Recognition of expertise : an important concept in the acquisition of nephrology nursing expertise

The present article, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept of recognition of expertise. The study used grounded theory methodology and involved 17 registered nurses who were practising in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participant observations and interviews. According to nurses in this study, patients, doctors and other nurses recognized that some nurses were experts while others were not. In addition, being trusted, being a role model and teaching others were important components of being recognized as an expert nephrology nurse. Of importance for nursing, the results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.

A process mining-based investigation of adverse events in care processes

This paper proposes the Clinical Pathway Analysis Method (CPAM) approach that enables the extraction of valuable organisational and medical information on past clinical pathway executions from the event logs of healthcare information systems. The method deals with the complexity of real-world clinical pathways by introducing a perspective-based segmentation of the date-stamped event log. CPAM enables the clinical pathway analyst to effectively and efficiently acquire a profound insight into the clinical pathways. By comparing the specific medical conditions of patients with the factors used for characterising the different clinical pathway variants, the medical expert can identify the best therapeutic option. Process mining-based analytics enables the acquisition of valuable insights into clinical pathways, based on the complete audit traces of previous clinical pathway instances. Additionally, the methodology is suited to assess guideline compliance and analyse adverse events. Finally, the methodology provides support for eliciting tacit knowledge and providing treatment selection assistance.

The clinical reasoning characteristics of diagnostic experts

The aim of this study was to identify and describe the clinical reasoning characteristics of diagnostic experts. A group of 21 experienced general practitioners were asked to complete the Diagnostic Thinking Inventory (DTI) and a set of 10 clinical reasoning problems (CRPs) to evaluate their clinical reasoning. Both the DTI and the CRPs were scored, and the CRP response patterns of each GP examined in terms of the number and type of errors contained in them. Analysis of these data showed that six GPs were able to reach the correct diagnosis using significantly less clinical information than their colleagues. These GPs also made significantly fewer interpretation errors but scored lower on both the DTI and the CRPs. Additionally, this analysis showed that more than 20% of misdiagnoses occurred despite no errors being made in the identification and interpretation of relevant clinical information. These results indicate that these six GPs diagnose efficiently, effectively and accurately using relatively few clinical data and can therefore be classified as diagnostic experts. They also indicate that a major cause of misdiagnoses is failure to properly integrate clinical data. We suggest that increased emphasis on this step in the reasoning process should prove beneficial to the development of clinical reasoning skill in undergraduate medical students.

Clinical teaching: Maintaining an educational role for doctors in the new health care environment

Context and objectives: Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods: Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results: The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can 'teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion: Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers.

Real-time image denoising algorithm in teleradiology systems - art.no.606304

Denoising of medical images in wavelet domain has potential application in transmission technologies such as teleradiology. This technique becomes all the more attractive when we consider the progressive transmission in a teleradiology system. The transmitted images are corrupted mainly due to noisy channels. In this paper, we present a new real time image denoising scheme based on limited restoration of bit-planes of wavelet coefficients. The proposed scheme exploits the fundamental property of wavelet transform - its ability to analyze the image at different resolution levels and the edge information associated with each sub-band. The desired bit-rate control is achieved by applying the restoration on a limited number of bit-planes subject to the optimal smoothing. The proposed method adapts itself to the preference of the medical expert; a single parameter can be used to balance the preservation of (expert-dependent) relevant details against the degree of noise reduction. The proposed scheme relies on the fact that noise commonly manifests itself as a fine-grained structure in image and wavelet transform allows the restoration strategy to adapt itself according to directional features of edges. The proposed approach shows promising results when compared with unrestored case, in context of error reduction. It also has capability to adapt to situations where noise level in the image varies and with the changing requirements of medical-experts. The applicability of the proposed approach has implications in restoration of medical images in teleradiology systems. The proposed scheme is computationally efficient.

