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Crowe, B. L., and I. G. Mcdonald. "Telemedicine in Australia. Recent developments." Journal of Telemedicine and Telecare 3, no. 4 (December 1, 1997): 188–93. http://dx.doi.org/10.1258/1357633971931147.
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There have been a number of important developments in Australia in the area of telemedicine. At the national level, the House of Representatives' Standing Committee on Family and Community Affairs has been conducting the Inquiry into Health Information Management and Telemedicine. The Australian Health Ministers' Advisory Council has supported the establishment of a working party convened by the South Australian Health Commission to prepare a detailed report on issues relating to telemedicine. State governments have begun a number of telemedicine projects, including major initiatives in New South Wales and Victoria and the extensive development of telepsychiatry services in Queensland. Research activities in high-speed image transmission have been undertaken by the Australian Computing and Communications Institute and Telstra, and by the Australian Navy. The matter of the funding of both capital and recurrent costs of telemedicine services has not been resolved, and issues of security and privacy of medical information are subject to discussion. The use of the Internet as a universal communications medium may provide opportunities for the expansion of telemedicine services, particularly in the area of continuing medical education. A need has been recognized for the coordinated evaluation of telemedicine services as cost-benefit considerations are seen to be very important.
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Hardie, Rae-Anne, Donna Moore, Derek Holzhauser, Michael Legg, Andrew Georgiou, and Tony Badrick. "Informatics External Quality Assurance (IEQA) Down Under: evaluation of a pilot implementation." LaboratoriumsMedizin 42, no. 6 (December 19, 2018): 297–304. http://dx.doi.org/10.1515/labmed-2018-0050.
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AbstractExternal quality assurance (EQA) provides ongoing evaluation to verify that laboratory medicine results conform to quality standards expected for patient care. While attention has focused predominantly on test accuracy, the diagnostic phases, consisting of pre- and post-laboratory phases of testing, have thus far lagged in the development of an appropriate diagnostic-phase EQA program. One of the challenges faced by Australian EQA has been a lack of standardisation or “harmonisation” resulting from variations in reporting between different laboratory medicine providers. This may introduce interpretation errors and misunderstanding of results by clinicians, resulting in a threat to patient safety. While initiatives such as the Australian Pathology Information, Terminology and Units Standardisation (PITUS) program have produced Standards for Pathology Informatics in Australia (SPIA), conformity to these requires regular monitoring to maintain integrity of data between sending (laboratory medicine providers) and receiving (physicians, MyHealth Record, registries) organisations’ systems. The PITUS 16 Informatics EQA (IEQA) Project together with the Royal College of Pathologists of Australasia Quality Assurance Programs (RCPAQAP) has created a system to perform quality assurance on the electronic laboratory message when the laboratory sends a result back to the EQA provider. The purpose of this study was to perform a small scale pilot implementation of an IEQA protocol, which was performed to test the suitability of the system to check compliance of existing Health Level-7 (HL7 v2.4) reporting standards localised and constrained by the RCPA SPIA. Here, we present key milestones from the implementation, including: (1) software development, (2) installation, and verification of the system and communication services, (3) implementation of the IEQA program and compliance testing of the received HL7 v2.4 report messages, (4) compilation of a draft Informatics Program Survey Report for each laboratory and (5) review consisting of presentation of a report showing the compliance checking tool to each participating laboratory.
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Moshi, Magdalena Ruth, Jacqueline Parsons, Rebecca Tooher, and Tracy Merlin. "Evaluation of Mobile Health Applications: Is Regulatory Policy Up to the Challenge?" International Journal of Technology Assessment in Health Care 35, no. 4 (2019): 351–60. http://dx.doi.org/10.1017/s0266462319000461.
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AbstractObjectivesThe aim of this study is to determine whether the approach used in Australia to regulate mobile medical applications (MMA) is consistent with international standards and is suitable to address the unique challenges of these technologies.MethodsThe policies of members of the International Medical Device Regulator's Forum (IMDRF) were analyzed, to determine whether these regulatory bodies address IMDRF recommendations for the clinical evaluation of software as a medical device (SaMD). Case-studies of varying types of regulated MMAs in Australia and the United States were also reviewed to determine how well the guidance in the IMDRF's SaMD: Clinical Evaluation (2017) document was operationalized.ResultsAll included jurisdictions evaluated the effectiveness of MMAs and addressed the majority of the key sub-categories recommended in the IMDRF guidance document. However, safety principles concerning information security (cybersecurity) and potential dangers of misinformation (risk-classification) were generally not addressed in either the case-studies or in the policy documents of international regulatory bodies. Australia's approach was consistent with MMA regulation conducted internationally. None of the approaches used by global regulatory bodies adequately addressed the risk of misinformation from apps and the potential for adverse clinical consequences.ConclusionsThe risks posed by MMAs are mainly through the information they provide and how this is used in clinical decision-making. Policy in Australia and elsewhere should be adjusted to follow the IMDRF risk-classification criteria to address potential harms from misinformation. Australian regulatory information should also be updated so the harm posed by cybersecurity and connectivity can be comprehensively evaluated.
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Croll, P., B. Li, C. P. Wong, S. Gogia, A. Faud, Y. S. Kwak, S. Chu, et al. "Survey on Medical Records and EHR in Asia-Pacific Region." Methods of Information in Medicine 50, no. 04 (2011): 386–91. http://dx.doi.org/10.3414/me11-02-0002.
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SummaryObjectives: To clarify health record background information in the Asia-Pacific region, for planning and evaluation of medical information systems.Methods: The survey was carried out in the summer of 2009. Of the 14 APAMI (Asia-Pacific Association for Medical Informatics) delegates 12 responded which were Australia, China, Hong Kong, India, Indonesia, Japan, Korea, New Zealand, the Philippines, Singapore, Thailand, and Taiwan.Results: English is used for records and education in Australia, Hong Kong, India, New Zealand, the Philippines, Singapore and Taiwan. Most of the countries/regions are British Commonwealth. Nine out of 12 delegates responded that the second purpose of medical records was for the billing of medical services. Seven out of nine responders to this question answered that the second purpose of EHR (Electronic Health Records) was healthcare cost cutting. In Singapore, a versatile resident ID is used which can be applied to a variety of uses. Seven other regions have resident IDs which are used for a varying range of purposes. Regarding healthcare ID, resident ID is simply used as healthcare ID in Hong Kong, Singapore and Thailand. In most cases, disclosure of medical data with patient’s name identified is allowed only for the purpose of disease control within a legal framework and for disclosure to the patient and referred doctors. Secondary use of medical information with the patient’s identification anonymized is usually allowed in particular cases for specific purposes.Conclusion: This survey on the health record background information has yielded the above mentioned results. This information contributes to the planning and evaluation of medical information systems in the Asia-Pacific region.
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Moshi, Magdalena, Rebecca Tooher, and Tracy Merlin. "OP144 mHealth App Evaluation Framework For Reimbursement Decision-making." International Journal of Technology Assessment in Health Care 35, S1 (2019): 33. http://dx.doi.org/10.1017/s0266462319001703.
