Safe use of symbols in handover documentation for medical teams

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008, Sheppard et al. 2008). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research

Computer delivery of gesture therapy for people with severe aphasia

Background: Using gesture as a compensatory communication strategy may be challenging for people with severe aphasia. Therapy can improve skills with gesture, at least in elicitation tasks, but gains ar often modest. Raising the treatment dose with technology might improve outcomes. Aims: This feasibility study developed a computer gesture therapy tool (GeST), and piloted it with nine people who have severe aphasia. It aimed to determine whether practice with GeST would improve gesture production and/or spoken naming. It also explored whether GeST encouraged independent practice and was easy to use. Methods & Procedures: Pilot participants had 6 weeks practice with GeST, flanked by pre- and post-therapy tests of gesture and word production. Usability was explored through interviews and structured observations, and the amount of time spent in the programme was monitored. Outcomes & Results: Scores on the gesture test were evaluated by 36 independent raters. Recognition scores for gestures practised with the tool improved significantly after therapy and the gain was maintained. However, gains were small and only occurred on items that were practised with regular therapist support. There was no generalisation to unpractised gestures and no effect on spoken naming. Usability results were positive. Participants undertook an average of 64.4 practice sessions with GeST, and the average session length was just under 14 minutes. Conclusions: GeST was proved to be easy and enjoyable to use and had some effect on participants’ gesturing skills. Increasing the magnitude of gains would be desirable. The effect on everyday communication needs to be explored

The ConStratO model of handover: a tool to support technology design and evaluation

Handovers are a specific kind of multidisciplinary team meeting. Shift handovers and transfers are both regular features of hospital work but there is currently great variation in how such handovers are conducted, presenting a challenging for those seeking to develop technology to support handover. This paper presents the ConStratO model of handover, which captures aspects of the context that influence how the handover is conducted, a range of different handover strategies relating to different aspects of the handover, and possible outcomes of handover. The model is based on detailed data collection in a range of clinical settings. We present the model as a tool for developing and evaluating technology support for handover

A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study

Objective: To test the feasibility of a Randomised Controlled Trial comparing face to face and remotely delivered word finding therapy for people with aphasia Design: A quasi-randomised controlled feasibility study comparing remote therapy delivered from a University lab, remote therapy delivered from a clinical site, face to face therapy and an attention control condition Setting: A University lab and NHS outpatient service Participants: Twenty-one people with aphasia following left hemisphere stroke Interventions: Eight sessions of word finding therapy, delivered either face to face or remotely, were compared to an attention control condition comprising eight sessions of remotely delivered supported conversation. The remote conditions used mainstream video conferencing technology. Outcome measures: Feasibility was assessed by recruitment and attrition rates, participant observations and interviews, and treatment fidelity checking. Effects of therapy on word retrieval were assessed by tests of picture naming and naming in conversation. Results: Twenty-one participants were recruited over 17 months, with one lost at baseline. Compliance and satisfaction with the intervention was good. Treatment fidelity was high for both remote and face to face delivery (1251/1421 therapist behaviours were compliant with the protocol). Participants who received therapy improved on picture naming significantly more than controls (mean numerical gains: 20.2 (remote from University); 41 (remote from clinical site); 30.8 (face to face); 5.8 (attention control); p <.001). There were no significant differences between groups in the assessment of conversation. Conclusions: Word finding therapy can be delivered via mainstream internet video conferencing. Therapy improved picture naming, but not naming in conversation

A Literature Review on Cloud Computing Adoption Issues in Enterprises

Part 3: Creating Value through ApplicationsInternational audienceCloud computing has received increasing interest from enterprises since its inception. With its innovative information technology (IT) services delivery model, cloud computing could add technical and strategic business value to enterprises. However, cloud computing poses highly concerning internal (e.g., Top management and experience) and external issues (e.g., regulations and standards). This paper presents a systematic literature review to explore the current key issues related to cloud computing adoption. This is achieved by reviewing 51 articles published about cloud computing adoption. Using the grounded theory approach, articles are classified into eight main categories: internal, external, evaluation, proof of concept, adoption decision, implementation and integration, IT governance, and confirmation. Then, the eight categories are divided into two abstract categories: cloud computing adoption factors and processes, where the former affects the latter. The results of this review indicate that enterprises face serious issues before they decide to adopt cloud computing. Based on the findings, the paper provides a future information systems (IS) research agenda to explore the previously under-investigated areas regarding cloud computing adoption factors and processes. This paper calls for further theoretical, methodological, and empirical contributions to the research area of cloud computing adoption by enterprises

Interpretation and reporting of process capability results: focus on improvement

A global financial services company followed a software-mediated process assessment (SMPA) approach based on ISO/IEC 15504, ISO/IEC 20000 and the IT Infrastructure Library (ITIL®). Using an action research approach, the Incident Management, Problem Management, and Change Management processes were assessed at two points in time during an ITSM process improvement project. This paper analyzes the results of the process assessments, highlights issues with the interpretation of the results, and offers an alternative method to report process capability results to motivate process improvement. The study found that by using the proportion of SMPA recommendations as a proxy measure for process improvement, the processes did improve yielding fewer recommendations in cycle 2 when compared to cycle 1 of the action research

Persuasion as a form of inter-agent negotiation

Agents in a multi-agent environment must often cooperate to achieve their objectives. In this paper an agent, B, cooperates with another agent, A, if B adopts a goal that furthers A's objectives in the environment. If agents are independent and motivated by their own interests, cooperation cannot be relied upon and it may be necessary for A to persuade B to adopt a cooperative goal. This paper is concerned with the organisation and construction of persuasive argument, and examines how a rational agent comes to hold a belief, and thus, how new beliefs might be engendered and existing beliefs altered, through the process of argumentation. Argument represents an opportunity for an agent to convince a possibly sceptical or resistant audience of the veracity of its own beliefs. This ability is a vital component of rich communication, facilitating explanation, instruction, cooperation and conflict resolution. An architecture is described in which a hierarchical planner is used to develop discourse plans which can be realised in natural language using the LOLITA system. Planning is concerned with the intentional, contextual and pragmatic aspects of discourse structure as well as with the logical form of the argument and its stylistic organisation. In this paper attention is restricted to the planning of persuasive discourse, or monologue

A Situational Alignment Framework for PACS

This paper reports the outcomes of a study on an integrated situational alignment framework for picture archiving and communication systems (PACS) labeled as PISA. Following the design research cycle, complementary validation methods and pilot cases were used to assess the proposed framework and its operationalized survey. In this paper, the authors outline (a) the process of the framework’ development, (b) the validation process with its underlying iterative steps, (c) the outcomes of pilot cases, and (d) improvement opportunities to refine and further validate the PISA framework. Results of this study support empirical application of the framework to hospital enterprises in order to gain insights into their PACS maturity and alignment. We argue that the framework can be applied as a valuable tool for assessments, monitoring and benchmarking purposes and strategic PACS planning