Data driven and practice-based evidence : design and development of efficient and effective clinical decision support system

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

Choosing a model of maternity care: decision support needs of Australian women

- BACKGROUND Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. - METHODS A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. - RESULTS Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. - CONCLUSIONS This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.

A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease

Aim To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial. Background Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited. Design. A multisite single blinded pragmatic randomized controlled trial is proposed. Methods Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014. Conclusion This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.

Construction planning workbench

This report is an attempt to present the current state of product and process modelling in the building industry in general, and in construction planning and scheduling in particular. This report endeavours to describe what has been achieved by the Construction Planning Workbench (CPW) project.

Final report : feasibility study linking best value procurement assessment to outcome performance indicators

This feasibility study was established to investigate the application of the concept of ‘best value’ in construction procurement in Australia. In the case of ‘best value’ in the business enterprise, ‘best value’ is that which returns greatest value to the business enterprise’s shareholders. However, in the case of the public sector, ‘best value’ is more complex. For that reason, this research project focuses mainly on public sector construction project procurement.

First interim report : cost of tendering

This is the first interim report on the Cost of Tendering component of the Best Value project. This report provides some insight from ‘cost of tendering’ literature and discussions with CRC partners. With the completion of this scoping project, sufficient understanding will be developed to determine the need for more detailed research. This scoping project does not intend to provide guidance for the way to change the tendering process, although a need will be demonstrated for control and reduction of cost of tendering.

Best value second interim report

This first interim report on ‘best value’ reviewed the academic literature relating to ‘best value’ and illustrated the varying interpretations that the concept of ‘best value’ has attracted. It also examined current state of the literature on best value in construction project procurement. ‘Best value’ was explored from the perspective of both the business enterprise and public sector. It was concluded that ‘best value’ in the public sector is considerably more complex. This second interim report explores how ‘best value’ has been implemented in the UK. Focus is directed towards the UK, particularly Scotland’s approach to examine the complexity of implementation of ‘best value’ in the public sector context. Scotland has been recognised as a leader in the field of ‘best value’ in the public sector (Curry, 1999; Wisniewski and Stewart, 2001, 2004; Jaconelli and Sheffield, 2000)

Construction supply chain development interim report

The supply chain in the construction industry is less well developed than in manufacturing. This project proposes to bring world class international business profile benchmarking to assist in the development of small and medium sized (SME) subcontractors. This approach has been widely used in Europe and has enabled significant sectoral supply chain development. The construction SME supply chain is a critical component in the delivery of all construction projects. Furthermore, it undermines the sustainability of the individual enterprise and puts construction projects and jobs at risk. Government procurement agencies view this as construction industry capacity building. In the developed and developing worlds, SME sector firms routinely make up over 95% of companies. The construction industry supply chain is dominated by such firms. Supply chain development and capacity building have been largely neglected in the construction sector, despite rhetoric about the importance of the SME sector to the economy This project seeks to investigate the potential to apply the International Business Profile Benchmarking instrument with the construction industry. The project recognises that there are many facets to the quest for continuous improvement in the construction industry and in wider workplace in general. This first interim report reviews the international literature relating to construction industry performance measurement and performance improvement. A summary of the findings follow. ‘Best value’ is dealt with in a separate interim report.

Report : wireless data throughput testing on a mobile device using WiFi and GPRS

This project report presents the results of a study on wireless communication data transfer rates for a mobile device running a custombuilt construction defect reporting application. The study measured the time taken to transmit data about a construction defect, which included digital imagery and text, in order to assess the feasibility of transferring various types and sizes of data and the ICT-supported construction management applications that could be developed as a consequence. Data transfer rates over GPRS through the Telstra network and WiFi over a private network were compared. Based on the data size and data transfer time, the rate of transfer was calculated to determine the actual data transmission speeds at which the information was being sent using the wireless mobile communication protocols. The report finds that the transmission speeds vary considerably when using GPRS and can be significantly slower than what is advertised by mobile network providers. While WiFi is much faster than GPRS, the limited range of WiFi limits the protocol to residential-scale construction sites.

Report : enabling team collaboration with pervasive and mobile computing : a review of existing mobile computing technologies

The application of Information and Communication Technology (ICT) in construction industry has been recognised widely by some practitioners and researchers for the last several years. During the 1990s the international construction industry started using with the increasing confidence information and communication technology. The use of e-mail became usual and web-sites were established for marketing purposes. Intranets and extranets were also established to facilitate communication within companies and throughout their branches. One of the important applications of the ICT in construction industry was the use of mobile computing devices to achieve better communication and data transmission between construction sites and offices.

Where the actions are : bring reality into virtual reality

This paper describes a work-in-progress on developing design environments that combine wireless and mobile technologies with augmented reality to facilitate bringing context from the physical environment to the virtual models for design work. One of the challenges for designers in a variety of end-user-oriented design disciplines such as architecture and industrial design has been capturing and replaying the contextual information of the intended domain of the artifact being designed. Either the technology is decidedly low-tech, such as charcoal drawings in a sketchbook, out-of-reach, such as immersive virtual reality CAVEs, or a “make-do” with existing technologies, such as a collage of digital photos. This paper describes a novel combination of “off-the-shelf” technologies that may allow designers more capability to create models using standard computer-aided design applications and augmented reality to combine the current, physical context with the projected, digital context. We demonstrate this approach in the building design domain to address a common problem in building construction, construction defect resolution.