scholarly journals One list to rule them all and many semantics to bind them: Building a shared, scalable and sustainable source for the problem oriented medical record (Preprint)

2021 ◽  
Author(s):  
Christophe Gaudet-Blavignac ◽  
Andrea Rudaz ◽  
Christian Lovis
Keyword(s):  
Medical Record ◽  
Public Hospitals ◽  
Machine Learning Techniques ◽  
Free Text ◽  
Problem List ◽  
Snomed Ct ◽  
University Hospitals ◽  
Additional Information ◽  
Work Breaks ◽  
The Impact

BACKGROUND Since the creation of the Problem Oriented Medical Record, the building of problem lists has been the focus of many researches. To this day, this issue is not well resolved, and building an appropriate contextualized problem list is still a challenge. OBJECTIVE This paper presents the process of building a shared multi-purpose common problem list at the University Hospitals of Geneva, a consortium of all public hospitals and 30 outpatient clinics of the state of Geneva. This list aims at bridging the gap between clinicians’ language expressed in free text and secondary usages requiring structured information. METHODS The strategy focuses on the needs of clinicians by building a list of uniquely identified expressions to support their daily activities. In a second stage, these expressions are connected to additional information, building a complex graph of information. A list of 45,946 expressions manually extracted from clinical documents has been manually curated and encoded in multiple semantic dimensions, such as ICD-10, ICPC-2, SNOMED-CT or dimensions dictated by specific usages, such as identifying expressions specific to a domain, a gender, or an intervention. The list has been progressively deployed for clinicians with an iterative process of quality control, maintenance and improvements, including addition of new expressions, or dimensions for specific needs. The problem management of the electronic health record allowed to measure and correct the encoding based on real-world usage. RESULTS The list was deployed in production in January 2017 and was regularly updated and deployed in new divisions of the hospital. In 4 years, 684,102 problems were created using the list. The proportion of free text entries reduced progressively from 37.47% (8,321/22,206) in December 2017 to 18.38% (4,547/24,738) in December 2020. In the last version of the list, over 14 dimensions were mapped to expressions, among them 5 international classifications and 8 other classifications for specific usages. The list became a central axis in the EHR, being used for many different purposes linked to care such as surgical planning or emergency wards, or in research, for various predictions using machine learning techniques. CONCLUSIONS This work breaks with common approaches primarily by focusing on real clinicians’ language when expressing patient’s problems and secondly by mapping whatever is required, including controlled vocabularies to answer specific needs. This approach improves the quality of the expression of patients’ problems, while allowing to build as many structured dimensions as needed to convey semantics according to specific contexts. The method is shown to be scalable, sustainable and efficient at hiding the complexity of semantics or the burden of constraint structured problem list entry for clinicians. Ongoing work is analyzing the impact of this approach at influencing how clinicians express patient’s problems.

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

scholarly journals Finance-oriented vs. operations-oriented management control in public hospitals

2014 ◽  
Vol 3 (6) ◽  
pp. 190
Author(s):  
Antonio Vera ◽  
Ludwig Kuntz
Keyword(s):  
Organizational Performance ◽  
Role Conflict ◽  
Structural Equation ◽  
Professional Autonomy ◽  
Management Control ◽  
Public Hospitals ◽  
Equation Modeling ◽  
Control Environment ◽  
University Hospitals ◽  
The Impact

The purpose of this paper is to investigate the impact of finance-oriented vs. operations-oriented management control in public hospitals on physicians’ role conflict and cost consciousness as well as on perceived organizational performance. First, we conduct a participatory research project, and identify two public university hospitals with clearly differing management control environments: one finance-oriented, the other operations-oriented. Then we collect quantitative data from 211 physicians employed in these hospitals, and analyze it using regression analyses and structural equation modeling. Our empirical results indicate that a finance-oriented control environment is preferable to an operations-oriented control environment with respect to cost consciousness, but with respect to role conflict the reverse is true. Regarding the perceived organizational performance, our findings indicate that an operations-oriented control environment is more advantageous than a finance-oriented control environment. The main implication of our study is that management control issues in public hospitals are important, risky, and therefore merit dedicated managerial support. To enable effective coordination without unnecessarily creating conflicts, top management has to find an appropriate balance not only between professional autonomy and monitoring requirements, or between trust and control, but also between financial and operational performance measures.

scholarly journals The impact of ownership concentration and shareholder identity on dividend payout probabilities: New evidence from the German stock market

2017 ◽  
Vol 15 (1) ◽  
pp. 18-32 ◽  
Author(s):  
Sebastian Kuhlmann ◽  
Joachim Rojahn
Keyword(s):  
Ownership Concentration ◽  
Machine Learning Techniques ◽  
Classification Techniques ◽  
Dividend Payout ◽  
Additional Information ◽  
Dividend Payments ◽  
Learning Techniques ◽  
German Stock ◽  
The Impact ◽  
New Evidence

