Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.

The thematic core of the thesis is about how to manage modeling procedures in real settings. The view taken in this thesis is that modeling is a heuristic tool to outline a problem, often conducted in a context of a larger development process. Examples of applications, in which modeling are used, include development of software and business solutions, design of experiments etc. As modeling often is used in the initial phase of such processes, then there is every possibility of failure, if initial models are false or inaccurate. Modeling often calls for eliciting knowledge from experts. Access to relevant expertise is limited, and consequently, efficient use of time and sampling of experts is crucial. The process is highly interactive, and data are often of qualitative nature rather than quantitative. Data from different experts often vary, even if the task is to describe the same phenomenon. As with quantitative data, this variation between data sources can be treated as a source of error as well as a source of information. Irrespective of specific modeling technique, variation and interaction during the model development process should be possible to characterize in order to estimate the elicited knowledge in terms of correctness and comprehensiveness. The aim of the thesis is to explore a methodological approach on how to manage such variations and interactions. Analytical methods tailored for this purpose have the potential to impact on the quality of modeling in the fields of application. Three studies have been conducted, in which principles for eliciting, controlling, and judging the modeling procedures were explored. The first one addressed the problem of how to characterize and handle qualitative variations between different experts, describing the same modeling object. The judgment approach, based on a subjective comparison between different expert descriptions, was contrasted with a criterion-based approach, using a predefined structure to explicitly estimate the degree of agreement. The results showed that much of the basis for the amalgamation of models used in the judgment-approach was concealed, even if a structured method was used to elicit the criteria for the independent experts’ judgment. In contrast, by using the criterion-based approach the nature of the variation was possible to characterize explicitly. In the second study, the same approach was used to characterize variation between, as well as within, different modeling objects, analogical to a one-way statistical analysis of variance. The results of the criterion-based approach indicated a substantial difference between the two modeling subjects. Variances within each of the modeling tasks were about the same and lower than the variance between modeling tasks. The result supports the findings from the first study and indicates that the approach can be generalized as a way of comparing modeling tasks. The third study addressed the problem of how to manage the interaction between experts in team modeling. The aim was to explore the usability of an analytical method with on-line monitoring of the team communication. Could the basic factors of task, participants, knowledge domains, communication form, and time be used to characterize and manipulate team modeling? Two contrasting case studies of team modeling were conducted. The results indicated that the taxonomy of the suggested analytical method was sensitive enough to capture the distinctive communication patterns for the given task conditions. The results also indicate that an analytical approach can be based on the relatively straightforward task of counting occurrences, instead of the relatively more complex task of establish sequences of occurrence.

Dissertation--Augsburg--Philosophisch-Sozialwissenschaftlichen Fakultät, 2004.

Reproduction de : Thèse de doctorat : informatique : Grenoble 1 : 1989. / Titre provenant de l'écran-titre. Bibliogr. p. 217-221.

Reproduction de : Thèse de doctorat : informatique : Grenoble 1 : 1995. / Titre provenant de l'écran-titre. Bibliogr. p. 253-262.

Reproduction de : Thèse de doctorat : Informatique : Lyon 1 : 2005. / Titre provenant de l'écran titre. 160 Réf. bibliogr.

Reproduction de : Thèse de doctorat : Informatique et applications : Poitiers : 2009. / Titre provenant de l'écran-titre. Bibliogr. 158 réf.

This paper proposes a mixture of experts recurrent events model. This general model accommodates an unobservable frailty variable, intervention effect, influence of accumulating event occurrences, and covariate effects. A latent class variable is utilized to deal with a heterogeneous population and associated covariates. A homogeneous nonparametric baseline hazard and heterogeneous parametric covariate effects are assumed. Maximum likelihood principle is employed to obtain parameter estimates. Since the frailty variable and latent classes are unobserved, an estimation procedure is derived through the EM algorithm. A simulated data set is generated to illustrate the data structure of recurrent events for a heterogeneous population.

