Family-AiD: a family-centred assessment tool in young-onset dementia

2014 ◽  
Vol 15 (3) ◽  
pp. 136-150
Author(s):  
Pamela Roach ◽  
John David Keady ◽  
Penny Bee
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Clinical Decision ◽  
Family Assessment ◽  
Content Type ◽  
Young Onset ◽  
People With Dementia ◽  
Young Onset Dementia ◽  
Family Aid

Purpose – Standards of care and care pathways for younger people with dementia vary greatly, making clinical development and service planning challenging. Staff working in dementia services identify that they use biographical knowledge of families to influence clinical decision making. This information is not collected or implemented in a formal manner; highlighting an important knowledge-practice gap. The paper aims to discuss these issues. Design/methodology/approach – The development of a family-centred assessment for use in dementia care has three core components: first, thematic development from qualitative interviews with younger people with dementia and their families; second, clinical input on a preliminary design of the tool; and third, feedback from an external panel of clinical and methodological experts and families living with young-onset dementia. Findings – The 12-item Family Assessment in Dementia (Family-AiD) tool was developed and presented for clinical use. These 12 questions are answered with a simple Likert-type scale to determine areas of unmet need and identify where families may need additional clinical support. Also included is a series of open-ended questions and a biographical timeline designed to assist staff with the collection and use of biographical and family functioning information. Originality/value – A dementia-specific clinical family assessment tool, which also collects background biographical data on family units may be a useful way to document information; inform clinical decision making; and address otherwise unmet needs. Family-AiD has potential to improve clinical care provision of people with dementia and their families. Evaluation of the feasibility and acceptability of its implementation in practice are now required.

Combined data mining techniques based patient data outlier detection for healthcare safety

2016 ◽  
Vol 9 (1) ◽  
pp. 42-68 ◽  
Author(s):  
Gebeyehu Belay Gebremeskel ◽  
Chai Yi ◽  
Zhongshi He ◽  
Dawit Haile
Keyword(s):  
Data Mining ◽  
Decision Making ◽  
Patient Safety ◽  
Outlier Detection ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Services ◽  
Content Type ◽  
Outliers Detection

Purpose – Among the growing number of data mining (DM) techniques, outlier detection has gained importance in many applications and also attracted much attention in recent times. In the past, outlier detection researched papers appeared in a safety care that can view as searching for the needles in the haystack. However, outliers are not always erroneous. Therefore, the purpose of this paper is to investigate the role of outliers in healthcare services in general and patient safety care, in particular. Design/methodology/approach – It is a combined DM (clustering and the nearest neighbor) technique for outliers’ detection, which provides a clear understanding and meaningful insights to visualize the data behaviors for healthcare safety. The outcomes or the knowledge implicit is vitally essential to a proper clinical decision-making process. The method is important to the semantic, and the novel tactic of patients’ events and situations prove that play a significant role in the process of patient care safety and medications. Findings – The outcomes of the paper is discussing a novel and integrated methodology, which can be inferring for different biological data analysis. It is discussed as integrated DM techniques to optimize its performance in the field of health and medical science. It is an integrated method of outliers detection that can be extending for searching valuable information and knowledge implicit based on selected patient factors. Based on these facts, outliers are detected as clusters and point events, and novel ideas proposed to empower clinical services in consideration of customers’ satisfactions. It is also essential to be a baseline for further healthcare strategic development and research works. Research limitations/implications – This paper mainly focussed on outliers detections. Outlier isolation that are essential to investigate the reason how it happened and communications how to mitigate it did not touch. Therefore, the research can be extended more about the hierarchy of patient problems. Originality/value – DM is a dynamic and successful gateway for discovering useful knowledge for enhancing healthcare performances and patient safety. Clinical data based outlier detection is a basic task to achieve healthcare strategy. Therefore, in this paper, the authors focussed on combined DM techniques for a deep analysis of clinical data, which provide an optimal level of clinical decision-making processes. Proper clinical decisions can obtain in terms of attributes selections that important to know the influential factors or parameters of healthcare services. Therefore, using integrated clustering and nearest neighbors techniques give more acceptable searched such complex data outliers, which could be fundamental to further analysis of healthcare and patient safety situational analysis.

