew D. Gilman, et al. "Evaluation of an Artificial Intelligence Model for Detection of Pneumothorax and Tension Pneumothorax in Chest Radiographs." JAMA Network Open 5, no. 12 (December 15, 2022): e2247172. http://dx.doi.org/10.1001/jamanetworkopen.2022.47172.
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ImportanceEarly detection of pneumothorax, most often via chest radiography, can help determine need for emergent clinical intervention. The ability to accurately detect and rapidly triage pneumothorax with an artificial intelligence (AI) model could assist with earlier identification and improve care.ObjectiveTo compare the accuracy of an AI model vs consensus thoracic radiologist interpretations in detecting any pneumothorax (incorporating both nontension and tension pneumothorax) and tension pneumothorax.Design, Setting, and ParticipantsThis diagnostic study was a retrospective standalone performance assessment using a data set of 1000 chest radiographs captured between June 1, 2015, and May 31, 2021. The radiographs were obtained from patients aged at least 18 years at 4 hospitals in the Mass General Brigham hospital network in the United States. Included radiographs were selected using 2 strategies from all chest radiography performed at the hospitals, including inpatient and outpatient. The first strategy identified consecutive radiographs with pneumothorax through a manual review of radiology reports, and the second strategy identified consecutive radiographs with tension pneumothorax using natural language processing. For both strategies, negative radiographs were selected by taking the next negative radiograph acquired from the same radiography machine as each positive radiograph. The final data set was an amalgamation of these processes. Each radiograph was interpreted independently by up to 3 radiologists to establish consensus ground-truth interpretations. Each radiograph was then interpreted by the AI model for the presence of pneumothorax and tension pneumothorax. This study was conducted between July and October 2021, with the primary analysis performed between October and November 2021.Main Outcomes and MeasuresThe primary end points were the areas under the receiver operating characteristic curves (AUCs) for the detection of pneumothorax and tension pneumothorax. The secondary end points were the sensitivities and specificities for the detection of pneumothorax and tension pneumothorax.ResultsThe final analysis included radiographs from 985 patients (mean [SD] age, 60.8 [19.0] years; 436 [44.3%] female patients), including 307 patients with nontension pneumothorax, 128 patients with tension pneumothorax, and 550 patients without pneumothorax. The AI model detected any pneumothorax with an AUC of 0.979 (95% CI, 0.970-0.987), sensitivity of 94.3% (95% CI, 92.0%-96.3%), and specificity of 92.0% (95% CI, 89.6%-94.2%) and tension pneumothorax with an AUC of 0.987 (95% CI, 0.980-0.992), sensitivity of 94.5% (95% CI, 90.6%-97.7%), and specificity of 95.3% (95% CI, 93.9%-96.6%).Conclusions and RelevanceThese findings suggest that the assessed AI model accurately detected pneumothorax and tension pneumothorax in this chest radiograph data set. The model’s use in the clinical workflow could lead to earlier identification and improved care for patients with pneumothorax.
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Christoph, J., L. Griebel, I. Leb, I. Engel, F. Köpcke, D. Toddenroth, H. U. Prokosch, J. Laufer, K. Marquardt, and M. Sedlmayr. "Secure Secondary Use of Clinical Data with Cloud-based NLP Services." Methods of Information in Medicine 54, no. 03 (2015): 276–82. http://dx.doi.org/10.3414/me13-01-0133.
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SummaryObjectives: The secondary use of clinical data provides large opportunities for clinical and translational research as well as quality assurance projects. For such purposes, it is necessary to provide a flexible and scalable infrastructure that is compliant with privacy requirements. The major goals of the cloud4health project are to define such an architecture, to implement a technical prototype that fulfills these requirements and to evaluate it with three use cases.Methods: The architecture provides components for multiple data provider sites such as hospitals to extract free text as well as structured data from local sources and de-identify such data for further anonymous or pseudonymous processing. Free text documentation is analyzed and transformed into structured information by text-mining services, which are provided within a cloud-computing environment. Thus, newly gained annotations can be integrated along with the already available structured data items and the resulting data sets can be uploaded to a central study portal for further analysis.Results: Based on the architecture design, a prototype has been implemented and is under evaluation in three clinical use cases. Data from several hundred patients provided by a University Hospital and a private hospital chain have already been processed.Conclusions: Cloud4health has shown how existing components for secondary use of structured data can be complemented with text-mining in a privacy compliant manner. The cloud-computing paradigm allows a flexible and dynamically adaptable service provision that facilitates the adoption of services by data providers without own investments in respective hardware resources and software tools.
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Aldridge, Michael N., Stephen J. Lee, Julian D. Taylor, Greg I. Popplewell, Fergus R. Job, and Wayne S. Pitchford. "The use of walk over weigh to predict calving date in extensively managed beef herds." Animal Production Science 57, no. 3 (2017): 583. http://dx.doi.org/10.1071/an15172.
