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Author: Brian S McGowan, PhD

ABSRACT: Understanding the Etiology of Prescription Opioid Abuse

Although studies on the initiation of substance abuse abound, the body of literature on prescription opioid abuse POA etiology is small. Little is known about why and how the onset of POA occurs, especially among high-risk populations. In this study we aimed to fill this important knowledge gap by exploring the POA initiation experiences of 90 prescription opioid abusers currently in treatment and their narrative accounts of the circumstances surrounding their POA onset. This research was conducted within a storyline framework, which operates on the premise that the path to drug abuse represents a biography or a process rather than a static condition. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of four trajectories leading to POA. This study adds to the limited research on POA etiology by not only illuminating the psychosocial factors that contribute to POA onset, but also by situating initiation experiences within broader life processes. The study findings provide crucial insights to policymakers and interventionists in identifying who is at risk for POA, and more important, when and how to intervene most efficaciously.

via Understanding the Etiology of Prescription Opioid Abuse.

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RESOURCE: Simple Techniques for Applying Active Learning Strategies to Online Course Videos

From Web-enhanced face-to-face courses to MOOCs, flipped, blended, and fully online courses, videos are an integral component of today’s educational landscape—from kindergarten all the way through higher education.
But there’s a big difference between watching a video and learning something from it. Videos are great for presenting visual information and emotional appeals, but not particularly effective at diving below the surface of non-visual theoretical or abstract topics or for driving critical thinking. What’s more, any video presented in class must compete for attention and memory with the five-plus hours the typical student spends outside of class watching television programs, movies, and other onscreen entertainment. (Nielsen, 2013)
To help increase the educational effectiveness of an online course video, consider applying one or more of the following active learning strategies.

via Simple Techniques for Applying Active Learning Strategies to Online Course Videos | Faculty Focus.

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MANUSCRIPT: Resident physicians as human information systems: sources yet seekers

Objective To characterize question types that residents received on overnight shifts and what information sources were used to answer them.

Materials and Methods Across 30 overnight shifts, questions asked of on-call senior residents, question askers’ roles, and residents’ responses were documented. External sources were noted.

Results 158 of 397 questions (39.8%) related to the plan of care, 53 (13.4%) to medical knowledge, 48 (12.1%) to taskwork knowledge, and 44 (11.1%) to the current condition of patients. For 351 (88.4%) questions residents provided specific, direct answers or visited the patient. For 16 of these, residents modeled or completed the task. For 216 questions, residents used previous knowledge or their own clinical judgment. Residents solicited external information sources for 118 questions and only a single source for 77 (65.3%) of them. For the 118, most questions concerned either the plan of care or the patient’s current condition and were asked by interns and nurses (those with direct patient care responsibilities).

Discussion Resident physicians serve as an information system and they often specifically answer the question using previous knowledge or their own clinical judgment, suggesting that askers are contacting an appropriately knowledgeable person. However, they do need to access patient information such as the plan of care. They also serve an educator role and answer many knowledge-related questions.

Conclusions As synchronous verbal communications continue to be important pathways for information flow, informaticians need to consider the relationship between such communications and workflow in the development of healthcare support tools.

via Resident physicians as human information systems: sources yet seekers — Bass et al. 20 (4): 736 — Journal of the American Medical Informatics Association.

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RESOURCE: The Pedagogy of MOOCs

There is a great deal of energy, enthusiasm, and change happening in today’s education sector. Existing and new education providers are leveraging the Internet, ICT infrastructure, digital content, open licensing, social networking, and interaction to create new forms of education. Open Educational Resources (OER) (including open textbooks), Open Access, and Massive Open Online Courses (MOOCs) have all gained traction as significant drivers of education innovation.

MOOCs in particular are stimulating widespread discussion around the potential to reach and serve hundreds of thousands of learners who would otherwise not have access to education. Like all of you I’ve been tracking MOOC’s with great interest.

While MOOC’s have attracted huge attention, and hype, for supporting massive enrollments and for being free its the pedagogical aspects of MOOC’s that interest me the most.

via The Pedagogy of MOOCs | Paul Stacey.

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ABSTRACT: Knowledge transfer in surgery: skills, process and evaluation

INTRODUCTION:
Knowledge transfer is an essential element in the management of surgical health care. In a routine clinical practice, surgeons need to make changes to the health care they provide as new clinical evidence emerges.
MATERIALS AND METHODS:
The information was derived from the authors’ experience and research in evidence-based practice, searching of the literature, teaching and organisation of various national and international workshops on evidence-based medicine.
DISCUSSION:
This manuscript discusses principles of knowledge transfer in surgery including evaluation of recommended changes that can improve quality of health care in routine surgical practice. Skills, process and evaluation are carefully described. Continuous information delivery is required to enable surgeons to improve knowledge transfer and to keep up to date their knowledge.

via Knowledge transfer in surgery: skills, … [Ann R Coll Surg Engl. 2007] – PubMed – NCBI.

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RESOURCE: The newest revolution in higher ed

In 1837, the Massachusetts Board of Education devoted part of its first annual report to praising a recent classroom innovation called the blackboard. This “invaluable and indispensible” innovation enabled the “rapid and vivid communication of knowledge.” It created opportunities for teachers to engage learners in ways that had been unimaginable just a generation earlier.