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IntroductionMobile health (mHealth) applications (app) are being integrated into healthcare by patients and practitioners in Australia. However, there are currently no policies or frameworks available that can be used to conduct a health technology assessment (HTA) on mHealth apps for reimbursement purposes. The aim of the study was to determine what policy changes and assessment criteria are needed to facilitate the development of a system that evaluates mobile medical apps for regulatory and reimbursement purposes in Australia.MethodsTo obtain the information to determine what policy changes are needed and create an evidence-based framework that can evaluate mHealth apps for reimbursement decision-making, four studies were conducted. This research included (i) a policy analysis on international mHealth app regulation; (ii) a case study on American and Australian app regulation; (iii) a methodological systematic review on the suitability of current mHealth evaluation frameworks for reimbursement purposes; and (iv) the identification of HTA pathways and impediments to app reimbursement through stakeholder interviews. An evaluation framework for apps was created by combining and synthesizing the results.ResultsSoftware changes, connectivity, and cybersecurity need to be considered when evaluating mHealth apps for reimbursement purposes. Additionally, the potential dangers of apps providing misinformation, and poor software reliability in current regulation must be considered. Stakeholders indicated that they trust how traditional medical devices are currently appraised for reimbursement in Australia. They expressed caution around the lack of clarity regarding who is responsible for app quality as well as concerns about the digital literacy of medical practitioners and their patients.ConclusionsSince stakeholder trust in the current HTA process for medical devices in Australia is high, the process was adapted to create an evaluation framework for mHealth apps. The adaptations included making provisions for cybersecurity, software updates, and compatibility issues. Provisions to address concerns around practitioner responsibility and misinformation were incorporated into the framework.
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Mac, Olivia A., Amy Thayre, Shumei Tan, and Rachael H. Dodd. "Web-Based Health Information Following the Renewal of the Cervical Screening Program in Australia: Evaluation of Readability, Understandability, and Credibility." Journal of Medical Internet Research 22, no. 6 (June 26, 2020): e16701. http://dx.doi.org/10.2196/16701.
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Background Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population. Objective This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program. Methods The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria. Results Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider–focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider–focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider–focused websites. Moreover, 9 consumer-focused and 3 health care provider–focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode. Conclusions It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability.
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Monrouxe, Lynn V., Peter Hockey, Priya Khanna, Christiane Klinner, Lise Mogensen, D. A. O'Mara, Abbey Roach, Stephen Tobin, and Jennifer Ann Davids. "Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol." BMJ Open 11, no. 9 (September 2021): e045822. http://dx.doi.org/10.1136/bmjopen-2020-045822.
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IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.
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Alderman, Christopher P. "Development and Evaluation of an Electronic Drug and Therapeutics Bulletin." Annals of Pharmacotherapy 36, no. 10 (October 2002): 1637–41. http://dx.doi.org/10.1345/aph.1a330.
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OBJECTIVE: To describe the development, implementation, and initial evaluation of a paperless drug and therapeutics bulletin that is distributed by electronic mail from the pharmacy department of an Australian teaching hospital. OUTCOMES: A standardized format for the bulletin was designed and approved in February 2001. The aim of the bulletin is to facilitate the timely dissemination of concise, factual information about issues of current interest in therapeutics, drug safety, and the cost-effective use of medicines. A simple and attractive graphic design was chosen, and the hospital's clinical pharmacists and drug information staff developed an initial bank of content during the period immediately preceding the launch. The bulletin is presented as a 1-page, read-only file in Word for Windows format and was initially distributed by electronic mail to all users of the hospital's computerized communication network. As the popularity of the bulletin increased, healthcare practitioners from outside of the hospital began to request permission for inclusion on the circulation list, and the content was frequently forwarded by E-mail to workers in other hospitals and community-based settings. The bulletin is now distributed to pharmacists around Australia via 2 separate moderated discussion lists, one of which provides an archive site for previous editions. Healthcare workers in Singapore, the US, Canada, and New Zealand also receive the bulletin, which is now also abstracted by a major Australian pharmacy journal. A readership survey (also electronically distributed) was used to seek feedback after the publication of the first 12 editions. Readers indicated a high level of satisfaction with the content, format, and frequency of distribution of the materials. CONCLUSIONS: Although the concept and execution of this project was relatively simple, an extensive literature review did not reveal any previously published reports describing this type of approach to the distribution of a pharmacy bulletin. The development and implementation of the electronic drug and therapeutics bulletin has provided an opportunity to use modern communication technology to promote safe and effective medication use and appears to have been well received.
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Wootton, Richard, Helen Gramotnev, and David Hailey. "Telephone-supported care coordination in an Australian veterans population: a randomized controlled trial." Journal of Telemedicine and Telecare 16, no. 2 (December 11, 2009): 57–62. http://dx.doi.org/10.1258/jtt.2009.090408.
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An evaluation was undertaken on the effectiveness and efficiency of care coordination in delivering health services to Australian veterans with chronic or complex medical conditions requiring multidisciplinary care and who had moderate to high care needs. The veterans participated in a randomized controlled trial (RCT) supported by the Department of Veterans' Affairs. For evaluation of the RCT, information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Of 525 veterans who were recruited, 481 were surveyed at baseline (243 in the intervention group and 238 controls). At follow-up, 421 were surveyed (213 intervention and 208 controls). There were no significant differences between the coordinated care and control groups of veterans in costs of care or in QOL measurements using the SF-12 Health Survey and the EuroQol Group EQ-5D. These findings are consistent with those reported in earlier studies which suggest that benefits from care coordination programmes may take some time to emerge.
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Hale, Andrew R., Danielle A. Stowasser, Ian D. Coombes, Julie Stokes, and Lisa Nissen. "An evaluation framework for non-medical prescribing research." Australian Health Review 36, no. 2 (2012): 224. http://dx.doi.org/10.1071/ah10986.
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Without robust and credible evidence for the benefits in health outcomes of non-medical prescribing, widespread implementation will be challenging. Our aim is to develop a consistent evaluation framework that could be applied to non-medical prescribing research. An informal collaboration was initiated in 2008 by a group of pharmacists from Australia and New Zealand to assist in information sharing, pilot design, methodologies and evaluation for pharmacist prescribing. Different pilots used different models, methodologies and evaluation. It was agreed that the development of a consistent evaluation framework to be applied to future research on non-medical prescribing was required. The framework would help to align the outcomes of different research pilots and enable the comparison of endpoints to determine the effectiveness of a non-medical prescribing intervention. This article presents the results of a workshop held at The University of Queensland in January 2009. Participants were asked to consider how to evaluate the effectiveness of different models of pharmacist prescribing. What is known about the topic? Little is known about the effectiveness and safety of non-medical prescribing services due to a lack of robust evidence. What does this paper add? This paper adds a methodology for clinicians and healthcare managers to be able to evaluate any new service of non-medical prescribing, either in the pilot phase or once introduced as a new model of care. What are the implications for practitioners? The implication for practitioners is the ability to prove to healthcare providers that non-medical prescribing services are at least as effective as usual care, so informing whether a change should be introduced in the way healthcare is delivered to patients.
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Nguyen, Long, Mark Stoové, Douglas Boyle, Denton Callander, Hamish McManus, Jason Asselin, Rebecca Guy, Basil Donovan, Margaret Hellard, and Carol El-Hayek. "Privacy-Preserving Record Linkage of Deidentified Records Within a Public Health Surveillance System: Evaluation Study." Journal of Medical Internet Research 22, no. 6 (June 24, 2020): e16757. http://dx.doi.org/10.2196/16757.
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Background The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link individual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures. Objective The aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance. Methods Although ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs. Results Sensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches. Conclusions This study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
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Omelyanovskiy, V. V., E. S. Saybel, T. P. Bezdenezhnykh, and G. R. Khachatryan. "The health technology assessment system in Australia." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (February 18, 2020): 333–41. http://dx.doi.org/10.17749/2070-4909.2019.12.4.333-341.
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In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a review of general information about the product, assessment of its clinical efficacy, cost-effectiveness analysis, assessment of financial implications of including the drug in the reimbursement list, and consideration of any other factors that may influence the committee decision. In addition to the full reimbursement of pharmaceuticals, the committee may decide to provide funding based on a managed entry agreement.
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Bate, Frank, Sue Fyfe, Dylan Griffiths, Kylie Russell, Chris Skinner, and Elina Tor. "A preliminary evaluation of data-informed mentoring at an Australian medical school." Asia Pacific Scholar 6, no. 1 (January 5, 2021): 60–69. http://dx.doi.org/10.29060/taps.2021-6-1/oa2239.