Healthcare is a knowledge-intensive field. A significant quantum of extremely vital and viable healthcare knowledge exists in a tacit form, yet due to various operational and technical reasons such healthcare knowledge is not entirely utilized and put into professional practice. The strong increase in expert work and knowledge-intensive fields make examining the topic timely and hypothetically interesting.The most significant contribution of this study is the increase in understanding, as well as, tacit healthcare knowledge sharing amongst physicians and clinicians with the type of collaborative tools and technologies they have at their disposal. Collaborative tools and technologies help employees of an organization work closely with their colleagues, partner organization and other volunteers as tacit healthcare knowledge sharing among clinicians such as sharing of best practices, tips and tricks, inter professional collaborative networking, clinical experiences and skills are known to have a significant impact on the quality of medical diagnosis and decisions.This paper posits that collaboration tools and technologies can provide new opportunities for tacit healthcare knowledge sharing amongst health-experts, and demonstrates this by presenting findings from a review of relevant literature and a survey conducted with Medical Doctors who have moderate to high interaction with collaborative tools and technologies in the healthcare industry. Semi-structure interviews were conducted with health-experts (Medical Doctors and clinicians) of Akademiska Hospital, Uppsala, Sweden. Final thematic analysis unveiled six themes as potential contributors of collaborative tools and technologies in facilitating tacit healthcare knowledge sharing among clinicians. The newly developed themes are described and interpreted briefly; extensive literature review has been carried out to relate the emerged themes with the literatures and part of interview participant responses are supported as well. Finally this research suggests further empirical studies shall be conducted to acknowledge this study.

Emergency on-call duties have been highlighted as a key stress factor in newly qualified physiotherapists whose job performance may be affected. The concept of stress relating to on-call work, the general lack of interest or confidence in the respiratory on-call field, and subsequent difficulties with recruitment and retention, pose a difficult problem for managers of services responsible for the maintenance of a competent workforce and a high standard of service provision. Differences in novice and expert physiotherapists’ patient management and clinical reasoning strategies have been previously examined in orthopaedic, neurology, domiciliary and cardiorespiratory fields. However, no such investigations have been undertaken in the field of emergency on-call. The purpose of this study was to determine if differences existed between novice and expert physiotherapists who had by definition differing levels of context-related experience within the emergency on-call environment. This study also aimed to consider what factors may influence their physiotherapy intervention for an acute cardiorespiratory patient. A purpose-designed vignette-based postal questionnaire was administered to 26 emergency on-call providers in New Zealand. The questionnaire sought demographic data, investigated participants’ attitudes towards emergency on-call service provision and presented a vignette-based clinical scenario which asked questions throughout an evolving clinical case scenario. Analysis was performed using the computer software package for social sciences, SPSS for Windows (version 14), results were analysed using descriptive statistics, and significance testing was performed using non-parametric methods. A good response rate was achieved (78.8%; n = 56). Statistically significant differences between novices and experts were determined in scores for confidence, stress, and support required, also in the factors affecting stress levels. Novices are less confident (p = < .0001), more stressed (p = < .001) and require more support than experts (p = < .001). Factors which influenced both novice, and to a lesser extent, expert stress levels when working as emergency on-call physiotherapists, were established. A relationship was determined between confidence and level of support required (r = -.65; p = < .001); confidence and amount of stress felt (r = -.58; p = < .001); and support required and stress felt (r = .47; p = < .001). Some differences were demonstrated between novice and expert physiotherapists in their answers to a clinical case scenario. Although these were not statistically significant, a trend was noted which may reflect the different clinical reasoning strategies of these physiotherapists. There is a need for novices to gain the type of experience which includes independent problem solving and guided reflection; the use of vignette-based case studies may be one method which could be further exploited. The profession is responsible for the provision of better ways to meet the needs of our future emergency on-call workforce. If this is not achieved, other professional groups will be required to fill the gaps and physiotherapy; particularly cardiorespiratory physiotherapy will lose out.