The same and more will be said of online learning tools. We are at the beginning of a technology-led revolution in pedagogy: Our innovation is not the blackboard, but instead an evolving suite of tools that allows interactive learning online. While one outcome of this revolution has rightly caught the world’s attention — the power to democratize access to education on a scale never seen in history — we are just as excited about the promise that these new tools hold for colleges and universities throughout the world.

via The newest revolution in higher ed | Harvard University.

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ABSTRACT: A social network of hospital acquired infection built from electronic medical record data

Abstract
Objective Social networks have been used in the study of outbreaks of infectious diseases, including in small group settings such as individual hospitals. Collecting the data needed to create such networks, however, can be time consuming, costly, and error prone. We sought to create a social network of hospital inpatients using electronic medical record (EMR) data already collected for other purposes, for use in simulating outbreaks of nosocomial infections.

Materials and methods We used the EMR data warehouse of a tertiary academic hospital to model contact among inpatients. Patient-to-patient contact due to shared rooms was inferred from admission-discharge-transfer data, and contact with healthcare workers was inferred from clinical documents. Contacts were used to generate a social network, which was then used to conduct probabilistic simulations of nosocomial outbreaks of methicillin-resistant Staphylococcus aureus and influenza.

Results Simulations of infection transmission across the network reflected the staffing and patient flow practices of the hospital. Simulations modeling patient isolation, increased hand hygiene, and staff vaccination showed a decrease in the spread of infection.

Discussion We developed a method of generating a social network of hospital inpatients from EMR data. This method allows the derivation of networks that reflect the local hospital environment, obviate the need for simulated or manually collected data, and can be updated in near real time.

Conclusions Inpatient social networks represent a novel secondary use of EMR data, and can be used to simulate nosocomial infections. Future work should focus on prospective validation of the simulations, and adapting such networks to other tasks.

via A social network of hospital acquired infection built from electronic medical record data — Cusumano-Towner et al. — Journal of the American Medical Informatics Association.

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ABSTRACT: The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system

Abstract
Objective As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare ‘ecosystem’ in infection control.

Materials and methods We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases.

Results To demonstrate RHEA’s capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity).

Discussion Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities.

Conclusions A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

via The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system — Lee et al. — Journal of the American Medical Informatics Association.

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ABSTRACT: Teaching medical students a clinical approach to altered mental status: simulation enhances traditional curriculum.

Abstract
Introduction: Simulation-based medical education (SBME) is increasingly being utilized for teaching clinical skills in undergraduate medical education. Studies have evaluated the impact of adding SBME to third- and fourth-year curriculum; however, very little research has assessed its efficacy for teaching clinical skills in pre-clerkship coursework. To measure the impact of a simulation exercise during a pre-clinical curriculum, a simulation session was added to a pre-clerkship course at our medical school where the clinical approach to altered mental status (AMS) is traditionally taught using a lecture and an interactive case-based session in a small group format. The objective was to measure simulation’s impact on students’ knowledge acquisition, comfort, and perceived competence with regards to the AMS patient. Methods: AMS simulation exercises were added to the lecture and small group case sessions in June 2010 and 2011. Simulation sessions consisted of two clinical cases using a high-fidelity full-body simulator followed by a faculty debriefing after each case. Student participation in a simulation session was voluntary. Students who did and did not participate in a simulation session completed a post-test to assess knowledge and a survey to understand comfort and perceived competence in their approach to AMS. Results: A total of 154 students completed the post-test and survey and 65 (42%) attended a simulation session. Post-test scores were higher in students who attended a simulation session compared to those who did not (p<0.001). Students who participated in a simulation session were more comfortable in their overall approach to treating AMS patients (p=0.05). They were also more likely to state that they could articulate a differential diagnosis (p=0.03), know what initial diagnostic tests are needed (p=0.01), and understand what interventions are useful in the first few minutes (p=0.003). Students who participated in a simulation session were more likely to find the overall AMS curriculum useful (p<0.001). Conclusion: Students who participated in a simulation exercise performed better on a knowledge-based test and reported increased comfort and perceived competence in their clinical approach to AMS. SBME shows significant promise for teaching clinical skills to medical students during pre-clinical curriculum.

via Teaching medical students a clinical approac… [Med Educ Online. 2013] – PubMed – NCBI.

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MANUSCRIPT: Privacy policies for health social networking sites

Abstract
Health social networking sites (HSNS), virtual communities where users connect with each other around common problems and share relevant health data, have been increasingly adopted by medical professionals and patients. The growing use of HSNS like Sermo and PatientsLikeMe has prompted public concerns about the risks that such online data-sharing platforms pose to the privacy and security of personal health data. This paper articulates a set of privacy risks introduced by social networking in health care and presents a practical example that demonstrates how the risks might be intrinsic to some HSNS. The aim of this study is to identify and sketch the policy implications of using HSNS and how policy makers and stakeholders should elaborate upon them to protect the privacy of online health data.

via Privacy policies for health social networking sites — Li — Journal of the American Medical Informatics Association.

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