Numerous studies analyse the impact of ownership concentration and shareholder identity on dividend payout probabilities. In this paper, we seek to provide additional information about the importance different ownership proxies have for dividend payments. Because the importance of those proxies varies with the classification techniques applied, we use both traditional and machine learning techniques. We examine the dividend payout behaviour of German issuers, which is considered rather flexible in terms of its distribution frequencies and dividend yields compared to international practice. Our sample period covers the years 2007 to 2014. Despite considerable differences in the classification techniques applied, we find that previous years’ dividend payments, corporate profitability and firm size are consistently the most important firm-specific determinants of dividend payout probabilities. Only the largest shareholders with equity stakes that are either between 25% and 50% or above 50% rank among the most important variables. The impact is nonlinear. When controlling for shareholders’ identities, we find that both financial institutional and managerial ownership are especially important. Taking the location of institutional investors into account, only foreign financial investors influence payout probabilities.

Gendered Impact of Corruption in Healthcare Service Delivery in Nigeria

2013 ◽  
Vol 11 (1) ◽  
Author(s):  
Yetunde A. Aluko
Keyword(s):  
Service Delivery ◽  
Public Hospitals ◽  
Public Health Care ◽  
Women's Voices ◽  
Medical Supplies ◽  
Poor Women ◽  
Level Information ◽  
Life Threatening ◽  
Threatening Situation ◽  
The Impact

This paper supports the hypothesis that corruption and non-delivery of services in key sectors such as health have gender-specific poverty consequences. The study utilized qualitative micro-level information about the structures of corruption and its impact on poor women. Respondents expressed their perceptions on the occurrence of corrupt practices in public health care system and its wider impact on society. The findings revealed that the impact of corruption is felt disproportionately by women and the poor, who are most dependent on public services, and have no alternative even when facing corrupt practices in a life threatening situation, such as complicated birth delivery. Pregnant women denied access to doctors tended to deliver at home, which increased the likelihood of complications and maternal and child mortality. Medical supplies meant for public hospitals are sold to private clinics who charge more for drugs and supplies. There is need to strengthen sectoral oversight mechanisms and transparency as well as increase women’s voices in service delivery.

Burden of Congenital Rubella Syndrome (CRS) in Bangladesh: Systematic Review of Existing Literature and Transmission Modelling of Seroprevalence Studies

2020 ◽  
Vol 20 (3) ◽  
pp. 284-290
Author(s):  
Jocelyn Chan ◽  
Yue Wu ◽  
James Wood ◽  
Mohammad Muhit ◽  
Mohammed K. Mahmood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deterministic Model ◽  
Case Series ◽  
Controlled Vocabulary ◽  
Congenital Rubella Syndrome ◽  
Free Text ◽  
Childbearing Age ◽  
Vaccination Programs ◽  
Congenital Rubella ◽  
The Impact

Background and Objectives: Congenital Rubella Syndrome (CRS) is the leading cause of vaccine-preventable congenital anomalies. Comprehensive country-level data on the burden of CRS in low and middle-income countries, such as Bangladesh, are scarce. This information is essential for assessing the impact of rubella vaccination programs. We aim to systematically review the literature on the epidemiology of CRS and estimate the burden of CRS in Bangladesh. Methods: We conducted a systematic review of existing literature and transmission modelling of seroprevalence studies to estimate the pre-vaccine period burden of CRS in Bangladesh. OVID Medline (1948 – 23 November 2016) and OVID EMBASE (1974 – 23 November 2016) were searched using a combination of the database-specific controlled vocabulary and free text terms. We used an age-stratified deterministic model to estimate the pre-vaccination burden of CRS in Bangladesh. Findings: Ten articles were identified, published between 2000 and 2014, including seven crosssectional studies, two case series and one analytical case-control study. Rubella seropositivity ranged from 47.0% to 86.0% among all age population. Rubella sero–positivity increased with age. Rubella seropositivity among women of childbearing age was 81.0% overall. The estimated incidence of CRS was 0·99 per 1,000 live births, which corresponds to approximately 3,292 CRS cases annually in Bangladesh. Conclusion: The estimated burden of CRS in Bangladesh during the pre-vaccination period was high. This will provide important baseline information to assess the impact and cost-effectiveness of routine rubella immunisation, introduced in 2012 in Bangladesh.