El perito médico en los delitos sexuales. Buenos Aires 1850-1890

En esta tesina analizo el rol jugado por el perito médico en los delitos sexuales entre 1850 y 1890 en Buenos Aires. El punto central es mostrar como ayuda a crear a la 'victima aceptable' sea hombre o mujer. Para hacer esto, explico la pericia médica en sí y muestro como este va mucho más allá de su deber para asegurarse de no estar ayudando al varón o la mujer a ocultar una perversión como la homosexualidad o la masturbación. Al mismo tiempo muestro que los crímenes sexuales son tratados en una forma particular respecto de otros tipos de delitos por la justicia de ese momento. Finalmente, en el último capítulo, intento mostrar como los conocimientos y la práctica jurídica se combinan con el saber y el ejercicio de la medicina para intentar definir la niñez y su sexualidad

El perito médico en los delitos sexuales. Buenos Aires 1850-1890

En esta tesina analizo el rol jugado por el perito médico en los delitos sexuales entre 1850 y 1890 en Buenos Aires. El punto central es mostrar como ayuda a crear a la 'victima aceptable' sea hombre o mujer. Para hacer esto, explico la pericia médica en sí y muestro como este va mucho más allá de su deber para asegurarse de no estar ayudando al varón o la mujer a ocultar una perversión como la homosexualidad o la masturbación. Al mismo tiempo muestro que los crímenes sexuales son tratados en una forma particular respecto de otros tipos de delitos por la justicia de ese momento. Finalmente, en el último capítulo, intento mostrar como los conocimientos y la práctica jurídica se combinan con el saber y el ejercicio de la medicina para intentar definir la niñez y su sexualidad

El perito médico en los delitos sexuales. Buenos Aires 1850-1890

En esta tesina analizo el rol jugado por el perito médico en los delitos sexuales entre 1850 y 1890 en Buenos Aires. El punto central es mostrar como ayuda a crear a la 'victima aceptable' sea hombre o mujer. Para hacer esto, explico la pericia médica en sí y muestro como este va mucho más allá de su deber para asegurarse de no estar ayudando al varón o la mujer a ocultar una perversión como la homosexualidad o la masturbación. Al mismo tiempo muestro que los crímenes sexuales son tratados en una forma particular respecto de otros tipos de delitos por la justicia de ese momento. Finalmente, en el último capítulo, intento mostrar como los conocimientos y la práctica jurídica se combinan con el saber y el ejercicio de la medicina para intentar definir la niñez y su sexualidad

El perito médico en los delitos sexuales, 1880-1890

En la Argentina se institucionalizó la figura del perito médico con la creación del Cuerpo Médico de Policía por decreto del Gobernador de la Provincia de Buenos Aires Gral. Martín Rodríguez en 1822, apareciendo en los expedientes judiciales con la designación de "Médico de Policía" o "Médico de Tribunales". Sin embargo la primera definición de este auxiliar de la justicia como "experto en arte o cosa" es más antigua, apareciendo en la legislación base de nuestro sistema penal: las Leyes de Partidas (especialmente la 3a y la 7a). En este capítulo analizaremos la actuación de este agente en los casos de violencia sexual, mostrando la importancia vital de su función para la determinación misma de su existencia como delito punible por la ley, veremos como se mezclan a un tiempo las consideraciones científicas, sociales e incluso personales en sus informes pretendida y idealmente neutrales. Además buscaremos resaltar cuando sea posible el nivel de imbricación de los saberes médicos y legales en los abogados y médicos de esta época caracterizada por la profesionalización de ambas ramas.

Combined Machine Learning Techniques for Decision Making Support in Medicine

Computational intelligent support for decision making is becoming increasingly popular and essential among medical professionals. Also, with the modern medical devices being capable to communicate with ICT, created models can easily find practical translation into software. Machine learning solutions for medicine range from the robust but opaque paradigms of support vector machines and neural networks to the also performant, yet more comprehensible, decision trees and rule-based models. So how can such different techniques be combined such that the professional obtains the whole spectrum of their particular advantages? The presented approaches have been conceived for various medical problems, while permanently bearing in mind the balance between good accuracy and understandable interpretation of the decision in order to truly establish a trustworthy ‘artificial’ second opinion for the medical expert.

