Fuzzy logic in clinical practice decision support systems

Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how fuzzy logic can be applied and give a set of heuristics for the clinical guideline knowledge engineer for addressing uncertainty in practice guidelines. We describe the specific applicability of fuzzy logic to the decision support behavior of Care Plan On-Line, an intranet-based chronic care planning system for General Practitioners.

Towards understanding the impacts of the pet food industry on world fish and seafood supplies

The status of wild capture fisheries has induced many fisheries and conservation scientists to express concerns about the concept of using forage fish after reduction to fishmeal and fish oil, as feed for farmed animals, particularly in aquaculture. However, a very large quantity of forage fish is being also used untransformed (fresh or frozen) globally for other purposes, such as the pet food industry. So far, no attempts have been made to estimate this quantum, and have been omitted in previous fishmeal and fish oil exploitation surveys. On the basis of recently released data on the Australian importation of fresh or frozen fish for the canned cat food industry, here we show that the estimated amount of raw fishery products directly utilized by the cat food industry equates to 2.48 million metric tonnes per year. This estimate, plus the previously reported global fishmeal consumption for the production of dry pet food suggest that 13.5% of the total 39.0 million tonnes of wild caught forage fish is used for purposes other than human food production. This study attempts to bring forth information on the direct use of fresh or frozen forage fish in the pet food sector that appears to have received little attention to this date and that needs to be considered in the global debate on the ethical nature of current practices on the use of forage fish, a limited biological resource.

Consumer socialization : the mother and daughter shopping experience

As part of a broader study of women and shopping, we found that many women often talked about shopping with their mothers. We pursued this theme and explored the mother and daughter shopping experience. We position this work within the literature of consumer socialization. The objectives of this part of the research project were 1) gain knowledge of why mother and daughters shop together and 2) uncover what is valued in the shopping experience. Interviews were conducted in person and supplemented using email. The women were aged 18-70. The women provide accounts of how consumer habits, preferences and experiences are transferred across generations. We found that the bonds between mother and daughter relationship are acted out when shopping and the reciprocal coaching occurs.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Background : Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care ‘packages’ that could provide an alternative approach to early postnatal care.

Methods : Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants’ experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what ‘value’ women placed on the various components of care.

Findings : Overall, women expressed a preference for what they had experienced or expected, which may be explained by the ‘what is must be best’ phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors.

Key conclusions and implications for practice : Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's individual needs.

But they won't come to lectures ... : the impact of recorded lectures on student experience and attendance

The move to provide increasingly flexible platforms for student learning and experience through provision of on-line lecture recordings, is often interpreted by students as meaning attendance at lectures is optional. The trend toward the use of such recordings is often met with resistance from some academic staff who cite anecdotal evidence that student attendance will reduce. This study aimed to explore students’ views of the use of on-line recorded lectures and to measure the impact of this technology on student attendance at lectures. A pre and post evaluation methodology was undertaken using a self-administered questionnaire that gathered both quantitative and qualitative data from students. Overall attendance was recorded at each lecture throughout the semester. Results indicated that attendance remained high throughout the semester and while only a minority of students used the recorded lectures, those who did found them to be helpful to their learning. Most students used the recordings to either supplement their learning or to make up a lecture that they had not been able to attend due to other circumstances. The study also provides evidence that contrary to popular belief, not all Generation Y students aspire to replace lectures with downloadable on-line versions. Many of the students in this study still valued the opportunity for interactive learning provided by face-to-face teaching. Finally, a model that outlines the attributes that contribute to quality teaching is used to describe how recording technology can contribute to positive student experiences and can enhance reflective teaching practices on the part of teachers.

Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Lessons from arts experiences for service-dominant logic

Purpose – The purpose of this paper is to consider whether art experiences can inform service-dominant logic (SDL) discourse through an exploration of the co-production and co-creation processes of art experiences.

Design/methodology/approach – Empirical knowledge gained about art experiences is analysed to identify emergent themes about co-production and co-creation. Four modes of qualitative data collection are employed: research participant diaries, photo elicitation, in depth interviews and focus groups.

Findings – Key findings are there are three stakeholders involved in the co-creation of art experiences, which all have critical and different roles; co-creation and co-production are both temporally based and evolving and there are points where they interact and intersect; and high levels of engagement in co-production enhance individuals' contribution to the co-creation of positive value and make their participation in future co-production opportunities more likely.

Research limitations/implications – The paper is exploratory and not a general population study. The methodology and sample of participants employed do not allow for the generalisation of the findings to the broader population.

Practical implications – Organisations may benefit from devising strategies to encourage greater dialogue and connection between all stakeholders involved in co-production and co-creation. The higher the level of individuals' co-production of art experiences the greater likelihood of positive value being co-created. Furthermore, the greater the possibility of individuals engaging in other co-production experiences in the future. While individuals are attracted to co-production possibilities, there are factors that are external to an experience that can act as either barriers to or facilitators of co-production, and that consequently impact on co-creation.

Originality/value – There is little extant research that explores the applicability of art experiences to SDL. This paper is significant in that it employs empirical research methods to develop knowledge on the topic. Furthermore, this paper is innovative in that it seeks to see whether the art experiences can inform generic marketing models, rather than whether generic marketing models can inform arts marketing.

A systematic grounded approach to the development of complex interventions : The Australian WorkHealth Program – Arthritis as a case study

Despite demands for evidence-based research and practice, little attention has been given to systematic approaches to the development of complex interventions to tackle workplace health problems. This paper outlines an approach to the initial stages of a workplace program development which integrates health promotion and disease management. The approach commences with systematic and genuine processes of obtaining information from key stakeholders with broad experience of these interventions. This information is constructed into a program framework in which practice-based and research-informed elements are both valued. We used this approach to develop a workplace education program to reduce the onset and impact of a common chronic disease – osteoarthritis.

To gain information systematically at a national level, a structured concept mapping workshop with 47 participants from across Australia was undertaken. Participants were selected to maximise the whole-of-workplace perspective and included health education providers, academics, clinicians and policymakers. Participants generated statements in response to a seeding statement: Thinking as broadly as possible, what changes in education and support should occur in the workplace to help in the prevention and management of arthritis? Participants grouped the resulting statements into conceptually coherent groups and a computer program was used to generate a ‘cluster map’ along with a list of statements sorted according to cluster membership.

In combination with research-based evidence, the concept map informed the development of a program logic model incorporating the program's guiding principles, possible service providers, services, training modes, program elements and the causal processes by which participants might benefit. The program logic model components were further validated through research findings from diverse fields, including health education, coaching, organisational learning, workplace interventions, workforce development and osteoarthritis disability prevention.

In summary, wide and genuine consultation, concept mapping, and evidence-based program logic development were integrated to develop a whole-of-system complex intervention in which potential effectiveness and assimilation into the workplace for which optimised.