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Introduction: In 2017, the School of Medicine of the University of Notre Dame Australia implemented a data-informed mentoring program as part of a more substantial shift towards programmatic assessment. Data-informed mentoring, in an educational context, can be challenging with boundaries between mentor, coach and assessor roles sometimes blurred. Mentors may be required to concurrently develop trust relationships, guide learning and development, and assess student performance. The place of data-informed mentoring within an overall assessment design can also be ambiguous. This paper is a preliminary evaluation study of the implementation of data informed mentoring at a medical school, focusing specifically on how students and staff reacted and responded to the initiative. Methods: Action research framed and guided the conduct of the research. Mixed methods, involving qualitative and quantitative tools, were used with data collected from students through questionnaires and mentors through focus groups. Results: Both students and mentors appreciated data-informed mentoring and indications are that it is an effective augmentation to the School’s educational program, serving as a useful step towards the implementation of programmatic assessment. Conclusion: Although data-informed mentoring is valued by students and mentors, more work is required to: better integrate it with assessment policies and practices; stimulate students’ intrinsic motivation; improve task design and feedback processes; develop consistent learner-centred approaches to mentoring; and support data-informed mentoring with appropriate information and communications technologies. The initiative is described using an ecological model that may be useful to organisations considering data-informed mentoring.
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Krahe, Michelle A., Julie Toohey, Malcolm Wolski, Paul A. Scuffham, and Sheena Reilly. "Research data management in practice: Results from a cross-sectional survey of health and medical researchers from an academic institution in Australia." Health Information Management Journal 49, no. 2-3 (March 11, 2019): 108–16. http://dx.doi.org/10.1177/1833358319831318.
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Background: Building or acquiring research data management (RDM) capacity is a major challenge for health and medical researchers and academic institutes alike. Considering that RDM practices influence the integrity and longevity of data, targeting RDM services and support in recognition of needs is especially valuable in health and medical research. Objective: This project sought to examine the current RDM practices of health and medical researchers from an academic institution in Australia. Method: A cross-sectional survey was used to collect information from a convenience sample of 81 members of a research institute (68 academic staff and 13 postgraduate students). A survey was constructed to assess selected data management tasks associated with the earlier stages of the research data life cycle. Results: Our study indicates that RDM tasks associated with creating, processing and analysis of data vary greatly among researchers and are likely influenced by their level of research experience and RDM practices within their immediate teams. Conclusion: Evaluating the data management practices of health and medical researchers, contextualised by tasks associated with the research data life cycle, is an effective way of shaping RDM services and support in this group. Implications: This study recognises that institutional strategies targeted at tasks associated with the creation, processing and analysis of data will strengthen researcher capacity, instil good research practice and, over time, improve health informatics and research data quality.
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Suominen, Hanna, Maree Johnson, Liyuan Zhou, Paula Sanchez, Raul Sirel, Jim Basilakis, Leif Hanlen, Dominique Estival, Linda Dawson, and Barbara Kelly. "Capturing patient information at nursing shift changes: methodological evaluation of speech recognition and information extraction." Journal of the American Medical Informatics Association 22, e1 (October 21, 2014): e48-e66. http://dx.doi.org/10.1136/amiajnl-2014-002868.
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Abstract Objective We study the use of speech recognition and information extraction to generate drafts of Australian nursing-handover documents. Methods Speech recognition correctness and clinicians’ preferences were evaluated using 15 recorder–microphone combinations, six documents, three speakers, Dragon Medical 11, and five survey/interview participants. Information extraction correctness evaluation used 260 documents, six-class classification for each word, two annotators, and the CRF++ conditional random field toolkit. Results A noise-cancelling lapel-microphone with a digital voice recorder gave the best correctness (79%). This microphone was also the most preferred option by all but one participant. Although the participants liked the small size of this recorder, their preference was for tablets that can also be used for document proofing and sign-off, among other tasks. Accented speech was harder to recognize than native language and a male speaker was detected better than a female speaker. Information extraction was excellent in filtering out irrelevant text (85% F1) and identifying text relevant to two classes (87% and 70% F1). Similarly to the annotators’ disagreements, there was confusion between the remaining three classes, which explains the modest 62% macro-averaged F1. Discussion We present evidence for the feasibility of speech recognition and information extraction to support clinicians’ in entering text and unlock its content for computerized decision-making and surveillance in healthcare. Conclusions The benefits of this automation include storing all information; making the drafts available and accessible almost instantly to everyone with authorized access; and avoiding information loss, delays, and misinterpretations inherent to using a ward clerk or transcription services.
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Perron, Janaya Elizabeth, Michael Jonathon Coffey, Andrew Lovell-Simons, Luis Dominguez, Mark E. King, and Chee Y. Ooi. "Resuscitating Cardiopulmonary Resuscitation Training in a Virtual Reality: Prospective Interventional Study." Journal of Medical Internet Research 23, no. 7 (July 29, 2021): e22920. http://dx.doi.org/10.2196/22920.
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Background Simulation-based technologies are emerging to enhance medical education in the digital era. However, there is limited data for the use of virtual reality simulation in pediatric medical education. We developed Virtual Doc as a highly immersive virtual reality simulation to teach pediatric cardiopulmonary resuscitation skills to medical students. Objective The primary objectives of this study were to evaluate participant satisfaction and perceived educational efficacy of Virtual Doc. The secondary aim of this study was to assess the game play features of Virtual Doc. Methods We conducted a prospective closed beta-testing study at the University of New South Wales (Sydney, Australia) in 2018. All medical students from the 6-year undergraduate program were eligible to participate and were recruited through voluntary convenience sampling. Participants attended a 1-hour testing session and attempted at least one full resuscitation case using the virtual reality simulator. Following this, participants were asked to complete an anonymous postsession questionnaire. Responses were analyzed using descriptive statistics. Results A total of 26 participants were recruited, consented to participate in this study, and attended a 1-hour in-person closed beta-testing session, and 88% (23/26) of participants completed the anonymous questionnaire and were included in this study. Regarding participant satisfaction, Virtual Doc was enjoyed by 91% (21/23) of participants, with 74% (17/23) intending to recommend the simulation to a colleague and 66% (15/23) intending to recommend the simulation to a friend. In assessment of the perceived educational value of Virtual Doc, 70% (16/23) of participants agreed they had an improved understanding of cardiopulmonary resuscitation, and 78% (18/23) agreed that Virtual Doc will help prepare for and deal with real-life clinical scenarios. Furthermore, 91% (21/23) of participants agreed with the development of additional Virtual Doc cases as beneficial for learning. An evaluation of the game play features as our secondary objective revealed that 70% (16/23) of participants agreed with ease in understanding how to use Virtual Doc, and 74% (17/23) found the game play elements useful in understanding cardiopulmonary resuscitation. One-third (7/23, 30%) found it easy to work with the interactive elements. In addition, 74% (17/23) were interested in interacting with other students within the simulation. Conclusions Our study demonstrates a positive response regarding trainee satisfaction and perceived educational efficacy of Virtual Doc. The simulation was widely accepted by the majority of users and may have the potential to improve educational learning objectives.
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Moshi, Magdalena, Jacqueline Parsons, Rebecca Tooher, and Tracy Merlin. "OP143 Assessment Of mHealth Apps: Is Current Regulation Policy Adequate?" International Journal of Technology Assessment in Health Care 35, S1 (2019): 33. http://dx.doi.org/10.1017/s0266462319001697.
