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Nasir Hamid
Healthcare Data Quality Language (HDQL): Streamlining the Translation of Healthcare System Requirements into Software Quality Attributes
Existing software quality definition models often fall short in addressing the dynamic and evolving requirements of Healthcare Information Systems (HIS), particularly the unique regulatory and infrastructural challenges inherent to healthcare environments. This poster introduces the Healthcare Data Quality Language (HDQL), a novel framework designed to bridge the gap between HIS requirements and software quality attributes. HDQL enables healthcare professionals to intuitively define software features tailored to their needs, fostering improved system acceptance, enhanced performance, and system evolution.
Barriers and Opportunities in Developing Health Information System (HIS) Architectures to Support Universal Health Coverage in Resource-Limited Settings
Health Information Systems (HIS) are critical for effective healthcare delivery, especially in resource-limited settings, where access to quality care is challenging. HIS supports Universal Health Coverage (UHC) delivery by managing health data efficiently and aligning national health policies with organisational needs for a more patient-centred approach. This paper explores the barriers and opportunities in developing robust HIS software architectures in such healthcare settings. Key barriers include unreliable infrastructure, insufficient technical support, poor data quality, and financial constraints. However, opportunities for improvement exist, such as adopting interoperable systems, open-source standards, cloud-based solutions, modular upgrades, and capacity-building initiatives. Involving key stakeholders and developing strong policy frameworks are also essential. Future research should focus on improving global interoperability, data quality, sustainability, and scalability to ensure HIS can support UHC goals in resource-limited environments.
General practice characteristics associated with emergency hospital attendances for ambulatory care sensitive conditions
BACKGROUND: Ambulatory care sensitive conditions (ACSC) can be managed in primary care and high-quality care should reduce emergency hospital attendances (EHA) due to ACSC. AIM: To identify general practice characteristics associated with different levels of EHA for ACSC. METHOD: Composite index analysis, including agglomerative hierarchical clustering. Data (2019) from the English general practice workforce minimum data set (wMDS), openly available practice indicators, and hospital-linked routine pseudonymised primary care records. Clustering was performed at practice level. Logistic regression, controlling for patient-level factors, explored if the odds of EHA differed across clusters. RESULTS: Two clusters were identified. Cluster 1, n = 281 practices, 3 175 300 patients - the partnership training model, had: more practices with a GMS contract (70.1% versus 45.4%, P<0.001) and providing GP training (73.0% versus 38.0% P<0.001), partners accounting for a higher proportion of total GP FTE (63.4% versus 29.5%, P<0.001), fewer encounters per patient per year (10 versus 20), higher proportions of patients reporting good experiences (85.9% versus 79.2%, p<0.001). Cluster 2, n = 97 practices, 1 163 030 patients - the multiprofessional urban deprived model had: lower proportions of practice FTE performed by GPs (19.4% versus 23.9%, P<0.001), higher proportions of encounters delivered by other healthcare professionals (15.5% versus 5.7%, P<0.001), more urban practices (90.7% versus 80.0%, P<0.01, greater deprivation (P = 0.02). The odds of EHA in Cluster 1 was 11% lower than Cluster 2 (P<0.0001). CONCLUSION: These findings have implications for policies about the partnership model, and current trends that encourage more encounters with a multiprofessional team.
Developmental Insights from Modelling the Digital Maturity of the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)
The Oxford-RCGP Research and Surveillance Centre (RSC) is one of the largest health surveillance systems in Europe, using real-world primary care data to inform public health policy and clinical practice. As UK general practice has evolved digitally and the demand for strong information governance (IG) has increased, the RSC has expanded its technological capabilities. This paper applies a Digital Maturity Model (DMM) to assess the RSC's progress across five dimensions and ten key informatics and IG elements. The analysis highlights the RSC's strengths in meeting public health needs and identifies areas for improvement. This review identifies predictive analytics, cloud-based services, multi-dimensional modelling, and advanced visualisations as areas for future development.