Evaluation of offending behaviour programme selection: the PNA

2019 ◽  
Vol 21 (4) ◽  
pp. 264-277
Author(s):  
Laura Ramsay ◽  
Jamie S. Walton ◽  
Gavin Frost ◽  
Chloe Rewaj ◽  
Gemma Westley ◽  
...  
Keyword(s):  
Decision Making ◽  
High Intensity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Policy Makers ◽  
Content Type ◽  
Maximum Security ◽  
Research Findings ◽  
Probation Service ◽  
Offending Behaviour

Purpose The purpose of this paper is to outline the qualitative research findings of the effectiveness of Her Majesty’s Prison and Probation Service Programme Needs Assessment (PNA) in supporting decision making regarding selection onto high-intensity offending behaviour programmes. Design/methodology/approach Qualitative data analysis was used through the application of thematic analysis. Results were pooled using principles from meta-synthesis in order to draw conclusions as to whether the PNA was operating as designed. Findings Four overarching themes were identified, which have meaning in guiding decision making into, or out of high-intensity programmes. These were risk, need and responsivity, the importance of attitudes, motivation and formulation and planning. Research limitations/implications The majority of data were collected from category C prisons. Generalisability of findings to high-intensity programmes delivered in maximum security prisons and prisons for younger people aged 18–21 years is limited. The research team had prior knowledge of the PNA, whether through design or application. Procedures were put in place to minimise researcher biases. Practical implications Findings suggest that the PNA is effective in guiding clinical decision making. Practitioners and policy makers can be assured that the processes in place to select into high-intensity programmes are effective, and aligned with the What Works in reducing re-offending. Originality/value This is the first evaluation into the effectiveness of the PNA designed to support clinical decision making regarding participant selection onto accredited offending behaviour programmes. Implications for practice have been discussed.

Understanding critical care nurses’ autonomy in Jordan

2017 ◽  
Vol 30 (4) ◽  
pp. 432-442 ◽  
Author(s):  
Mahmoud Maharmeh
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Critical Care Nurses ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Content Type

Purpose The aim of this study was to describe Jordanian critical care nurses’ experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse’s autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses’ job satisfaction. Therefore, improving nurses’ clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.

scholarly journals Three Speech-language Pathology Graduate Programs, One Model: Using Systematic Instruction to Develop Students’ Clinical Decision-making Skills

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Bryan Ness ◽  
Therese O'Neil-Pirozzi ◽  
Peter Meulenbroek
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Communication Disorders ◽  
Clinical Decision ◽  
Systematic Instruction ◽  
Student Knowledge ◽  
Educational Approach ◽  
Language Pathology ◽  
Based Instruction

To prepare graduate students to implement evidence-based practice effectively, educators must integrate instruction on rational clinical decision-making into course curricula. Three faculty members at different universities adopted an educational approach derived from the Rehabilitation Treatment Specification System (RTSS) to teach and assess clinical decision-making in the context of treating acquired cognitive-communication disorders for people with traumatic brain injury. Using treatment theory illustrated in the RTSS, the authors piloted instruction and assessment materials to examine potential usefulness of the approach and effects on student knowledge and confidence in clinical decision-making. The results indicated that the instructional approach effectively bolstered students’ knowledge of and confidence implementing memory-based cognitive-communication intervention. Additionally, using a case-based assessment tool, the authors were able to measure how students modified treatment activities in response to different contextual variables. Implications and suggestions for implementing theory-based instruction in graduate education are discussed.

The Readiness to Change for Bariatric Surgery Assessment Tool: Validity, Factor Structure, and Reliability

2017 ◽  
Vol 31 (4) ◽  
pp. 393-401
Author(s):  
Susan M. S. Carlson
Keyword(s):  
Bariatric Surgery ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Readiness To Change ◽  
Clinical Decision ◽  
Obesity Research ◽  
Bariatric Patients ◽  
Diet And Lifestyle ◽  
Decision Making Tool