The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

2020 ◽  
Author(s):  
Emma Chavez ◽  
Vanessa Perez ◽  
Angélica Urrutia
Keyword(s):  
Decision Making ◽  
Essential Hypertension ◽  
Medical History ◽  
Medical Records ◽  
Medical Training ◽  
Relevant Information ◽  
Domain Ontology ◽  
Free Text ◽  
Snomed Ct ◽  
History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

scholarly journals Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

2021 ◽  
pp. 026921632110198
Author(s):  
Catriona R Mayland ◽  
Rosemary Hughes ◽  
Steven Lane ◽  
Tamsin McGlinchey ◽  
Warren Donnellan ◽  
...  
Keyword(s):  
Public Health ◽  
Family Support ◽  
Online Survey ◽  
Free Text ◽  
Professional Networks ◽  
Dying Patients ◽  
The Face ◽  
Individualised Care ◽  
The Impact ◽  
Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

News and Idiosyncratic Volatility: The Public Information Processing Hypothesis*

2020 ◽  
Author(s):  
Robert F Engle ◽  
Martin Klint Hansen ◽  
Ahmet K Karagozoglu ◽  
Asger Lunde
Keyword(s):  
Information Processing ◽  
Public Information ◽  
Selection Procedure ◽  
Autoregressive Process ◽  
Return Volatility ◽  
Market Outcomes ◽  
The Public ◽  
Additional Information ◽  
Financial News ◽  
The Impact

Abstract Motivated by the recent availability of extensive electronic news databases and advent of new empirical methods, there has been renewed interest in investigating the impact of financial news on market outcomes for individual stocks. We develop the information processing hypothesis of return volatility to investigate the relation between firm-specific news and volatility. We propose a novel dynamic econometric specification and test it using time series regressions employing a machine learning model selection procedure. Our empirical results are based on a comprehensive dataset comprised of more than 3 million news items for a sample of 28 large U.S. companies. Our proposed econometric specification for firm-specific return volatility is a simple mixture model with two components: public information and private processing of public information. The public information processing component is defined by the contemporaneous relation with public information and volatility, while the private processing of public information component is specified as a general autoregressive process corresponding to the sequential price discovery mechanism of investors as additional information, previously not publicly available, is generated and incorporated into prices. Our results show that changes in return volatility are related to public information arrival and that including indicators of public information arrival explains on average 26% (9–65%) of changes in firm-specific return volatility.

scholarly journals Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2897
Author(s):  
Néstor Martínez-Hernández ◽  
Usue Caballero Silva ◽  
Alberto Cabañero Sánchez ◽  
José Luis Campo-Cañaveral de la Cruz ◽  
Andrés Obeso Carillo ◽  
...  
Keyword(s):  
Overall Response Rate ◽  
Early Stage ◽  
Care Delivery ◽  
Public Hospitals ◽  
Clinical Activity ◽  
Spanish Society ◽  
Lung Cancer Patients ◽  
Oncological Patients ◽  
Multiple Choice Questionnaire ◽  
The Impact

After the first wave of COVID-19, the Spanish Society of Thoracic Surgeons (SECT) surveyed its members to assess the impact of the pandemic on thoracic oncology surgery in Spain. In May 2020, all SECT members were invited to complete an online, 40-item, multiple choice questionnaire. The questionnaire was developed by the SECT Scientific Committee and sent via email. The overall response rate was 19.2%. The respondents answered at least 91.5% of the items, with only one exception (a question about residents). Most respondents (89.3%) worked in public hospitals. The reported impact of the pandemic on routine clinical activity was considered extreme or severe by 75.5% of respondents (25.5% and 50%, respectively). Multidisciplinary tumour boards were held either with fewer members attending or through electronic platforms (44.6% and 35.9%, respectively). Surgical activity decreased by 95.7%, with 41.5% of centers performing surgery only on oncological patients and 11.7% only in emergencies. Nearly 60% of respondents reported modifying standard protocols for early-stage cancer and in the preoperative workup. Most centers (≈80%) reported using full personal protective equipment when operating on COVID-19 positive patients. The COVID-19 pandemic severely affected thoracic oncology surgery in Spain. The lack of common protocols led to a variable care delivery to lung cancer patients.

scholarly journals Grading Investment Diversification Options in Presence of Non-Historical Financial Information

Mathematics ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 692
Author(s):  
Clara Calvo ◽  
Carlos Ivorra ◽  
Vicente Liern ◽  
Blanca Pérez-Gladish
Keyword(s):  
Risk Measure ◽  
Statistical Information ◽  
Expected Returns ◽  
Financial Assets ◽  
Expected Return ◽  
Additional Information ◽  
Subjective Risk ◽  
The Impact ◽  
Statistical Risk ◽  
Reduction Index

Modern portfolio theory deals with the problem of selecting a portfolio of financial assets such that the expected return is maximized for a given level of risk. The forecast of the expected individual assets’ returns and risk is usually based on their historical returns. In this work, we consider a situation in which the investor has non-historical additional information that is used for the forecast of the expected returns. This implies that there is no obvious statistical risk measure any more, and it poses the problem of selecting an adequate set of diversification constraints to mitigate the risk of the selected portfolio without losing the value of the non-statistical information owned by the investor. To address this problem, we introduce an indicator, the historical reduction index, measuring the expected reduction of the expected return due to a given set of diversification constraints. We show that it can be used to grade the impact of each possible set of diversification constraints. Hence, the investor can choose from this gradation, the set better fitting his subjective risk-aversion level.

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