Randomized trial of inhaled fluticasone propionate in chronic stable pulmonary sarcoidosis: A pilot study
Pulmonary sarcoidosis is a disease in which the pathological processes are distributed along lymphatic pathways, particularly those around the broncho-vascular bundles. Delivery of disease-modulating drugs by the inhaled route is therefore an attractive option. The aim of this study was to determine the efficacy of inhaled fluticasone propionate 2 mg·day-1 in adults with stable pulmonary sarcoidosis. Forty-four adult patients (22 from each centre) were enrolled from outpatient clinics in two London teaching hospitals in a two centre, double-blind, randomized, placebo-controlled trial. Primary end points were home recordings of peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). Secondary end points were symptom scores, use of rescue bronchodilator medication, and clinic values for PEFR, FEV1, FVC, forced mid-expiratory flow (FEF25-75%), diffusion capacity of the lung for carbon monoxide (DL,CO), and total lung capacity (TLC). Symptom scores of cough, breathlessness and wheeze were lower in the active treatment group, but this did not reach statistical significance, and a general health perception assessment (Short Form (SF)-36) showed a difference between active and placebo treatment. No significant differences were found between the two groups in any physiological outcome measure. No new adverse reactions were detected. The results of this pilot study do not show an objective benefit of inhaled fluticasone propionate in pulmonary sarcoidosis where the disease is stable and is controlled without the use of inhaled corticosteroids.
Collecting stories: Is it research? Is it good research? Preliminary guidance based on a Delphi study
Context: The use of narratives (stories) in research, education, audit and evaluation is increasingly common, but there is no consensus on when research ethics committee approval is necessary for such studies or what counts as 'good narrative research'. Objective: This study aimed to produce preliminary guidance for researchers, reviewers and ethics committees on what to classify as narrative research in health care and how to evaluate it. Methods: We carried out a 3-round Delphi study on a volunteer sample of 20 academic researchers, practitioners and service users who were active in narrative health research and its application. After reading academic papers on narrative theory and method, and via extensive online discussion, participants generated a set of preliminary statements. Each participant ranked these on a 9-point Likert scale for relevance and validity (round 1), and then received feedback on his or her scorings compared with the group median and range for each item. This cycle of group discussion, revision of statements, individual rankings and aggregation of scores was repeated twice. Results: The study produced a definition of narrative research which allows such work to be distinguished from the non-research use of stories in health care, and preliminary quality standards for evaluating narrative research. Most participants on this heterogeneous panel felt able to sign up to the final guidance. Residual disagreements were generally attributable to incommensurabilities in philosophical positions. Conclusions: Research ethics committees and scientific reviewers may find the guiding principles in this paper a useful starting point for further reflection and discussion about narrative research studies. © Blackwell Publishing Ltd 2008.
Recognizing rhetoric in health care policy analysis
Critiques of the 'naïve rationalist' model of policy-making abound in the sociological and political science literature. Yet academic debate on health care policy-making continues to be couched in the dominant discourse of evidence-based medicine, whose underlying assumptions - that policies are driven by facts rather than values and these can be clearly separated; that 'evidence' is context-free, can be objectively weighed up and placed unproblematically in a 'hierarchy'; and that policy-making is essentially an exercise in decision science - have constrained both thinking and practice. In this paper, drawing on theoretical work from political science and philosophy, and innovative empirical work in the health care sector, we argue that health care is well overdue for a re-defining of what policy-making is. Policy-making is the formal struggle over ideas and values, played out by the rhetorical use of language and the enactment of social situations. While the selection, evaluation and implementation of research evidence are important in the policy-making process, they do not equate to that process. The study of argument in the construction of policy has the potential to illuminate dimensions of the process that are systematically occluded when policy-making is studied through a naïve rationalist lens. In particular, a rhetorical perspective highlights the struggle over ideas, the 'naming and framing' of policy problems, the centrality of audience and the rhetorical use of language in discussion to increase the audience's adherence to particular framings and proposals. Rhetorical theory requires us to redefine what counts as 'rationality' - which must extend from what is provably true (by logic) and probably true (by Bayesian reasoning) to embrace, in addition, that which is plausibly true (i.e. can convince a reasonable audience). Future research into health care policy-making needs to move beyond the study of 'getting evidence into practice' and address the language, arguments and discourse through which policy is constructed and enacted. © The Royal Society of Medicine Press Ltd 2008.