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IntroductionAustralians are adjusting to mobile health (mHealth) applications (apps) being used in clinical care. The nature of apps presents unique challenges (e.g. rapid lifecycle) to mHealth regulation. The risks they pose are mainly through the information they provide and how it is used in clinical decision-making. This study explores the international regulation of mHealth apps. It assesses whether the approach used in Australia to regulate apps is consistent with international standards and suitable to address the unique challenges presented by the technology.MethodsA policy analysis was conducted of all nine member jurisdictions of the International Medical Device Regulator's Forum (IMDRF), to determine if their regulatory agencies addressed the IMDRF recommendations relevant to the clinical evaluation of mHealth apps. Case-studies (submission to regulatory agencies) were also selected on varying types of regulated apps (standalone, active implantable, etc.) and assessed relative to the principles in the IMDRF's software as a medical device (SaMD): Clinical evaluation (2017) guidance document.ResultsAll included jurisdictions evaluated the effectiveness of mHealth apps, assessing the majority of the key sub-categories recommended by SaMD: Clinical evaluation. The submissions and jurisdictional regulatory bodies did not address the IMDRF safety principles in terms of the apps’ information security (cybersecurity). Furthermore, by failing to use the method recommended by the IMDRF (risk-classification), none of the submissions or jurisdictions recognized the potential dangers of misinformation on patient safety.ConclusionsNone of the approaches used by global regulatory bodies adequately address the unique challenges posed by apps. Australia's approach is consistent with app regulatory procedures used internationally. We recommend that mHealth apps are evaluated for cybersecurity and are also classified using the IMDRF risk-categories so as to fully protect the public.
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Cheng, Heilok, Alison Tutt, Catherine Llewellyn, Donna Size, Jennifer Jones, Sarah Taki, Chris Rossiter, and Elizabeth Denney-Wilson. "Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation." JMIR mHealth and uHealth 8, no. 5 (May 27, 2020): e17300. http://dx.doi.org/10.2196/17300.
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Background Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources.
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McSwiggan, Sally, Susanne Meares, and Melanie Porter. "Decision-making capacity evaluation in adult guardianship: a systematic review." International Psychogeriatrics 28, no. 3 (September 28, 2015): 373–84. http://dx.doi.org/10.1017/s1041610215001490.
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ABSTRACTBackground:Evidence of impaired decision-making capacity is a legal requirement for adult guardianship. To understand the quality of the evidence health professionals commonly provide in reports submitted to guardianship courts, a systematic review was undertaken to appraise the design and methodological quality of the published literature on health professionals’ written reports of decision-making capacity and to describe the content of these reports.Methods:Electronic searches from 1980 to 2015 identified 1183 articles of which 11 met the inclusion criteria where each evaluated quantitatively the content of health professionals’ written reports submitted to adult guardianship proceedings. Methodological quality of the selected studies was rated using a critical appraisal tool.Results:Nine studies sourced files from courts in the U.S. and one from Sweden; another reported on guardianship decisions from Australia. Four studies were rated as moderately strong or strong. Strengths included the use of comparison groups and a reliable and valid instrument to code reports. The review showed a person's medical condition was often cited as evidence of impaired decision-making capacity. Cognitive, psychiatric and functional abilities were less often described, and a person's values and preferences were rarely recorded.Conclusions:It is recommended health professionals describe the process by which a person makes a particular decision (their ability to understand, appreciate, reason and communicate) in addition to providing medical information, including cognitive, psychiatric and functional abilities. This approach provides support for a professional's opinion and evidence for a court. International studies of health professionals’ approach to decision-making capacity evaluation are needed.
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Liaw, Siaw-Teng, and Simon De Lusignan. "An “integrated health neighbourhood” framework to optimise the use of EHR data." Journal of Innovation in Health Informatics 23, no. 3 (October 4, 2016): 547. http://dx.doi.org/10.14236/jhi.v23i3.826.
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General practice should become the hub of integrated health neighbourhoods (IHNs), which involves sharing of information to ensure that medical homes are also part of learning organisations that use electronic health record (EHR) data for care, decision making, teaching and learning, quality improvement and research. The IHN is defined as the primary and ambulatory care services in a locality that relates largely to a single hospital-based secondary care service provider and is the logical denominator and unit of comparison for the optimal use of EHR data and health information exchange (HIE) to facilitate integration and coordination of care. Its size may vary based on the geography and requirements of the population, for example between city, suburban and rural areas. The conceptual framework includes context; integration of data, information and knowledge; integration of clinical workflow and practice; and inter-professional integration to ensure coordinated shared care to deliver safe and effective services that are equitable, accessible and culturally respectful. We illustrate how this HIE-supported IHN vision may be achieved with an Australian case study demonstrating the integration of linked pseudonymised records with knowledge- and evidence-based guidelines using semantic web tools and informatics-based methods, researching causal links bewteen data quality and quality of care and the key issues to address. The data presented in this paper form part of the evaluation of the informatics infrastructure - HIE and data repository – for its reliability and utility in supporting the IHN. An IHN can only be created if the necessary health informatics infrastructure is put in place. Integrated care may struggle to be effective without HIE.
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Mueller, Evelyn, Georg Bollig, Gerhild Becker, and Christopher Boehlke. "Lessons Learned from Introducing Last Aid Courses at a University Hospital in Germany." Healthcare 9, no. 7 (July 16, 2021): 906. http://dx.doi.org/10.3390/healthcare9070906.
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In recent years, so called “Last Aid courses”, concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care of the dying) are especially high, and may differ from the general population. To evaluate if Last Aid courses are feasible in hospital settings, and if informational needs of hospital staff are met by the curriculum, we introduced Last Aid courses at a university hospital. Five courses were offered; participants of courses 1 and 2 completed surveys with open-ended questions; the answers were used to develop the evaluation questionnaire employed in courses 3–5. In these three courses, 55 of the 56 participants completed an evaluation survey to explore their learning goals and obtain feedback. Courses were fully booked; participants were heterogeneous with regard to their professional background. The most prevalent learning goals were “preparation for emotional aspects in care of dying” (65.5% ratings “very important”), “preparation for medical/care aspects in care of dying” (60.0%), and “knowledge of supportive services and facilities” (54.5%). Overall, the evaluation showed that Last Aid courses were more suitable to educate non-medical hospital staff about care of the dying. Medical staff, in contrast to non-medical staff, more often requested courses with an extended curriculum in order to meet their learning goals. Last Aid courses were well accepted and helped to reduce information deficits on care of the dying in a heterogeneous population of hospital staff.
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Gardner, Glenn, Anne Gardner, Sandy Middleton, Julie Considine, Gerard Fitzgerald, Luke Christofis, Anna Doubrovsky, Margaret Adams, and Jane O'Connell. "Mapping workforce configuration and operational models in Australian emergency departments: a national survey." Australian Health Review 42, no. 3 (2018): 340. http://dx.doi.org/10.1071/ah16231.
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Objective Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. The aim of the present study was to comprehensively measure these variables in Australian EDs. Methods Australian hospital EDs with 24-h medical and nursing cover were identified and invited to participate in the study. Telephone interviews were conducted with nursing or medical department managers to collect data related to hospital characteristics, ED workforce and training and ED service and operational models. Results Surveys were completed in 87% of the population sample (n = 135). Metropolitan EDs were significantly more likely to retain higher full-time equivalents (FTEs) in several medical (staff specialist, registrar, resident and intern) and nursing (nurse practitioner (NP), nurse educator, nurse unit manager and registered nurse) positions. NPs were employed by 52% of Australian EDs overall, but this ranged from 40% to 75% depending on jurisdiction. The most commonly used operational models were FastTrack teams (72% of EDs), short-stay/observational unit (59%) and patient liaison models for aged care (84%) and mental health (61%). EDs that employed NPs were significantly more likely to use FastTrack (P = 0.002). Allied health services most frequently available within these EDs were radiology (60%), social work (69%), physiotherapy (70%) and pharmacy (65%). Conclusions The present study has established a baseline measure of the staffing configuration and organisational characteristics of Australian EDs. What is known about the topic? EDs are overcrowded due, in part, to the combined effect of increased service demand and access block. Innovative service and workforce models have been implemented by health departments aiming to improve service and performance. National uptake of these service and workforce innovations is unknown. What does this paper add? The present study is the most comprehensive to date profiling Australian EDs covering hospital characteristics, workforce configuration, operational models and NP service patterns and practice. What are the implications for practitioners? Information from the present study will assist health service planners to evaluate workforce and service reform models, and to monitor trends in emergency service development.
