Indiana University-Purdue University Indianapolis (IUPUI) / Biomedical data exists in the form of journal articles, research studies, electronic health records, care guidelines, etc. While text mining and natural language processing tools have been widely employed across various domains, these are just taking off in the healthcare space. A primary hurdle that makes it difficult to build artificial intelligence models that use biomedical data, is the limited amount of labelled data available. Since most models rely on supervised or semi-supervised methods, generating large amounts of pre-processed labelled data that can be used for training purposes becomes extremely costly. Even for datasets that are labelled, the lack of normalization of biomedical concepts further affects the quality of results produced and limits the application to a restricted dataset. This affects reproducibility of the results and techniques across datasets, making it difficult to deploy research solutions to improve healthcare services. The research presented in this thesis focuses on reducing the need to create labels for biomedical text mining by using unsupervised recurrent neural networks. The proposed method utilizes word embeddings to generate vector representations of biomedical concepts based on semantics and context. Experiments with unsupervised clustering of these biomedical concepts show that concepts that are similar to each other are clustered together. While this clustering captures different synonyms of the same concept, it also captures the similarities between various diseases and the symptoms that those diseases are symptomatic of. To test the performance of the concept vectors on corpora of documents, a document vector generation method that utilizes these concept vectors is also proposed. The document vectors thus generated are used as an input to clustering algorithms, and the results show that across multiple corpora, the proposed methods of concept and document vector generation outperform the baselines and provide more meaningful clustering. The applications of this document clustering are huge, especially in the search and retrieval space, providing clinicians, researchers and patients more holistic and comprehensive results than relying on the exclusive term that they search for. At the end, a framework for extracting clinical information that can be mapped to electronic health records from preventive care guidelines is presented. The extracted information can be integrated with the clinical decision support system of an electronic health record. A visualization tool to better understand and observe patient trajectories is also explored. Both these methods have potential to improve the preventive care services provided to patients.

Sammanfattning   Bakgrund: Andelen personer som är 65 år eller äldre fortsätter att öka globalt. Åldrandet medför fysiska och neurologiska förändringar, funktionsnedsättningar samt ökad risk för sjukdomar, vilket i sin tur ökar risken att drabbas av negativa konsekvenser såsom fallskador, trycksår, undernäring och oral ohälsa. Negativa konsekvenser kan ofta förebyggas eller mildras genom att arbeta vårdpreventivt på ett samordnat, genomtänkt och effektivt sätt i hela sjukvårdssystemet. Sjuksköterskor kan med hjälp av validerade riskbedömningsinstrument tidigt identifiera risker gällande fall, trycksår, undernäring och oral ohälsa vilket minskar risken för att äldre personer ska drabbas av onödigt lidande.   Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att använda riskbedömningsinstrument för fall, trycksår, undernäring och oral ohälsa inom kommunal vård och omsorg för äldre personer. Metod: En kvalitativ intervjustudie med induktiv ansats genomfördes med åtta sjuksköterskor inom kommunal vård och omsorg. Resultat: Under analysprocessen framkom två huvudkategorier: riskbedömningar prioriteras bort med underkategorierna tidsbrist, brist på stöd, brist på kunskap och förståelse för riskbedömningsinstrumentens vinster, samt riskbedömningar bidrar till en säkrare vård och bättre hälsa för de äldre med underkategorierna riskbedömning bidrar till ett strukturerat arbetssätt och möjliggör identifiering av risker.     Slutsats: Tidsbrist, brist på stöd samt brist på kunskap om fördelar och vinster med användandet av bedömningsinstrumenten var orsaker till att arbetet med riskbedömningar prioriterades bort av sjuksköterskorna. De sjuksköterskor som hade kunskap om skillnaden mellan riskbedömningsinstrument jämfört med andra instrument som skattar ett pågående symtom ansåg att användandet av riskbedömningsinstrument ökade möjligheten att tidigt identifiera risker.   