Reframing evidence synthesis as rhetorical action in the policy making drama.
This paper presents a novel conceptualization of policy making as social drama. The selection and presentation of evidence for policy making, including the choice of which questions to ask, which evidence to compile in a synthesis and which syntheses to bring to the policy making table, should be considered as moves in a rhetorical argumentation game and not as the harvesting of objective facts to be fed into a logical decision-making sequence. Viewing policy making as argument does not mean it is beyond rationality--merely that we must redefine rationality to include not only logical inference and probabilistic reasoning, but also the consideration of plausibility by a reasonable audience. We need better evidence, but we also urgently need better awareness by policy makers of the language games on which their work depends.
Diabetes in British South Asians: Nature, nurture, and culture
Diabetes mellitus and its complications account for a high proportion of avoidable morbidity and premature mortality in people of South Asian origin living in the UK. This review examines available evidence as to why this might be and what can be done to address the problems. The sources for data were a Medline search by MeSH terms, free text and key authors by name, and relevant references, searched by hand, from all review articles in the AIM journals, up to April 1996. Most trials identified were epidemiological surveys. The high instance of diabetes and some of its complications do not have a single explanation. The early incidence of diabetes and its link with coronary heart disease may be partially explained by the central adiposity-insulin resistance syndrome. Predisposition to this is probably largely genetic but exacerbated by other factors such as diet, immune inflammatory changes, and physical activity levels. There is less evidence to support conventional dietary risk factors and some for potentially deleterious effects of traditional Western dietary advice in this population. The impact of the genetic and environmental influences is exacerbated by suboptimal use of health services. The contribution of economic deprivation to the poor outcome of diabetes in these patients may be substantial. There is a considerable impact of psychosocial stress on morbidity, supporting the view that a narrow biomedical model will neither fully explain the problem nor provide solutions. To be successful, strategies for the secondary prevention of diabetes complications in British South Asians need to incorporate a number of paradigms: genetic, physiological, psychological, anthropological, and sociological. Recommendations for a multidimensional approach to this important clinical issue are proposed.
Narrative based medicine: Narrative based medicine in an evidence based world
Even 'evidence based' clinicians uphold the importance of clinical expertise and judgement. Clinical method is an interpretive act which draws on narrative skills to integrate the overlapping stories told by patients, clinicians, and test results. The art of selecting the most appropriate medical maxim for a particularly clinical decision is acquired largely through the accumulation of 'case expertise' (the stories or 'illness scripts' of patients and clinical anecdotes). The dissonance we experience when trying to apply research findings to the clinical encounter often occurs when we abandon the narrative-interpretive paradigm and try to get by on 'evidence' alone.
Hands-on guide to questionnaire research: Selecting, designing, and developing your questionnaire
Anybody can write down a list of questions and photocopy it, but producing worthwhile and generalisable data from questionnaires needs careful planning and imaginative design.
Health beliefs and folk models of diabetes in British Bangladeshis: A qualitative study
Objective: To explore the experience of diabetes in British Bangladeshis, since successful management of diabetes requires attention not just to observable behaviour but to the underlying attitudes and belief systems which drive that behaviour. Design: Qualitative study of subjects' experience of diabetes using narratives, semi-structured interviews, focus groups, and pile sorting exercises. A new qualitative method, the structured vignette, was developed for validating researchers' understanding of primary level culture. Subjects: 40 British Bangladeshi patients with diabetes, and 10 non-Bangladeshi controls, recruited from primary care. Result: Several constructs were detected in relation to body image, cause and nature of diabetes, food classification, and knowledge of complications. In some areas, the similarities between Bangladeshi and non-Bangladeshi subjects were as striking as their differences. There was little evidence of a fatalistic or deterministic attitude to prognosis, and most informants seemed highly motivated to alter their diet and comply with treatment. Structural and material barriers to behaviour change were at least as important as 'cultural' ones. Conclusion: Bangladeshi culture is neither seamless nor static, but some widely held beliefs and behaviours have been identified. Some of these have a potentially beneficial effect on health and should be used as the starting point for culturally sensitive diabetes education.