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Mindel, A., C. Marks, R. Tideman, J. Taylor, C. Seifert, G. Berry, B. Trudinger, and A. Cunningham. "Sexual behaviour and social class in Australian women." International Journal of STD & AIDS 14, no. 5 (May 1, 2003): 344–49. http://dx.doi.org/10.1258/095646203321605567.
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Sexual behaviour is determined by social, cultural and personal factors. Sexual behaviour studies have been conducted in many countries. However, information from Australia is limited. This study was conducted in Obstetrics Department, Westmead Hospital, Sydney. Questionnaire-derived demographic and behavioural characteristics for public and private patients were compared using bivariate and logistic regression analyses. Of the patients, 3036 were public, and 595 private. On bivariate analysis some significant differences were private patients more likely to be born in Australia and have a higher education level whereas public patients were more likely to have had a greater number of lifetime sexual partners and younger age at first sex. Public patients were more likely to be herpes simplex virus type 2 (HSV-2) antibody positive (12%) than private patients (6%). On logistic regression significant variables included country of birth, being HSV-2 antibody positive, and age at first sex. A number of sexual and social variables were significantly different, comparing patients in the public and private sectors. Evaluation of interventions to reduce the sexual risk to women in the public sector should be considered, including encouraging young women to delay their sexual debut, and reducing the number of sexual partners.
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Miller, R., B. Whitehill, and D. Deere. "A national approach to risk assessment for drinking water catchments in Australia." Water Supply 5, no. 2 (September 1, 2005): 123–34. http://dx.doi.org/10.2166/ws.2005.0029.
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This paper comments on the strengths and weaknesses of different methodologies for risk assessment, appropriate for utilisation by Australian Water Utilities in risk assessment for drinking water source protection areas. It is intended that a suggested methodology be recommended as a national approach to catchment risk assessment. Catchment risk management is a process for setting priorities for protecting drinking water quality in source water areas. It is structured through a series of steps for identifying water quality hazards, assessing the threat posed, and prioritizing actions to address the threat. Water management organisations around Australia are at various stages of developing programs for catchment risk management. While much conceptual work has been done on the individual components of catchment risk management, work on these components has not previously been combined to form a management tool for source water protection. A key driver for this project has been the requirements of the National Health and Medical Research Council Framework for the Management of Drinking Water Quality (DWQMF) included in the draft 2002 Australian Drinking Water Guidelines (ADWG). The Framework outlines a quality management system of steps for the Australian water industry to follow with checks and balances to ensure water quality is protected from catchment to tap. Key steps in the Framework that relate to this project are as follows: Element 2 Assessment of the Drinking Water Supply System• Water Supply System analysis• Review of Water Quality Data• Hazard Identification and Risk Assessment Element 3 Preventive Measures for Drinking Water Quality Management• Preventive Measures and Multiple Barriers• Critical Control Points This paper provides an evaluation of the following risk assessment techniques: Hazard Analysis and Critical Control Points (HACCP); World Health Organisation Water Safety Plans; Australian Standard AS 4360; and The Australian Drinking Water Guidelines – Drinking Water Quality Management Framework. These methods were selected for assessment in this report as they provided coverage of the different approaches being used across Australia by water utilities of varying: scale of water management organisation; types of water supply system management; and land use and activity-based risks in the catchment area of the source. Initially, different risk assessment methodologies were identified and reviewed. Then examples of applications of those methods were assessed, based on several key water utilities across Australia and overseas. Strengths and weaknesses of each approach were identified. In general there seems some general grouping of types of approaches into those that: cover the full catchment-to-tap drinking water system; cover just the catchment area of the source and do not recognise downstream barriers or processes; use water quality data or land use risks as a key driving component; and are based primarily on the hazard whilst others are based on a hazardous event. It is considered that an initial process of screening water quality data is very valuable in determining key water quality issues and guiding the risk assessment, and to the overall understanding of the catchment and water source area, allowing consistency with the intentions behind the ADWG DWQM Framework. As such, it is suggested that the recommended national risk assessment approach has two key introductory steps: initial screening of key issues via water quality data, and land use or activity scenario and event-based HACCP-style risk assessment. In addition, the importance of recognising the roles that uncertainty and bias plays in risk assessments was highlighted. As such it was deemed necessary to develop and integrate uncertainty guidelines for information used in the risk assessment process. A hybrid risk assessment methodology was developed, based on the HACCP approach, but with some key additions and modifications to make it applicable to varying catchment risks, water supply operation needs and environmental management processes.
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Holden, Carol, Carolyn Poljski, Catherine Andrews, Megan Cock, Rory Wolfe, and David de Krester. "The Dynamics of Community Education in Male Reproductive Health: Findings from an Australian Study." Australian Journal of Primary Health 12, no. 2 (2006): 146. http://dx.doi.org/10.1071/py06034.
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A significant number of men are affected by reproductive health disorders; however, the level of awareness and education for some disorders is limited. Our aim was to explore the dynamics of community education activities being undertaken in Australia that address or include information on male reproductive health issues, to identify health promotion initiatives that help raise the awareness of male reproductive health disorders. A survey was distributed to medical practitioners, health services and community organisations across Australia to identify organisations providing male reproductive health information. Those organisations that had evaluated their activity were further analysed to determine if their focus was effectively providing education on male reproductive disorders. Of the 299 education activities reporting the inclusion of male reproductive health information, prostate cancer was the most commonly addressed health issue (55.5%). Only 89 activities (29.8%) had been evaluated by the education providers, to determine whether their aims had been met. Several factors were found to have an impact on the perceived success of education activities, including (i) the focus, but only for prostate cancer, prostate disease and testicular cancer activities (ii) method of delivery (face-to-face group presentations and one-on-one discussions), and (iii) location (remote areas). While the overall evaluation of community education activities focusing on male reproductive health is limited, several factors have been identified from this survey that may impact on the success of future male specific health promotion activities.
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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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Davis, Jenny, Amee Morgans, and Joan Stewart. "Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface." Australian Health Review 40, no. 4 (2016): 420. http://dx.doi.org/10.1071/ah15005.
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Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.
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Gazey, Angela, Shannen Vallesi, Karen Martin, Craig Cumming, and Lisa Wood. "The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness." Housing, Care and Support 22, no. 1 (November 6, 2018): 54–64. http://dx.doi.org/10.1108/hcs-08-2018-0020.
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Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia. Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage. Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support. Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality. Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions. Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.
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Choi, Seung Mi, and Young Sun Lee. "The Focus Group Interview on Infertility Experts for the Development of Infertility Counseling System." Journal of The Korean Society of Maternal and Child Health 24, no. 1 (January 31, 2020): 26–39. http://dx.doi.org/10.21896/jksmch.2020.24.1.26.
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Purpose: This study aimed to propose an effective model for the development of an infertility counseling system.Methods: We reviewed the infertility counseling system in Japan, Germany, the United States, the United Kingdom, and Australia. Additionally, we conducted a Focus Group Interview (FGI) with infertility experts and gathered their opinions about a potential counseling system tailored to the needs of infertile women and suitable for Korean context.Results: Based on the literature review and FGI, the proposed infertility counseling system aimed to promote the infertility treatment process; to build a user-friendly system, including financial support for infertility counseling; to incorporate the integrated model of providing medical information and psychological support for infertile women; and to develop a stepped care system. Additionally, the present findings revealed that, to promote infertility counseling, it is necessary to establish a central infertility counseling center that would be responsible for comprehensive planning, implementation, evaluation, research, and supervision of each counseling organization.Conclusion: The results of this study can be used as a basis for proposing a preliminary model for the development of an infertility counseling system in Korea.
