scholarly journals Surgical data science: the new knowledge domain

2017 ◽  
Vol 2 (3) ◽  
pp. 109-121 ◽  
Author(s):  
S. Swaroop Vedula ◽  
Gregory D. Hager
Keyword(s):  
Decision Making ◽  
Data Science ◽  
Care Pathway ◽  
Surgical Care ◽  
Care Providers ◽  
Knowledge Domain ◽  
New Knowledge ◽  
Surgical Data ◽  
And Training

AbstractHealthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care, with the goal of maximizing the quality and value of care. Whereas innovations in diagnostic and therapeutic technologies have driven past improvements in the quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytical techniques, and translation or integration of research findings into patient care. We foresee the emergence of surgical/interventional data science (SDS) as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model, and quantify the pathways or processes within the context of patient health states or outcomes and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data are pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care, including prevention, diagnosis, intervention, or postoperative recovery. The existing literature already provides preliminary results, suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from preoperative, intraoperative, and postoperative contexts, how it could support intraoperative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective assessments, automated virtual coaching, and robot-assisted active learning of surgical skill. However, the potential for transforming surgical care and training through SDS may only be realized through a cultural shift that not only institutionalizes technology to seamlessly capture data but also assimilates individuals with expertise in data science into clinical research teams. Furthermore, collaboration with industry partners from the inception of the discovery process promotes optimal design of data products as well as their efficient translation and commercialization. As surgery continues to evolve through advances in technology that enhance delivery of care, SDS represents a new knowledge domain to engineer surgical care of the future.

scholarly journals Health Care Analysis on Myocardial Revascularization in Patients with Chronic Coronary Artery Disease: The Multicenter REVASK Study: Design and Protocol

2020 ◽  
Author(s):  
Andreas Beckmann ◽  
Eva-Maria Bitzer ◽  
Mareike Lederle ◽  
Peter Ihle ◽  
Jochen Walker ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Health Care ◽  
Decision Making ◽  
Coronary Artery ◽  
Myocardial Revascularization ◽  
Care Providers ◽  
Chronic Coronary Artery Disease ◽  
Care Guideline ◽  
Artery Disease

AbstractCoronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are available for revascularization of coronary artery disease (CAD) with the aims to reduce cardiovascular morbidity and mortality and to improve disease-related quality of life in particular. The German National Care Guideline (NVL-cKHK) on chronic CAD recommends the establishment of so-called heart teams for decision making in myocardial revascularization to improve the quality of care. Preferred recommendations for PCI or CABG are given for different patient subgroups depending on patient characteristics, concomitant diseases, and coronary morphology. The myocardial revascularization study (REVASK) is a noninterventional cohort study on care of patients undergoing PCI or CABG based on retrospective statutory health insurance (SHI) routine data, registry data from the German Cardiac Society (DGK) resp., the German Society for Thoracic and Cardiovascular Surgery (DGTHG), combined with prospective primary data collection from health care providers and patients. The primary goal is to investigate whether and to which extent heart teams, consisting of cardiologists and cardiac surgeons, increase guideline adherence in decision making for myocardial revascularization. Ultimately the study project aims to improve patient care in terms of decision making for appropriate myocardial revascularization. Through the consistent implementation of the German National Care Guideline on chronic Coronary Artery Disease (NVL-cKHK) and the European Guidelines on myocardial revascularization, the reduction of morbidity, mortality and the reduced need for subsequent revascularization procedures are also desirable from a health economics perspective.

Education and Training for Digital Health

2020 ◽  
pp. 207-222
Author(s):  
Sisira Edirippulige ◽  
Buddhika Senanayake
Keyword(s):  
Health Workforce ◽  
Research Evidence ◽  
Digital Health ◽  
Healthcare Services ◽  
Education And Training ◽  
Care Providers ◽  
Services Research ◽  
New Knowledge ◽  
Systematic Education ◽  
And Training

Digital health is fast becoming an integral part of healthcare services. Research evidence suggests that digital health can benefit stakeholders involved in healthcare, including patients and care providers. As digital health continues to integrate into routine healthcare, practitioners may require new knowledge, skills, and competencies to make the best use of it and to be able to communicate with an increasingly digitally-enabled consumer. Much effort has been made to systematic education and training relating to digital health, an important aspect in developing the digital health workforce.

scholarly journals Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 29S-35S ◽  
Author(s):  
Christopher D. Witiw ◽  
Jefferson R. Wilson ◽  
Michael G. Fehlings ◽  
Vincent C. Traynelis
Keyword(s):  
Health Care Providers ◽  
Spine Surgery ◽  
Cost Optimization ◽  
Safety Data ◽  
Case Series ◽  
Surgical Care ◽  
Narrative Review ◽  
Care Providers ◽  
Ambulatory Surgical Centers

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.