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Beef cattle reproductive rate in northern Australia is low and substantial effort is underway to make improvements. Collection of calf birth date to inform female reproductive rate data is often not practical. Therefore, there is a need to find alternative methods for collecting birth date data. The aim of the project was to trial an automated animal weighing technology (walk over weigh) to estimate calving date for cows in a northern breeding herd grazing in an extensive pasture system. Two-hundred and thirty-two Wagyu cows from a herd of 1195 with confirmed pregnancy tests were stocked in a paddock with a walk over weigh unit at the entry point of the water yard. Each calf born in the paddock was weighed, ear-tagged and a DNA sample collected. After processing, cleaning and smoothing the data, weight profiles of the 232 cows over a 119-day period were analysed. From the weight profiles and confirmed DNA parentage, 96 out of a possible 162 (59%) cows that calved had a correct calving date prediction. It is proposed that improvements in calving date prediction could be increased through engineering changes designed to slow cow movement over the walk over weigh unit. The trial demonstrated with the proposed changes that walk over weigh could be used to estimate calving date in extensive beef herds, with the expectation that this information could be used in genetic evaluation to improve reproductive rate in northern Australia.
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Withers, Hannah G., Hueiming Liu, Joanne V. Glinsky, Jackie Chu, Matthew D. Jennings, Alison J. Hayes, Ian J. Starkey, et al. "Protocol for a process evaluation: face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: the REFORM trial." BMJ Open 12, no. 7 (July 2022): e057790. http://dx.doi.org/10.1136/bmjopen-2021-057790.
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IntroductionThe REFORM (REhabilitation FOR Musculoskeletal conditions) trial is a non-inferiority randomised controlled trial (n=210) designed to determine whether a supported home exercise programme is as good or better than a course of face-to-face physiotherapy for the management of some musculoskeletal conditions. The trial is currently being conducted across Sydney government hospitals in Australia. This process evaluation will run alongside the REFORM trial. It combines qualitative and quantitative data to help explain the trial results and determine the feasibility of rolling out supported home exercise programmes in settings similar to the REFORM trial.Methods and analysisTwo theoretical frameworks underpin our process evaluation methodology: the Realist framework (context, mechanism, outcomes) considers the causal assumptions as to why a supported home exercise programme may be as good or better than face-to-face physiotherapy in terms of the context, mechanisms and outcomes of the trial. The RE-AIM framework describes the Reach, Effectiveness, Adoption, Implementation and Maintenance of the intervention. These two frameworks will be broadly used to guide this process evaluation using a mixed-methods approach. For example, qualitative data will be derived from interviews with patients, healthcare professionals and stakeholders, and quantitative data will be collected to determine the cost and feasibility of providing supported home exercise programmes. These data will be analysed iteratively before the analysis of the trial results and will be triangulated with the results of the primary and secondary outcomes.Ethics and disseminationThis trial will be conducted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2018) and the Note for Good Clinical Practice (CPMP/ICH-135/95). Ethical approval was obtained on 17 March 2017 from the Northern Sydney Local Health District Human Research Ethics Committee (trial number: HREC/16HAWKE/431-RESP/16/287) with an amendment for the process evaluation approved on 4 February 2020. The results of the process evaluation will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.Trial registration numberACTRN12619000065190.
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Krell, Moritz, Samia Khan, and Jan van Driel. "Analyzing Cognitive Demands of a Scientific Reasoning Test Using the Linear Logistic Test Model (LLTM)." Education Sciences 11, no. 9 (August 27, 2021): 472. http://dx.doi.org/10.3390/educsci11090472.
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The development and evaluation of valid assessments of scientific reasoning are an integral part of research in science education. In the present study, we used the linear logistic test model (LLTM) to analyze how item features related to text complexity and the presence of visual representations influence the overall item difficulty of an established, multiple-choice, scientific reasoning competencies assessment instrument. This study used data from n = 243 pre-service science teachers from Australia, Canada, and the UK. The findings revealed that text complexity and the presence of visual representations increased item difficulty and, in total, contributed to 32% of the variance in item difficulty. These findings suggest that the multiple-choice items contain the following cognitive demands: encoding, processing, and combining of textually presented information from different parts of the items and encoding, processing, and combining information that is presented in both the text and images. The present study adds to our knowledge of which cognitive demands are imposed upon by multiple-choice assessment instruments and whether these demands are relevant for the construct under investigation—in this case, scientific reasoning competencies. The findings are discussed and related to the relevant science education literature.
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Higgins, Alisa M., Sandra L. Peake, Rinaldo Bellomo AO, D. Jamie Cooper AO, Anthony Delaney, Belinda D. Howe, Alistair D. Nichol, Steve A. Webb, Patricia J. Williams, and Anthony H. Harris. "The cost-effectiveness of early goaldirected therapy: an economic evaluation alongside the ARISE trial." Critical Care and Resuscitation 23, no. 3 (September 6, 2021): 329–36. http://dx.doi.org/10.51893/2021.3.oa10.
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OBJECTIVE: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock. DESIGN: Within-trial cost-effectiveness evaluation. SETTING: Nineteen hospitals in Australia and New Zealand. PARTICIPANTS AND INTERVENTIONS: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation. OUTCOME MEASURES: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective. RESULTS: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, −$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%. CONCLUSIONS: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT00975793.