Nyckelord: Preventiv vård, riskbedömningsinstrument, sjuksköterskor, äldre personer / Summary   Background: The proportion of people aged 65 or older continues to increase globally. Aging leads to physical and neurological changes, disabilities, and an increased risk of disease, which in turn increases the risk of suffering negative consequences such as falls, pressure ulcers, malnutrition, and oral ill-health. Negative consequences can often be prevented or mitigated by working in preventive care in a coordinated, well-thought-out, and effective manner throughout the healthcare system. With the help of validated risk assessment instruments, nurses can identify risks at an early stage regarding falls, pressure ulcers, malnutrition, and oral ill-health, which reduces the risk of elderly people suffering from unnecessary suffering.   Purpose: The aim was to describe nurses' experiences of using risk assessment instruments for falls, pressure ulcers, malnutrition, and oral ill-health in municipal care and care for the elderly.   Method: A qualitative interview study with an inductive approach was conducted with 8 nurses in municipal care and nursing.   Results: During the analysis process, two main categories emerged: risk assessments are prioritized away with the subcategories lack of time, lack of support, lack of knowledge and understanding of the benefits of risk assessment instruments, and risk assessments contribute to safer care and health for the elderly with subcategories risk assessment contributes to a structured approach. of risks.   Conclusion: Lack of time, lack of support, and lack of knowledge about the benefits and gains with the use of the assessment instruments were reasons why the work with risk assessments was prioritized away by the nurses. The nurses who had knowledge of the difference between risk assessment instruments compared to other instruments that estimate an ongoing symptom considered that the use of risk assessment instruments increased the ability to identify risks early.    Keywords: Preventive care, risk assessment instruments, Nurses, older people

Senare års forskning visar på att obstruktivt sömnapnésyndrom, OSAS, är en både underdiagnostiserad och underbehandlad sjukdom. Detta beror delvis på att många personer med OSAS är omedvetna om sitt tillstånd. Sjukdomen innebär återkommande totala andningsuppehåll under sömn och en hypoxi som leder till en rad olika komplikationer, däribland hjärtkärlsjukdomar. Syftet med denna studie var att utreda vad som påverkar OSAS och vilken roll sjuksköterskan kan spela i vården av dessa patienter. Metoden som användes var en litteraturundersökning. Resultatet baseras på tio vetenskapliga artiklar som erhölls genom databaserna PUBMED samt SAMSÖK. Teman som utkristalliserades var sömnposition, kroppsvikt och tandstatus. Trots att behandlingen av OSAS till stor del bygger på medicinska åtgärder visar resultaten i denna litteraturundersökning att sjuksköterskor har en viktig funktion i både upptäckten av nya fall samt i behandlingen. Omvårdnadsåtgärder såsom information om förändrad sömnposition och viktnedgång har visat sig ha signifikant betydelse för obstruktiv andning. / Medical research in recent years has shown that Obstructive Sleep Apnea Syndrome, OSAS, is an affliction for which both diagnosis and treatment are often inadequate. In part, this is due to the fact that many people suffering from OSAS are not aware of the problem. The disease causes recurrent complete stops of breathing during sleep and hypoxia that may bring about various complications, for instance cardiovascular disorders. The purpose of this study, carried out as a literature survey, was to determine what factors affect OSAS and what role the nurse may play in the care of patients suffering from this disease. The survey of the literature by means of the data bases PUBMED and SAMSÖK yielded ten scientific articles showing that although various medical measures constitute the treatment of choice of OSAS the nurse plays an important role in the treatment and the diagnosis of new cases. Preventive care measures such as information about appropriate sleeping positions and reduction of weight have proven to be of significant value in the treatment of OSAS.

