Thesis (Ph. D.)--University of Texas at Austin, 2005. / Supervisor: Deborah Lowe Volker. Vita. Includes bibliographical references.

The healthcare sector is facing a significant challenge: delivering quality clinical care in a costly and intricate environment. There is a general consensus that a solution for many aspects of this problem lies in establishing a framework for effective and efficient clinical decision support. The key to good decision support is offering clinicians just-in-time accessibility to relevant patient specific knowledge. However, at the present time, management of clinical knowledge and patient records is significantly inadequate resulting in sometimes uninformed, erroneous, and costly clinical decisions. One of the contributing factors is that the field of healthcare is characterized by large volumes of highly complex medical knowledge and patient information that must be captured, processed, interpreted, stored, analyzed, and exchanged. Moreover, different clinical information systems are typically not interoperable. This thesis introduces an approach for realizing a clinical decision support framework that manages complex clinical knowledge in a form of evidence-based clinical practice guidelines. The focus of presented work is directed on the interoperability of knowledge, information, and processes in a heterogeneous distributed environment. The main contributions of this thesis include definition of requirements, conceptual architecture, and approach for an interoperable clinical decision support system that is stand-alone, independent, and based on open source standards.

Thesis (M.Tech.: Emergency Medical Care)-Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 301 leaves, Annexures A-0 to A-7 / Paramedic clinical decision making (CDM) surrounding emergency airway management of the critically ill or injured patient in the pre-hospital environment is poorly understood. In order to deliver pre-hospital care effectively it is necessary to understand how paramedics make clinical decisions in this area and determine what influences clinical practice. This study primarily investigated the factors influencing paramedic CDM in the context of advanced emergency airway management with specific focus on the newly introduced skill of rapid sequence intubation (RSI). An evaluation of the correct application of RSI guidelines, the determination of the need for their review and the identification of measures to enhance CDM around RSI were secondary research questions.

This dissertation investigated the use of a variety of multivariate statistical procedures to answer questions regarding the value of a number of medical tests and procedures in the diagnosis of space-occupying liver disease. Also investigated were some aspects of test ordering behavior by physicians. A basic methodology was developed to deal with archival data. A number of methodological problems were addressed. Discriminant function analysis was used to determine which procedures and tests served to provide the best classification of disease entities. Although the results were not spectacular, some variables, including a physical examination variable and a number of laboratory procedures were identified as being important. A more detailed analysis of the role of the laboratory variables was afforded by the use of stepwise logistic regression. In these analyses pairs of disease classifications were compared. Two of the more specific laboratory tests, total bilirubin and alkaline phosphate, entered into the equations to provide a fit to the data. Logistic regression analyses employing patient variables mirrored the results obtained with the discriminant function analyses. Liver-spleen scan indicants were also employed as predictor variables in a series of logistic regression analyses. In general, for a range of comparisons, those indicants cited in the literature as being valuable in discriminating between disease entities entered into the equations. Log-Linear models were used to investigate test ordering behavior. In general, test ordering was independent of department. The sole exception being that of the Gynecology-oncology department which relies heavily on Ultrasound. Log-Linear analyses investigating the use of a number of procedures showed differential use of procedures consistent with what is usually suggested in the medical literature for the combination of different imaging and more specialized procedures. Finally, a set of analyses investigated the ordering of a number of procedures relative to specific disease classifications. This set of analyses suffers, as do a number of the other analyses, from insufficient numbers of cases. However, some indications of differential performance of tests for different disease classifications were evident. Suggestions for further study concentrated on the development of experimental procedures given the results of this study.

Project Thesis (D. Min.)--Denver Seminary, 1988. / Includes bibliographical references (leaves 313-329).

No description available.

Thesis (M.Tech.: Emergency Medical Care)-Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 301 leaves, Annexures A-0 to A-7 / Paramedic clinical decision making (CDM) surrounding emergency airway management of the critically ill or injured patient in the pre-hospital environment is poorly understood. In order to deliver pre-hospital care effectively it is necessary to understand how paramedics make clinical decisions in this area and determine what influences clinical practice. This study primarily investigated the factors influencing paramedic CDM in the context of advanced emergency airway management with specific focus on the newly introduced skill of rapid sequence intubation (RSI). An evaluation of the correct application of RSI guidelines, the determination of the need for their review and the identification of measures to enhance CDM around RSI were secondary research questions.

Project Thesis (D. Min.)--Denver Seminary, 1988. / This is an electronic reproduction of TREN, #090-0237. Includes bibliographical references (leaves 313-329).

Medical practitioners are often unable to access medical and health information at the point-of-care, thus preventing them from providing quality healthcare. Family Health International 360 (FHI) provided medical practitioners with a locally relevant, reliable, and accurate comprehensive library of medical information on mobile computing devices (MCDs), at the point-of-care, as part of a project in collaboration with the Department of Health in the Eastern Cape Province. As part of the latter project, Ricks (2012:7) conducted an investigation into the impact that accessing health information at the point-of-care, via MCDs, had on the clinical decision-making practice of medical practitioners and professional nurses in public hospitals and primary healthcare settings in the Eastern Cape Province. The researcher identified a gap in the aforementioned study and was thus motivated to conduct this study to explore and describe the experiences of medical practitioners at public hospitals in further detail by conducting a qualitative study, as the previous study was quantitative. The purpose of this study was therefore to explore and describe the experiences of medical practitioners regarding the accessing of information at the point-of-care, via mobile technology, for clinical decision making at public hospitals. To achieve the purpose of the study, a qualitative, explorative, descriptive and contextual research design was used. The research population comprised medical practitioners who were using MCDs to access information at the point-of-care for clinical decision making. Purposive sampling was used to select the research sample. Semi-structured interviews were used to collect the necessary research data. Tesch’s steps were used to analyse the data. The principles for ensuring trustworthiness and ethical considerations were adhered to throughout the study. Two main themes and six sub-themes emerged in relation to the experiences of medical practitioners regarding the accessing of information at the point-of-care, for clinical decision making, via mobile technology. The main findings of the research highlighted the benefits and challenges that were experienced by the medical practitioners when using the MCDs for accessing information at the point-of-care for clinical decision making. The study concludes with recommendations pertaining to the areas of practise, education and research.

No description available.