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Rosenberg, David M., Michael Kevin Rooney, Ritu Arya, Matthew J. Abrams, Steve E. Braunstein, Jennifer M. Croke, Meredith Elana Giuliani, et al. "Bridging the information gap: A scoping review of radiation oncology patient education scholarship." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23164-e23164. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23164.
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e23164 Background: Patient education (PE), the use of educational interventions to improve patient knowledge of healthcare, has been shown to reduce patient anxiety and facilitate shared decision making. In contrast to many other medical specialties, the state of radiation oncology (RO) PE is unclear. This scoping review aims to characterize the state of ROPE peer-review scholarship to describe strengths, identify gaps and guide future ROPE research. Methods: Predetermined medical subject headings and search terms were used to search PubMed for ROPE articles. Additional terms were identified from these articles and the search was repeated until no further articles were found. In-press articles in major RO and medical education (ME) journals were searched. English language articles published after 1/1/1990 that had a primary ROPE focus were included. Two independent reviewers performed the search and determined eligibility. Articles were categorized using the most predominant step of Kern’s six-step conceptual framework for ME curriculum development and the country and year of publication. Results: Of 11,756 identified articles, 182 met inclusion criteria. Articles per year increased over time (p < 0.01): 1990-1994 (5.5%); 1995-1999 (11.0%); 2000-2004 (13.7%); 2005-2009 (10.4%); 2010-2014 (25.8%); 2015-2019 (33.5%). Conceptual framework categorization was as follows: problem identification (22.0%); needs assessment (23.6%); goals and objectives (4.9%); education strategies (9.9%); implementation (7.7%); evaluation and feedback (31.9%). Regional breakdown was as follows with some articles spanning regions: Africa (1.1%); South America (2.2%); Asia (6.0%); Australia (15.4%); Europe (30.2%); North America (45.6%). Conclusions: Nearly half of articles are primarily problem identification or needs assessment (45.6%) which are descriptive in nature and only identify or clarify ROPE needs. Additionally while these results are limited to English language scholarship, there are significant regional maldistributions. Although there is an encouraging trend of increasing ROPE publications over time, this study identifies opportunities to further develop, implement and evaluate ROPE scholarship.
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Abbott, B., R. Lugg, B. Devine, A. Cook, and P. Weinstein. "Microbial risk classifications for recreational waters and applications to the Swan and Canning Rivers in Western Australia." Journal of Water and Health 9, no. 1 (February 3, 2011): 70–79. http://dx.doi.org/10.2166/wh.2011.016.
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Protecting recreational water quality where ‘whole-of-body contact’ activities occur is important from a public health and economic perspective. Numerous studies have demonstrated that infectious illnesses occur when swimming in faecally polluted waters. With the release of the 2008 Australian recreational water guidelines, the Western Australian (WA) Department of Health conducted a formal evaluation to highlight the advantages of applying the microbial risk management framework to 27 swimming beaches in the Swan and Canning Rivers in Perth, WA. This involved a two-phase approach: (i) calculation of 95th percentiles using historical enterococci data; and (ii) undertaking sanitary inspections. The outcomes were combined to assign provisional risk classifications for each site. The classifications are used to promote informed choices as a risk management strategy. The study indicates that the majority of swimming beaches in the Swan-Canning Rivers are classified as ‘very good’ to ‘good’ and are considered safe for swimming. The remaining sites were classified as ‘poor’, which is likely to be attributed to environmental influences. Information from the study was communicated to the public via a series of press releases and the Healthy Swimming website. The guidelines provide a sound approach to managing recreational water quality issues, but some limitations were identified.
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Wiles, Louise K., Peter D. Hibbert, Jacqueline H. Stephens, Enrico Coiera, Johanna Westbrook, Jeffrey Braithwaite, Ric O. Day, Ken M. Hillman, and William B. Runciman. "STANDING Collaboration: a study protocol for developing clinical standards." BMJ Open 7, no. 10 (October 2017): e014048. http://dx.doi.org/10.1136/bmjopen-2016-014048.
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IntroductionDespite widespread availability of clinical practice guidelines (CPGs), considerable gaps continue between the care that is recommended (‘appropriate care’) and the care provided. Problems with current CPGs are commonly cited as barriers to providing ’appropriate care'.Our study aims to develop and test an alternative method to keep CPGs accessible and up to date. This method aims to mitigate existing problems by using a single process to develop clinical standards (embodied in clinical indicators) collaboratively with researchers, healthcare professionals, patients and consumers. A transparent and inclusive online curated (purpose-designed, custom-built, wiki-type) system will use an ongoing and iterative documentation process to facilitate synthesis of up-to-date information and make available its provenance. All participants are required to declare conflicts of interest. This protocol describes three phases: engagement of relevant stakeholders; design of a process to develop clinical standards (embodied in indicators) for ‘appropriate care’ for common medical conditions; and evaluation of our processes, products and feasibility.Methods and analysisA modified e-Delphi process will be used to gain consensus on ‘appropriate care’ for a range of common medical conditions. Clinical standards and indicators will be developed through searches of national and international guidelines, and formulated with explicit criteria for inclusion, exclusion, time frame and setting. Healthcare professionals and consumers will review the indicators via the wiki-based modified e-Delphi process. Reviewers will declare conflicts of interest which will be recorded and managed according to an established protocol. The provenance of all indicators and suggestions included or excluded will be logged from indicator inception to finalisation. A mixed-methods formative evaluation of our research methodology will be undertaken.Ethics and disseminationHuman Research Ethics Committee approval has been received from the University of South Australia. We will submit the results of the study to relevant journals and offer national and international presentations.
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Xu, Rebecca, Emily Gilbert, Millicent Kuczynska-Burggraf, Bryan Tan, Helena Teede, Amanda Vincent, Melanie Gibson-Helm, and Jacqueline Boyle. "Ask PCOS: Identifying Need to Inform Evidence-Based App Development for Polycystic Ovary Syndrome." Seminars in Reproductive Medicine 36, no. 01 (January 2018): 059–65. http://dx.doi.org/10.1055/s-0038-1667187.
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Background People are increasingly seeking health information and managing their health through electronic technologies. We aimed to determine if women with polycystic ovary syndrome (PCOS) identified a need for PCOS-related mobile health apps and to evaluate related apps currently available. Design A national survey of women and a review of apps available on the iOS and Android platforms. Setting Community recruitment in Australia in 2016 and review of mobile apps available in 2017. Sample The survey received 264 responses. Sixteen apps related to PCOS were evaluated. Main Outcome Measures Survey: Women's likeliness to use mobile health apps, specifically a PCOS-related app and preferred features of apps. App review: Mapping of available apps and evaluation using the Mobile Application Rating Scale (MARS). Results Of 264 respondents, almost all women had a smartphone (98%), 72% had previously used an app to manage their health, and most (91%) would use a PCOS-specific app if available. The most important feature was the availability of current, evidence-based information. Current apps on PCOS lack provision of quality information. Conclusion Women with PCOS would use a PCOS-specific app of good quality that responds to their needs and facilitates self-care; however, currently available apps are unlikely to meet their information needs.
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Scott, Ian A., Clair Sullivan, and Andrew Staib. "Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation." Australian Health Review 43, no. 3 (2019): 302. http://dx.doi.org/10.1071/ah17153.
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Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Mesquita, Rafael Carneiro de, and Ian Edwards. "Systematic Literature Review of My Health Record System." Asia Pacific Journal of Health Management 15, no. 1 (March 15, 2020): 14–25. http://dx.doi.org/10.24083/apjhm.v15i1.311.