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A translational gap exists between the development of an evidence-based health promotion intervention and its eventual implementation in the intended setting. This lack of translation impacts the uptake of health promotion interventions within delivery systems such as the Cooperative Extension Service (Extension). Within this system, Extension educators serve as the intermediaries addressing needs in the communities in which they are employed with support from Extension health specialists. Previous research has shown that educators utilize other peer educators and specialists to learn and adopt health promotion programming, but these studies are over two decades old (e.g., missing technological advances such as Internet and social media) and often focused on a single state Extension system. The purpose of this research was to understand how evidence-based health promotion intervention information is shared within Cooperative Extension by 1) identifying information sources and channels of Extension specialists and educators while 2) identifying the characteristics of an intervention that aid in the adoption and uptake of these health promotion interventions. The first mixed-methods study aimed to identify information sources and channels used by Extension educators from a national sample and learn their preferences for information delivery. Results of this study (Manuscript 1), identified specialists as the key information source Therefore, the second study (Manuscript 2) focused on Extension health specialists' preferences for information sources and channels while also 1) determine how specialists communicate with educators 2) preliminary thoughts on a dissemination intervention. The final study (Manuscript 3) explored the intervention characteristics that are both educator and specialists deemed most important to their adoption decision-making process. The results of this dissertation inform the development of a dissemination intervention to bridge the translational gap across Extension. The information sources and channels used and trusted by both Extension educators and specialists are highlighted in this work. Additionally, specialists have given insight for consideration for an online repository that can be used on demand to both facilitate the adoption and uptake of health promotion interventions as needed by Extension Educators. / Doctor of Philosophy / A translational gap exists between the development of an evidence-based health promotion intervention and its eventual implementation in the intended setting. This lack of translation impacts the uptake of health promotion interventions within delivery systems such as the Cooperative Extension Service (Extension). Within this system, Extension educators serve as the intermediaries addressing needs in the communities in which they are employed with support from Extension health specialists. Previous research has shown that educators utilize other peer educators and specialists to learn and adopt health promotion programming, but these studies are over two decades old (e.g., missing technological advances such as Internet and social media) and often focused on a single state Extension system. The purpose of this research was to understand how evidence-based health promotion intervention information is shared within Cooperative Extension by 1) identifying information sources and channels of Extension specialists and educators while 2) identifying the characteristics of an intervention (e.g., duration, dose, cost) that aid in the adoption and uptake of these health promotion interventions. The first mixed-methods study aimed to identify information sources and channels used by Extension educators from a national sample and learn their preferences for information delivery. Results of this study (Manuscript 1), identified specialists as a key information source Therefore, the second study (Manuscript 2) focused on Extension health specialists’ preferences for information sources and channels while also 1) determine how specialists communicate with educators 2) preliminary thoughts on a dissemination intervention. The final study (Manuscript 3) determined the intervention characteristics that are both educator and specialists deemed most important to their adoption decision-making process. The results of this dissertation inform the development of a dissemination intervention to bridge the translational gap across Extension. The information sources and channels used and trusted by both Extension educators and specialists are highlighted in this work. Additionally, specialists have given insight for consideration for an online repository that can be used on demand to both facilitate the adoption and uptake of health promotion interventions as needed by Extension Educator.

The Patient Protection and Affordable Care Act (ACA) aimed to increase accessibility to medical resources for those previously uninsured. Certainly, the ACA has expanded insurance to millions of Americans, however, the evidence and discourse surrounding health accessibility calls into question why, despite the growth of insured Americans, the increase in health insurance coverage under the ACA has not lead to greater accessibility for low income minorities. I propose that disparities in preventive care, the emergency room, and primary care provider services stand as barriers for low income minorities. Insurance coverage does not necessarily equate to greater accessibility if individuals do not have the means to utilize those resources.