scholarly journals A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

2018 ◽  
Author(s):  
Colleen A. McHorney ◽  
Lindsey T. Murray ◽  
Dayo Jagun ◽  
Jennifer Whiteley ◽  
Miriam Kimel ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Of Care ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Quantitative Measure ◽  
Shared Decision ◽  
Care Providers ◽  
Clinician Communication

BACKGROUND Shared decision making (SDM) is a process in which health care providers and patients relate to and influence each other as they collaborate in making decisions about patients’ health care. Hypothesized as a means to improve quality of care, successful applications of SDM in routine cancer care have not been widely documented. OBJECTIVE The objective of this study was to examine the literature to determine if elements of SDM implementation between cancer patients and their clinicians were more or less successful at improving the quality of care and health outcomes. METHODS A systematic literature search of SDM approaches and outcomes in cancer care was conducted using PubMed and EMBASE. An integrative model for SDM was used to classify elements included in SDM intervention studies and the resulting outcomes. RESULTS From 1,018 unique publications, 23 articles meeting eligibility criteria were included. Only three studies addressed elements of patient-clinician interaction as part of the study objectives. Interventions included decision aid (DA) evaluation (n=22) and clinician communication training (n=1). SDM elements commonly included were: defining/explaining the problem (n=23); presenting options (n=19); discussing pros and cons (n=17); assessing patient priorities and preferences (n=17); clinician knowledge and recommendations (n=15); and making or deferring treatment decisions (n=12). The most frequently-measured outcomes were patient-reported outcomes including treatment preference or decision (n=12), decisional conflict (n=10), patient satisfaction (n=10), patient participation (n=9), and patient knowledge (n=7). No clear patterns demonstrating relationships between SDM elements and outcomes were identified. Information on how patients and clinicians utilized DA information to promote SDM was limited. CONCLUSIONS Evaluation of SDM in cancer care has been increasing. However, the term “SDM” was generally applied to studies that focused on the development and/or evaluation of DAs which limited the current analyses to a review of SDM elements as part of the DAs. Most studies did not include a qualitative or quantitative measure of SDM specific to patient-clinician communication and interaction. Instead, there was an underlying assumption that SDM occurred organically with DA implementation. Without a qualitative or quantitative measure of SDM, identification of successful SDM elements and their relationships to patient outcomes remains unclear. Additional research is warranted on SDM implementation and measurement in real-world cancer care settings.

scholarly journals VA Video Telehealth and Training Programs During the COVID-19 Response

2021 ◽  
Author(s):  
Rhonda Johnston ◽  
Rita F. Kobb ◽  
Claire Marty ◽  
Padraic McVeigh
Keyword(s):  
Online Survey ◽  
Surgical Care ◽  
Office Visits ◽  
Face To Face ◽  
Patient Interaction ◽  
Telemedicine Consultation ◽  
Physician Patient ◽  
And Training

Study Design: An online survey modeled after the TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were administered to gauge patient experience with electronic medical record-based telemedicine visits. Results: Participants noted several advantages of telemedicine visits over traditional in-office visits: shorter visits, saving money, and avoiding potential exposure during the pandemic. Thirty-six percent of the patients agreed that the quality of care was hindered by the lack of a physical exam, and 61.7% of the patients agreed that they prefer a face-to-face visit rather than telemedicine consultation. Most patients were satisfied with the care they received via telemedicine (Likert 6.19/7), and 95.8% of the patients would use telemedicine again. Participants self-reported an average saving of $108.70 when using telemedicine. When comparing the telemedicine cohort to the in-office control, the telemedicine patients noted an improved ability to communicate with their physician in 5 out of 8 domains of the MCCS. Conclusion: Surgical preoperative consultation, postoperative follow-up, and routine visits were conducted via telemedicine during the COVID-19 pandemic, representing a new direction for surgical appointments and consultations. This study shows that telehealth provides satisfactory care and increases access to surgical care for patients when external factors prevent the traditional physician–patient interaction. With better-perceived communication via telemedicine appointments, patients may subjectively feel that they can express their symptoms and gather information from the doctor regarding their diagnosis more efficiently.

scholarly journals Pharmaceutical Care as Described by Home-Dwelling Older People in Finland

Medicina ◽  
2011 ◽  
Vol 47 (11) ◽  
pp. 91
Author(s):  
Sini Eloranta ◽  
Sanna Hannukainen ◽  
Pirkko Routasalo ◽  
Matti Viitanen ◽  
Seija Arve
Keyword(s):  
Older People ◽  
Pharmaceutical Care ◽  
Health Care Providers ◽  
Sense Of Control ◽  
Care Providers ◽  
Knowledge And Attitudes ◽  
Precise Knowledge ◽  
New Knowledge ◽  
Therapeutic Tools

Background and Objective. Pharmaceutical care is one of the most important therapeutic tools in older people care. The aim of this study was to describe the knowledge and attitudes of older home-dwelling people’s about their perceptions of pharmaceutical care and use of medication. Material and Methods. The data were collected using theme interviews with 16 older Finnish people (born 1920). Inductive content analysis was used in analyzing the data. Results. Older people’s knowledge about their pharmaceutical care varied widely: some had precise knowledge whereas others had none. Guidance in pharmaceutical care was not readily available. The interviewees took a positive attitude toward their pharmaceutical care and favored a minimum use of medication. Being able to cope independently with their pharmaceutical care strengthened the older people’s sense of control over their lives. Conclusions. The study offers new knowledge about the significance of older people’s individual pharmaceutical care at home. By listening to and utilizing older people’s experiences, we can recognize the factors that promote the independent coping and inclusion of older people in their pharmaceutical care. This enables health care providers to increase the safety and quality of pharmaceutical care for older people.