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Background: On 2010 Australia launched a personally controlled electronic health record (PCEHR) later renamed and augmented by the My Health Record Act 2012 Cth. The main goal of the present systematic literature review was to assess if the system has improved Australia’s healthcare system according to the objectives stated by the federal government in the My Health Record Act 2012 Cth. Methods: This systematic literature review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Despite the MyHR system being available for seven years, there is limited empirical evaluation regarding its progress in achieving the stated goals. The results were segregated in four themes: (1) health information fragmentation, (2) Health information quality and management, (3) adverse medical events and duplication of treatment and (4) coordination of care. Regarding theme 1, it was evidenced that the system could reduce health information fragmentation; however, gaps in the workforce adoption were identified as a problem. About topic 2, improved access to information and possible misinterpretation were found. Theme 3 lacked research and theme 4 presented contradiction in the results.
Conclusion: The My Health Record (MyHR) system is founded on four key objectives. However, there is insufficient evidence that any outcomes have been achieved relating to any of the objectives. Research is required to determine whether the MyHR system helped improve Australia’s healthcare system according to the objectives stated in the Act 2012.
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Dillon, Eric, and Jozef Loermans. "Telehealth in Western Australia: The challenge of evaluation." Journal of Telemedicine and Telecare 9, no. 2_suppl (December 2003): 15–19. http://dx.doi.org/10.1258/135763303322596147.
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Moehr, Jochen R. "Evaluation: salvation or nemesis of medical informatics?" Computers in Biology and Medicine 32, no. 3 (May 2002): 113–25. http://dx.doi.org/10.1016/s0010-4825(02)00009-4.
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Garrett-Jones, Sam, Brian Wixted, and Tim Turpin. "Some international benchmarks for evaluating Australian health and medical research." Research Evaluation 13, no. 3 (December 1, 2004): 155–66. http://dx.doi.org/10.3152/147154404781776428.
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Martin, Carmel, Narelle Hinkley, Keith Stockman, and Donald Campbell. "Capitated Telehealth Coaching Hospital Readmission Service in Australia: Pragmatic Controlled Evaluation." Journal of Medical Internet Research 22, no. 12 (December 1, 2020): e18046. http://dx.doi.org/10.2196/18046.
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Background MonashWatch is a telehealth public hospital outreach pilot service as a component of the Government of Victoria’s statewide redesign initiative called HealthLinks: Chronic Care. Rather than only paying for hospitalizations, projected funding is released earlier to hospitals to allow them to reduce hospitalization costs. MonashWatch introduced a web-based app, Patient Journey Record System, to assess the risk of the journeys of a cohort of patients identified as frequent admitters. Telecare guides call patients using the Patient Journey Record System to flag potential deterioration. Health coaches (nursing and allied health staff) triage risk and adapt care for individuals. Objective The aim was a pragmatic controlled evaluation of the impact of MonashWatch on the primary outcome of bed days for acute nonsurgical admissions in the intention-to-treat group versus the usual care group. The secondary outcome was hospital admission rates. The net promoter score was used to gauge satisfaction. Methods Patients were recruited into an intention-to-treat group, which included active telehealth and declined/lost/died groups, versus a systematically sampled (4:1) usual care group. A rolling sample of 250-300 active telehealth patients was maintained from December 23, 2016 to June 23, 2019. The outcome—mean bed days in intervention versus control—was adjusted using analysis of covariance for age, gender, admission type, and effective days active in MonashWatch. Time-series analysis tested for trends in change patterns. Results MonashWatch recruited 1373 suitable patients who were allocated into the groups: usual care (n=293) and intention-to-treat (n=1080; active telehealth: 471/1080, 43.6%; declined: 485, 44.9%; lost to follow-up: 178 /1080, 10.7%; died: 8/1080, 0.7%). Admission frequency of intention-to-treat compared to that of the usual care group did not significantly improve (P=.05), with a small number of very frequent admitters in the intention-to-treat group. Age, MonashWatch effective days active, and treatment group independently predicted bed days. The analysis of covariance demonstrated a reduction in bed days of 1.14 (P<.001) in the intention-to-treat group compared with that in the usual care group, with 1236 bed days estimated savings. Both groups demonstrated regression-to-the-mean. The downward trend in improved bed days was significantly greater (P<.001) in the intention-to-treat group (Sen slope –406) than in the usual care group (Sen slope –104). The net promoter score was 95% in the active telehealth group compared with typical hospital scores of 77%. Conclusions Clinically and statistically meaningful reductions in acute hospital bed days in the intention-to-treat group when compared to that of the usual care group were demonstrated (P<.001), although admission frequency was unchanged with more short stay admissions in the intention-to-treat group. Nonrandomized control selection was a limitation. Nonetheless, MonashWatch was successful in the context of the HealthLinks: Chronic Care capitation initiative and is expanding.
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Walter, Garry, Ken Kffikby, Isaac Marks, Harvey Whtteford, Gavin Andrews, and Richard Swinson. "Outcome Measurement: Sharing Experiences in Australia." Australasian Psychiatry 4, no. 6 (December 1996): 316–18. http://dx.doi.org/10.3109/10398569609082075.
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There is growing attention to evidence-based medicine both in informing medical education and in guiding clinical practice. The result is increasing emphasis on evaluating treatment efficacy, the structure of health care delivery, the allocation of the health dollar and the application of information technology to these tasks. Implications are emerging for psychiatric care in Australia from everyday clinical practices to the political level. Collective experience in this area, as discussed at a conference forum in Sydney [1], is summarized in this paper. This information is presented to stimulate thought, foster comparisons and encourage a synthesis of clinical, administrative and political directions in this field.
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Missinou, M. A., S. Issifou, E. Anane-Sarpong, I. Abubakar, J. N. Gandi, M. Chagomerana, M. Pinder, et al. "Medical Informatics in Medical Research." Methods of Information in Medicine 45, no. 05 (2006): 483–91. http://dx.doi.org/10.1055/s-0038-1634108.
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Summary Objectives: Computers are widely used for data management in clinical trials in the developed coutries, unlike in developing countries. Dependable systems are vital for data management, and medical decision making in clinical research. Monitoring and evaluation of data management is critical.In this paper we describe database structures and procedures of systems used to implement, coordinate, and sustain data management in Africa. We outline major lessons, challenges and successes achieved, and recommendations to improve medical informatics application in biomedical research in sub-Saharan Africa. Methods: A consortium of experienced research units at five sites in Africa in studying children with disease formed a new clinical trials network, Severe Malaria in African Children. In December 2000, the network introduced an observational study involving these hospital-based sites. After prototyping, relational database management systems were implemented for data entry and verification, data submission and quality assurance monitoring. Results: Between 2000 and 2005, 25,858 patients were enrolled. Failure to meet data submission deadline and data entry errors correlated positively (correlation coefficient, r = 0.82), with more errors occurring when data was submitted late. Data submission lateness correlated inversely with hospital admissions (r = –0.62). Conclusions: Developing and sustaining dependable DBMS, ongoing modifications to optimize data management is crucial for clinical studies. Monitoring and communication systems are vital in multi-center networks for good data management. Data timeliness is associated with data quality and hospital admissions.
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Yogesan, K., C. Henderson, C. J. Barry, and I. J. Constable. "Online eye care in prisons in Western Australia." Journal of Telemedicine and Telecare 7, no. 2_suppl (December 2001): 63–64. http://dx.doi.org/10.1258/1357633011937173.