Bakgrund: HPV är den vanligaste sexuellt överförda infektionen i världen. Över en halv miljon kvinnor världen över drabbas av cervixcancer varje år där HPV är den primära orsaken. Föräldrars attityder kring faktorer rörande HPV-vaccin till deras barn spelade en avgörande roll för hur många som erhöll vaccinet. Föräldrar valde att inte vaccinera sina barn på grund av attityder och stigman som kom från omgivningen och samhället. Syfte: Att undersöka faktorer som påverkar attityder hos föräldrar kring HPV-vaccin till deras barn. Metod: Arbetet var en litteraturöversikt för att kartlägga det valda området, med analys av valda artiklarna. Artiklarna var vetenskapliga, skrivna på engelska och med kvalitativ grund. Resultat: Rätt information från sjuksköterskor till föräldrar ledde till positiva attityder, däremot var avsaknad av information angående vaccinets säkerhet och effekt en bidragande orsak till tvekan hos många föräldrar. Ekonomi, medias attityder, synen på sex samt rädsla för biverkningar påverkade föräldrars val att vaccinera sina barn. Åsikter kring lämplig ålder hos barnet vid erhållandet av vaccinet gick isär.Slutsats: Föräldrars attityder påverkade i stor grad andelen barn som vaccinerades. Ökad kunskap till föräldrar angående HPV och vaccinets verkan skulle leda till ett högre vaccinationstal och således förbättrad hälsa globalt. / Background: HPV is the most common sexually transmitted infection in the world. Over half a million women in the world suffer from cervical cancer each year were HPV-virus is the primary reason. Parents attitudes towards HPV vaccine for their children played a crucial part in how many actually got provided with the HPV-vaccine. Parents chose not to vaccinate their children because of attitudes and stigma that was founded in environments and communities. Aim: To examine factors that affect parents attitudes about HPV vaccine to their children. Methods: The chosen method was a literature review as topic, to explore the chosen subject and analyzing suitable articles. The articles have been scientific, in English and with qualitative reasons. Results: The right information from nurses to parents led to positive attitudes, however, the lack of information regarding the safety and efficacy of the vaccine was a contributing cause of doubt among many parents. Economics, media attitudes, views on sex and fear of side effects affected the parents' choice to vaccinate their children. Opinions about the appropriate age of the child when obtaining the vaccine went apart. Conclusions: Parents' attitudes largely affected the percentage of children who were vaccinated. Increased parents’ knowledge regarding HPV and the effect of the vaccine would lead to a higher vaccination rate and thus improved health globally

Preventive quality ordering is a provider intervention aimed at disease prevention through the ordering of industry-recommended health maintenance tests. This pilot study evaluated the effectiveness of provider mentoring/coaching to improve preventive quality ordering using the 2014 Agency for Healthcare Research and Quality best practice preventive clinical services guidelines. Literature indicates provider inconsistency in preventive and quality ordering as the primary cause of disparate health outcomes. Guided by theories of modeling and role-modeling, as well as the theory of cognitive continuum, this pilot study offered provider mentoring/coaching to encourage timely preventative quality ordering. Routinely monitored historic provider practice patterns in a proprietary database were analyzed; 10 providers with the lowest ordering patterns were identified for participation. Mentoring/coaching interventions were provided to improve preventive quality measure ordering. This process included a review of the 2014 Adult Healthcare Effectiveness Data and Information Set documentation criteria, a preventive measures clinical checklist, medical record preparation guidance, clinical shadowing, and post-training discussions. Following the pilot, a 5-person subject matter expert panel of key organizational leaders used on-site observations and standardized semi-structured interviews to evaluate the usefulness of mentoring/coaching and the developed documents to improve timely quality ordering. This small-scale pilot study (a) improved providers' awareness of quality ordering through peer mentoring, communication, and training; and (b) provided a platform for future initiatives. A larger follow-up study will allow healthcare leaders/providers to address disparate health outcomes, and patients will likely benefit from optimal delivery of preventive care.

Bakgrund: Urinvägsinfektion är den vanligast förekommande vårdrelaterade infektionen och innebär förekomst av bakterier i urinen med eller utan symtom. Det finns ett flertal faktorer som gör att äldre är en riskgrupp för att drabbas av urinvägsinfektion bland annat samsjuklighet och funktionsnedsättningar. Urinvägsinfektioner leder till lidande hos den äldre individen och stora kostnader för samhället. Sjuksköterskan har ett ansvar att förebygga sjukdom och minska lidande. Syfte: Syftet var att beskriva sjuksköterskans omvårdnadsåtgärder, upplevda effekter samt effekter av dessa, för att förebygga uppkomst av urinvägsinfektion hos äldre samt att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp. Metod: En litteraturstudie med deskriptiv design. Studien baseras på 14 vetenskapliga artiklar. Av dessa var 12 stycken skrivna med kvantitativ ansats och två med kvalitativ ansats. Resultatet analyserades deduktivt utifrån Orems fem hjälpmetoder och subkategorierna framkom efter en induktiv analys. Huvudresultat: Resultatet sammanställdes i följande kategorier: Att göra något eller handla för en annan person med subkategorierna; God