Background and Purpose: Currently, there is no guideline or standard of practice for performing the psychiatric/psychological evaluation that is a requirement for approval for bariatric surgery. The Readiness to Change for Bariatric Surgery Assessment Tool (RCB-SAT) establishes a means for psychiatric evaluators to objectively assess the patient’s cognition, beliefs, and motivation around the bariatric diet and lifestyle changes. Development of a clinical decision-making tool for assessing readiness to change in bariatric patients will be useful regarding The Strategic Plan for NIH Obesity Research. The strategic plan outlines 6 overarching themes, with the last 3 centering around creation of such a clinical decision-making tool to assess a bariatric patient’s readiness to change: evaluate promising strategies for obesity prevention and treatment in real-world settings and diverse populations, harness technology and tools to advance obesity research and improve health care delivery, and facilitate integration of research results into community programs and medical practice (National Institutes of Health, 2011). Methods: The pilot tool was administered to 153 potential bariatric patients, with 61 patients completing the survey a second time. Face and content validity of the items were established through an expert review process. Results: Principle axis factoring by means of varimax rotation with Kaiser normalization identified 15 items loading on 3 factors associated with Prochaska and DiClemente’s transtheoretical model of health behavior change: precontemplation, contemplation, and action (DiClemente & Prochaska, 1998). Test–retest reliability was also established for the tool. Implications for Practice: The proposed RCB-SAT demonstrates potential for assessing a patient’s readiness to change regarding the bariatric diet and lifestyle.

Learning disability and challenges in male prisons: programme screening evaluation

2019 ◽  
Vol 11 (1) ◽  
pp. 49-59
Author(s):  
Helen Wakeling ◽  
Laura Ramsay
Keyword(s):  
Decision Making ◽  
Learning Disability ◽  
Design Methodology ◽  
Screening Tool ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Makers ◽  
Screening Tools ◽  
Content Type ◽  
Effective Use

Purpose The purpose of this paper is to validate the learning screening tool (LST) and the adapted functioning checklist-revised (AFC-R) as screening tools to aid programme allocation, and to investigate whether programme decision makers were using the tools as per the guidance provided by HMPPS Interventions Services. Design/methodology/approach LST and AFC-R data were gathered for 555 men who had been assessed for programmes between 2015 and 2018 across eight prisons and one probation area. WAIS-IV IQ data were also gathered if completed. Findings The findings provide support for the use of the LST, and AFC-R in helping to make decisions about programme allocation. The LST and AFC-R correlate well with each other, and a measure of intellectual functioning (WAIS-IV). Those who were allocated to learning disability or challenges (LDC) programmes scored higher on the LST (greater problems) and lower on the AFC-R (lower functioning) compared to those allocated to mainstream programmes. The LST had adequate predictive validity. In the majority of cases, the correct procedures were followed in terms of using the tools for programme allocation. Research limitations/implications The sample size for examining the relationships between all three tools was limited. The research was also unable to take into consideration the clinical decision making involved in how the tools were interpreted. Originality/value This research contributes to the growing evidence about the effective use of LDC screening tools in forensic settings.

scholarly journals INTEGRATING HEALTH IT INTO CLINICAL WORKFLOW FOR DEMENTIA CARE: PROVIDER AND CAREGIVER PERSPECTIVES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S922-S923
Author(s):  
Nicole Ruggiano ◽  
Ellen Brown ◽  
Peter Clarke
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Mobile App ◽  
Practice Research ◽  
Care Providers ◽  
Medical Visit ◽  
Clinical Workflow ◽  
People With Dementia

Abstract Each year, more than 5.5 million people in the U.S. are affected by Alzheimer’s disease and related dementias (AD/RD), most of whom reside within the community, receive ongoing care from family caregivers, and medically managed by primary care providers. However, AD/RD caregiving and care is often compromised and costly, with medical costs projected to increase from $203 billion in 2013 to $1.2 trillion in 2050. A significant barrier to AD/RD care relates to collecting the health information needed for clinical decision making, due to patients’ communication problems associated with AD/RD, insufficient time to collect relevant patient information from caregivers during the medical visit, and lack of communication with in-home health and support providers. To address these issues, the research team has developed CareHeroes, a multi-functional web and mobile app designed to increase the quality of communication about patient symptoms between the caregivers and providers of people with dementia. This study integrates qualitative findings from two studies evaluating CareHeroes that involved: (a) interviews and a focus group with AD/RD caregivers and (b) focus groups with clinical staff at two memory clinics. Findings indicate that caregivers want technologies that can inform clinical decision making on a regular basis while providers emphasize the use of information technologies that prepare patients and caregivers for upcoming medical appointments. Implications for practice, research, and policy are discussed.

scholarly journals Impact of implementing a category 1 external quality assurance scheme for monitoring harmonization of clinical laboratories in Spain