Cross-Cultural Interactions and Shared Decision Making

2021 ◽  
pp. 141-164
Author(s):  
Sabrina F. Derrington ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Cultural Differences ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Cultural Humility ◽  
Shared Decision ◽  
Care Providers ◽  
Implicit Biases ◽  
Culturally Different

Authentic shared decision making depends on the quality of interpersonal interactions and communication, which can be profoundly influenced by cultural differences. The concept of culture itself is multidimensional and dynamic, including race, ethnicity, language, religion, socioeconomic status, geography, family traditions, perceptions of illness and death, and the culture of medicine itself. Cultural differences between health care providers and patients and families intersect and overlap in important ways. Shared decision making can be derailed when providers hold assumptions and implicit biases about culturally different patients and families. This chapter explores the interplay between culture and shared decision making, highlighting cases in which cultural differences may impact decision making and suggesting recommendations for optimizing cultural humility in all aspects of communication and shared decision making.

Decision-making framework for using ambient assisted living

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Majid H. Alsulami ◽  
Mohammed S. Alsaqer ◽  
Anthony S. Atkins
Keyword(s):  
Decision Making ◽  
Saudi Arabia ◽  
Health Care Providers ◽  
Assisted Living ◽  
Ambient Assisted Living ◽  
The Elderly ◽  
Care Providers ◽  
Content Type ◽  
Decision Making Framework

Purpose Technology plays an important role in assisting elderly people to live independently, longer and improve their quality of life and health, in supporting their daily activities, etc. The ageing population becomes a global phenomenon. The population of Saudi Arabia continues to age (>60 years of age) currently (5%) compared to other group ages. In 2050, it will increase rapidly to 20.9% of the Saudi population. The current research aims at examining the barriers that health-care providers in the Kingdom of Saudi Arabia are experiencing in the adoption of ambient assisted living (AAL) technologies among the elderly. The study aims to identify a challenging issue with the increasing the number of elderly among the population in the country, which has highlighted the need to use AAL technology to improve the quality of life among the elderly. Design/methodology/approach This study involved a community of practice (CoP) study as a method of data collection where data collected were presented and discussed in line with the existing literature review findings. Findings In total, 14 factors were identified in this study and discussed in the context of Saudi Arabia, which resulted in developing a decision-making framework for using AAL by health-care providers. Those factors are essential in boosting the usage of technology in improving elderly health in Saudi Arabia. Research limitations/implications This study includes implications for developing a decision-making framework for using AAL. Social implications This study clarifies that technology can connect elderly people with society. Originality/value In total, 14 factors were identified in this study and discussed in the context of Saudi Arabia.

Solving Dynamic Multi-Criteria Resource-Target Allocation Problem Under Uncertainty: A Comparison of Decomposition and Myopic Approaches

2017 ◽  
Vol 16 (06) ◽  
pp. 1465-1496 ◽  
Author(s):  
Anissa Frini ◽  
Adel Guitouni ◽  
Abderrezak Benaskeur
Keyword(s):  
Decision Making ◽  
Decision Tree ◽  
Allocation Problem ◽  
Dynamic Decision Making ◽  
Decomposition Approach ◽  
Decision Making Problem ◽  
Time Planning ◽  
Military Perspective ◽  
And Training

This paper is concerned with multi-criteria and dynamic resource allocation problem in a naval engagement context. The scenario under investigation considers air threats directed towards a ship that has to plan its engagement by efficiently allocating the available weapons against the threats to maximize its survivability. This dynamic and multi-criteria decision-making problem is modeled using a multi-criteria decision tree and solved with two approaches: the multi-criteria decomposition approach and the multi-criteria myopic approach. We propose a novel metric for comparing two strategies within a multi-criteria decision tree and have developed a testbed in order to simulate the engagements. The results show that, when sufficient decomposition conditions are verified, the decomposition approach produces superior decision-making strategies compared to the myopic approach. Conversely, when the multi-criteria decision aid (MCDA) method does not satisfy the decomposition conditions (e.g., TOPSIS), there is no guarantee that decomposition will provide the best compromise strategies. From a military perspective, this work will help develop tactics, procedures and training packages for such a highly complex and dynamic decision-making problem. The plans generated by the approach presented here can also serve as a reference for assessment of the quality of the engagement plans yielded by real-time planning algorithms.

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