Towards a knowledge-based approach for effective decision-making in railway safety

Purpose – This paper aims to contribute towards understanding how safety knowledge can be elicited from railway experts for the purposes of supporting effective decision-making. Design/methodology/approach – A consortium of safety experts from across the British railway industry is formed. Collaborative modelling of the knowledge domain is used as an approach to the elicitation of safety knowledge from experts. From this, a series of knowledge models is derived to inform decision-making. This is achieved by using Bayesian networks as a knowledge modelling scheme, underpinning a Safety Prognosis tool to serve meaningful prognostics information and visualise such information to predict safety violations. Findings – Collaborative modelling of safety-critical knowledge is a valid approach to knowledge elicitation and its sharing across the railway industry. This approach overcomes some of the key limitations of existing approaches to knowledge elicitation. Such models become an effective tool for prediction of safety cases by using railway data. This is demonstrated using passenger–train interaction safety data. Practical implications – This study contributes to practice in two main directions: by documenting an effective approach to knowledge elicitation and knowledge sharing, while also helping the transport industry to understand safety. Social implications – By supporting the railway industry in their efforts to understand safety, this research has the potential to benefit railway passengers, staff and communities in general, which is a priority for the transport sector. Originality/value – This research applies a knowledge elicitation approach to understanding safety based on collaborative modelling, which is a novel approach in the context of transport.

“There’s a Catch-22”. The complexities of pain management for people with advanced dementia nearing the end of life: a qualitative exploration of physicians’ perspectives

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.