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Carmen Ricós ◽  
Pilar Fernández-Calle ◽  
Fernando Marqués ◽  
Joana Minchinela ◽  
Ángel Salas ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Assurance ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Reference Value ◽  
Clinical Decision ◽  
Thyroid Stimulating Hormone ◽  
External Quality Assurance ◽  
External Quality ◽  
Content Type

AbstractBackgroundThe objective of the present study was to examine the evolution of the analytical performance specifications (APS) used in External Quality Assurance (EQA) schemes, as well as the efficacy of a category 1 EQA scheme in monitoring the harmonization of clinical laboratory results in Spain.MethodsA review of the literature on the types of quality specifications used in schemes in other countries and their evolution was performed. In addition, a comparative analysis of the potential impact that different APS from eight countries had on clinical decision-making was made based on three measurands: sodium, thyroid-stimulating hormone (TSH), and activated partial thromboplastin time (aPTT).ResultsHarmonization of analytical methods was demonstrated by assessing whether average results deviated from the certified reference value of control materials within the APS derived from biological variation (BV). The APS used in EQA have evolved from state-of-the-art models to BV. Poor clinical decision-making would occur if the results accepted by some APS were applied.ConclusionsIn Spain, only 2 of the 18 measurands studied are considered to be well harmonized. Closer collaboration between laboratories and analytical system providers would be required to resolve discrepancies.

What kind of support and training do junior qualified nurses working with women with learning disabilities in a secure setting require when dealing with violence and aggression?

2016 ◽  
Vol 7 (3) ◽  
pp. 140-150
Author(s):  
Helen Goulding ◽  
Sharon A. Riordan
Keyword(s):  
Decision Making ◽  
Learning Disabilities ◽  
Thematic Analysis ◽  
Clinical Decision Making ◽  
Small Sample Size ◽  
Clinical Decision ◽  
Small Sample ◽  
Home Office ◽  
Peer Supervision ◽  
Content Type

Purpose The purpose of this paper is to explore the perceived needs of junior nurses working with women with learning disabilities in a secure setting who display violence and aggression; and to contribute to this specialised area of research and to identify potential areas for further post registration education. Design/methodology/approach The study adopted a qualitative design using thematic analysis. Initial questionnaires were distributed and the results analysed in order to form initial themes. These initial themes were then used to carry out a one-off focus group and this was transcribed verbatim and then analysed using Braun and Clarke thematic analysis to develop final themes. Findings The findings identified a need for staff to be able to access effective immediate support following incidents of violence and aggression and support be offered within a clear structured environment. Staff indicated that peer supervision be made available and that they also receive adequate education relating to gender specific issues and the use of seclusion. Research limitations/implications The research had several limitations. These included a small sample size which was also largely self-selected. Bias may have to be acknowledged in respect of completion of questionnaires depending on their view of participation and what they might be contributing to. Despite this the results do raise further questions such as staff decision making around the use of seclusion. Practical implications Implications centred around the organisation’s delivery of education to staff in relation to the clinical decision-making skills they require in order to effectively support women with learning disabilities who display violent and/or aggressive behaviour. The study also has implications for potential supervision structures currently offered within these services. Originality/value This paper fulfils a need to explore services for women with a learning disability further and how services can be shaped using current perspective and up to date research in line with recent policy, e.g. Corston Report (Home Office, 2007).

Diagnosing, fast and slow

2020 ◽  
pp. postgradmedj-2019-137412
Author(s):  
JJ Coughlan ◽  
Cormac Francis Mullins ◽  
Thomas J Kiernan
Keyword(s):  
Decision Making ◽  
Cognitive Bias ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Medical Decision ◽  
Content Type ◽  
Clinical Paradigm ◽  
Improving Patient Care

Diagnostic error is increasingly recognised as a source of significant morbidity and mortality in medicine. In this article, we will attempt to address several questions relating to clinical decision making; How do we decide on a diagnosis? Why do we so often get it wrong? Can we improve our critical faculties?We begin by describing a clinical vignette in which a medical error occurred and resulted in an adverse outcome for a patient. This case leads us to the concepts of heuristic thinking and cognitive bias. We then discuss how this is relevant to our current clinical paradigm, examples of heuristic thinking and potential mechanisms to mitigate bias.The aim of this article is to increase awareness of the role that cognitive bias and heuristic thinking play in medical decision making. We hope to motivate clinicians to reflect on their own patterns of thinking with an overall aim of improving patient care.

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