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In prisons, prison medical officers provide general medical care. However, if specialist care is needed then the prisoner is transported to a specialist medical centre. This is a costly procedure and prison escapes occur during transportation. We have tested our Internet-based eye care system in prisons in Western Australia. Medical and ophthalmic history, visual acuity and intraocular pressure were stored in a browser-based multimedia database. Digital images of the retina and the external eye were recorded and transmitted to a central server. Based on the medical data and the digital images, the specialist ophthalmologist could provide a diagnosis within 24 h. Eleven patients (mean age 48, range 30–82 years) were reviewed during two separate visits to a maximum-security prison in Western Australia. Our main aim was to train prison medical officers and nurses to operate the portable ophthalmic imaging instruments and to use the Internet-based eye care system. The outcome of the pilot study indicated that considerable savings could be made in transport costs and the security risk could be reduced. The Ministry of Justice in Western Australia has decided to implement telemedicine services to provide regular ophthalmic consultation to its prisons.
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Crowe, Bernard, and Peter Maclsaac. "The application of qualitative approaches to the evaluation of telehealth systems in Australia." Journal of Telemedicine and Telecare 12, no. 3_suppl (November 2006): 33–35. http://dx.doi.org/10.1258/135763306779380057.
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Brijnath, Bianca, Nabita Singh, and Danielle Mazza. "Stakeholder perspectives on the new sickness certificate in Victoria: results from a mixed-methods qualitative study." Australian Health Review 40, no. 1 (2016): 27. http://dx.doi.org/10.1071/ah14136.
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Objective The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate. Methods A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015; after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. What is known about the topic? When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do). What does this paper add? Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate. What are the implications for practitioners? Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.
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Clarke, P. H. J. "A referrer and patient evaluation of a telepsychiatry consultation–liaison service in South Australia." Journal of Telemedicine and Telecare 3, no. 1_suppl (June 1997): 12–14. http://dx.doi.org/10.1258/1357633971930788.
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A study was carried out to describe the patient population assessed by a telepsychiatry consultation-liaison service in rural South Australia, and to assess the referrers’ and patients’ satisfaction rating with this service. The study was performed in two parts, with retrospective and prospective components. The author completed a semi-structured interview for each patient (n=75) with a Brief Psychiatric Rating Scale (BPRS) for the prospective group (n=32). A questionnaire was also sent to all referrers seeking an evaluation of the usefulness of the telepsychiatry interview in terms of assessment and management recommendations and outcome. Patients from the prospective group were sent a questionnaire examining their evaluation of the usefulness of the interview in terms of assessment and management recommendations, and difficulties with the technology. The patient population was characterized by high rates of affective disorder and personality disorder, and high indices of developmental disturbance. Referrers reported high rates of satisfaction with the service. Nursing staff rated the service more positively than general practitioners. The usefulness for assessment was rated more highly than for management.
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Bodenreider, O., A. Burgun, G. Botti, M. Fieschi, P. Le Beux, and F. Kohler. "Evaluation of the Unified Medical Language System as a Medical Knowledge Source." Journal of the American Medical Informatics Association 5, no. 1 (January 1, 1998): 76–87. http://dx.doi.org/10.1136/jamia.1998.0050076.
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Ji, Meng, Yanmeng Liu, Mengdan Zhao, Ziqing Lyu, Boren Zhang, Xin Luo, Yanlin Li, and Yin Zhong. "Use of Machine Learning Algorithms to Predict the Understandability of Health Education Materials: Development and Evaluation Study." JMIR Medical Informatics 9, no. 5 (May 6, 2021): e28413. http://dx.doi.org/10.2196/28413.
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Background Improving the understandability of health information can significantly increase the cost-effectiveness and efficiency of health education programs for vulnerable populations. There is a pressing need to develop clinically informed computerized tools to enable rapid, reliable assessment of the linguistic understandability of specialized health and medical education resources. This paper fills a critical gap in current patient-oriented health resource development, which requires reliable and accurate evaluation instruments to increase the efficiency and cost-effectiveness of health education resource evaluation. Objective We aimed to translate internationally endorsed clinical guidelines to machine learning algorithms to facilitate the evaluation of the understandability of health resources for international students at Australian universities. Methods Based on international patient health resource assessment guidelines, we developed machine learning algorithms to predict the linguistic understandability of health texts for Australian college students (aged 25-30 years) from non-English speaking backgrounds. We compared extreme gradient boosting, random forest, neural networks, and C5.0 decision tree for automated health information understandability evaluation. The 5 machine learning models achieved statistically better results compared to the baseline logistic regression model. We also evaluated the impact of each linguistic feature on the performance of each of the 5 models. Results We found that information evidentness, relevance to educational purposes, and logical sequence were consistently more important than numeracy skills and medical knowledge when assessing the linguistic understandability of health education resources for international tertiary students with adequate English skills (International English Language Testing System mean score 6.5) and high health literacy (mean 16.5 in the Short Assessment of Health Literacy-English test). Our results challenge the traditional views that lack of medical knowledge and numerical skills constituted the barriers to the understanding of health educational materials. Conclusions Machine learning algorithms were developed to predict health information understandability for international college students aged 25-30 years. Thirteen natural language features and 5 evaluation dimensions were identified and compared in terms of their impact on the performance of the models. Health information understandability varies according to the demographic profiles of the target readers, and for international tertiary students, improving health information evidentness, relevance, and logic is critical.
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Alexander, M. "Telemedicine in Australia. 2: The Health Communication Network." Journal of Telemedicine and Telecare 2, no. 1 (March 1, 1996): 1–6. http://dx.doi.org/10.1258/1357633961929079.
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The Health Communication Network HCN in Australia is reviewed. Early interest from both the government and the medical community led to the establishment of a number of pilot services. Because of the community interest in privacy issues, determined efforts to understand and build structures to cope with privacy have been made. The first HCN services began to be tested in 1995, and progressive expansion is planned. The HCN, while supported by the government, is a separate, commercial entity, and much early work has thus focused on corporate governance, so that it will be able to do what it was designed for.
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Crowe, B. L. "A review of the experience with teleradiology in Australia." Journal of Telemedicine and Telecare 7, no. 2_suppl (December 2001): 53–54. http://dx.doi.org/10.1258/1357633011937128.
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Because of the geographical dispersion of the Australian population (25–30% of the total population of 20 million live outside metropolitan areas), there has been considerable interest in the use of teleradiology. In general, the provision of teleradiology by private radiology practices has been successful. However, as regards the provision of publicly funded, statewide teleradiology services, progress has been slower than expected, following enthusiastic support for the technology in the early 1990s. While there have been some notable successes in the implementation of publicly funded teleradiology services, given the delays that have been experienced in Australia, there is a case for a closer connection between the conduct of teleradiology evaluation studies and the incorporation of the results into health policy. This link would ensure that the benefits of technology are made available to the public in as short a time as possible.
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Hughes, Emma, Chris King, and Sharon Kitt. "Using the Australian and New Zealand Telehealth Committee framework to evaluate telehealth: Identifying conceptual gaps." Journal of Telemedicine and Telecare 8, no. 3_suppl (December 2002): 36–38. http://dx.doi.org/10.1258/13576330260440790.
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summary Telehealth is strongly supported in policy rhetoric as being economically significant to Australia, but evaluation standards have been insufficiently developed to ensure that this is the case. The use of one such evaluation standard, the Australian and New Zealand Telehealth Committee (ANZTC) framework, for telehealth evaluation in Australia makes good sense. However, that framework emphasizes economic and technical considerations at the expense of social contexts. Furthermore, there must be questions about the utility of a framework which, it appears, has been used to evaluate only a single telehealth project in Australia. The combination of the economic rationalism of health-care policy and the technological determinism of a tool model of information and communication technologies (ICTs) can result in evaluations that fail to match the complexities of the intersection of health-care and ICTs. Using the ANZTC framework while at the same time focusing on explaining, rather than just describing, the links between interventions and outcomes seems a reasonable compromise. This involves understanding complex socio-technical networks and relationships, and requires investigators to engage with the gulf between private opinions, public statements and actual behaviour.