hygien, Specifika åtgärder relaterade till kateter, Ökat vätskeintag samt Profylaktiska läkemedel och tillskott. Att handleda en annan person, Att ge fysiskt och psykologiskt stöd, Att skapa en miljö som främjar utveckling samt Att undervisa. Slutsats: Sjuksköterskorna i studien använde sig av ett flertal olika omvårdnadsåtgärder för att förebygga urinvägsinfektion. Att förkorta tid med kateter samt att undvika att sätta kateter var de mest effektiva åtgärderna för att förebygga urinvägsinfektion. Sjuksköterskorna i studien upplevde att utbildning av patienter, omvårdnadspersonal och anhöriga samt ett ökat vätskeintag reducerade incidens av urinvägsinfektion. / Background: Urinary tract infection is the most common nosocomial infection and involves the presence of bacteria in the urine with or without symptoms. There are several factors that make that the elderly are at increased risk of suffering from urinary tract infection among other comorbidity and functional impairments. Urinary tract infections lead to suffering among elderly individuals and high costs for the society. The nurse has a responsibility to prevent disease and reduce suffering. Aim:The aim was to describe nursing care measures, perceived effects and the effects of these, in order to prevent the occurrence of urinary tract infection in the elderly and to describe the included articles in the sampling methodology and survey group. Method: A literature study with descriptive design. The study is based on 14 scientific articles. Of these, 12 studies with a quantitative approach and two studies with a qualitative approach. The results were analyzed deductively based on Orem´s five methods of helping. Subcategories emerged after an inductive analysis Main results: The results were compiled in the following categories: To do something or act for another person with subcategories; Good hygiene, Specific actions related to the indwelling urinary catheter, Increased fluid intake and Prophylactic agents / supplements. To mentor another person, To give physically and psychological support, To create an environment conducive to development and To educate. Conclusion: The nurses in the study used a variety of nursing interventions for preventing UTI. To shorten the time with the indwelling urinary catheter and to avoid inserting indwelling urinary catheter were the most effective methods to prevent urinary tract infections. The nurses in the study considered that education of patients, nursing staff and relatives and an increased fluid intake decreased incidence of urinary tract infections.

Bakgrund: CVK-relaterade infektioner i blodbanan är förenat med förlängd sjukhusvistelse, ökad mortalitet, ökade ekonomiska kostnader samt ökat lidande för patienten. Användningen av centrala venösa katetrar ökar och därmed är risken att drabbas av infektion större. Det finns en bristande kunskap hos sjuksköterskan gällande förebyggandet av dessa infektioner och en bristande följsamhet till riktlinjer. Syfte: Beskriva hur sjuksköterskan kan förebygga CVK-relaterade infektioner i blodbanan. Metod: Allmän litteraturstudie av kvantitativa artiklar. Resultat: En kombination av utbildning, praktiska åtgärder såsom skötsel, hygienrutiner och checklistor samt feedback minskade antalet CVK-relaterade infektioner i blodbanan. Slutsatser: Utbildning, olika typer av praktiska åtgärder samt feedback minskar antalet CVK-relaterade infektioner i blodbanan och är viktigt för sjuksköterskans förebyggande vård. En stor del av vad som framkom i resultat stämmer överens med riktlinjerna för förebyggandet av CVK-relaterade infektioner, dock bör utbildning och feedback prioriteras i högre utsträckning. Det är känt sedan tidigare att följsamhet till riktlinjer bland sjuksköterskor skulle underlätta utförandet av evidensbaserad omvårdnad. Mer fokus bör därför ligga på att få sjuksköterskor att följa riktlinjer. Klinisk betydelse: Studien kan bidra med ökad kunskap hos sjuksköterskor om hur CVK-relaterade infektioner i blodbanan kan förebyggas vilket i sin tur skulle kunna generera bättre vård, minskat lidande för patienten, minskad mortalitet samt ekonomiska besparingar. / Background: CVC-related bloodstream infections often lead to prolonged hospitalization, increased mortality, higher economical cost and more suffering for the patient. The usage of central venous catheters increases and therefore the risk of infection is also higher. When it comes to prevention of these infections there is a lack of knowledge amongst nurses and compliance with the guidelines. Aim: Describe how the nurse can prevent CVC-related bloodstream infections. Method: General literature review of quantitative studies. Results: A combination of education, hands-on initiatives such as management, hygieneroutines and checklists as well as feedback turned out to reduce CVC-related bloodstream infections. Conclusions: Education, different hands-on initiatives and feedback decreases the number of CVC-related bloodstream infection and is essential for the nurse’s preventive care. Most of the results correlate with the guidelines for the prevention of CVC-related bloodsteam infections, nevertheless education and feedback should be prioritized in higher extent. It is known that adherence to guidelines among nurses would facilitate the execution of evidence-based nursing. Therefore more focus should be on having nurses follow the guidelines. Clinical importance: This study would contribute with increased knowledge amongst nurses regarding prevention of CVC-related bloodstream infections which would give better care, diminish the suffering of the patient, decrease mortality and lead to economical benefits.