Discovering Hands - México

El modelo de Discovering Hands ha sido reconocido internacionalmente como un proyecto innovador que se ha expandido por diferentes países del mundo, como Austria, y se ha empezado a estudiar la propuesta en países como República Checa, India y Colombia. (Discovering Hands, 2016). Esto se debe a que no solo mejora el tratamiento de cáncer de mama, sino que también reduce los costos totales de tratamiento de la enfermedad y aumenta la fuerza laborar de los países donde esté presente. Al representar una gran oportunidad en diferentes aspectos, se quiso desarrollar un estudio de factibilidad del modelo de negocio en tres países de América Latina, Colombia –donde ya se encuentra en marcha un proyecto piloto liderado por la CAF en Cali - , Argentina y México. El presente trabajo consiste en dicho estudio de factibilidad, focalizado en México; por medio de este se buscaron tres cosas primordiales, conocer y estudiar el contexto del mercado y situación de salud en el país, analizar los datos recogidos, con el fin de proponer soluciones para disminuir una de las principales causas de muerte en el país. Actualmente en México el 52% de casos de cáncer de mama diagnosticados sucede en etapas tardías, aumentando el riesgo de muerte de los pacientes (Colima, 2013). Con el estudio se logró identificar una oportunidad potencial para Discovering Hands siendo su estrategia un recurso adicional para contribuir a mejorar el diagnóstico precoz de cáncer de mama en el país y debido a esto se presenta un modelo de negocio adaptable a las necesidades mexicanas

Adapting to concurrent expert evidence in medical litigation

In medical negligence litigation expert evidence has long played a dominant role. The trend towards the use of concurrent expert evidence is now well underway. However, for the lawyers and the doctors involved, the pathway is not yet familiar. Disputes have frequently arisen in the context of pre-hearing expert conclaves, given the adversarial nature of litigation and perhaps fuelled by fears of a less transparent process at this increasingly important stage. This article explains the concurrent expert evidence framework and examines areas of common dispute both in the conclaves and at trial, with a view to providing assistance to legal practitioners working in this area and the medical practitioners called upon to provide expert evidence in such litigation.

Policing expert testimony in a death investigation: Medical opinion as legal fact

Within coronial investigations, pathologists are called upon to given evidence as to cause of death. This evidence is given great weight by the coroners; after all, scientific ‘truth’ is widely deemed to be far more reliable than legal ‘opinion’. The purpose of this paper is to examine the ontological and epistemological status of that evidence, from the perspectives of both the pathologists and the coroners. As part of an Australian Research Council Linkage Grant, interviews were conducted with seven pathologists and 10 coroners from within the Queensland coronial system. Contrary to expectations, and the work of philosophers of science, such as Feyerabend (1975), pathologists did not present their findings in terms of unequivocal facts or objective truths relating to causes of death. Rather, their evidence was largely presented as ‘educated opinion’ based upon ‘the weight of evidence’. It was actually the coroners who translated that opinion into ‘medical fact’ within the proceedings of their death investigations, arguably as a consequence of the administrative necessity to reach a clear-cut finding as to cause of death, and on the basis of their own understanding of the ontology of medical knowledge. These findings support Latour’s (2010) claim that law requires a fundamentally different epistemology to science, and that science is not entirely to blame for the extravagant truth-claims made on its behalf

Belief, Knowledge and Expertise. The emergence of the lay expert in medical sociology

The paper has three main aims. First, to trace – through the pages of the Journal – the changing ways in which lay understandings of health and illness have been represented during the 1979-2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re-assessment of what lay people can offer to a democratised and customer sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. Key words: Lay health beliefs, lay expertise, Alzheimer’s, Traumatic Brain Injury, Vaccinations

Respiratory syncytial virus, an ongoing medical dilemma: an expert commentary on respiratory syncytial virus prophylactic and therapeutic pharmaceuticals currently in clinical trials

As the most important viral cause of severe respiratory disease in infants and increasing recognition as important in the elderly and immunocompromised, respiratory syncytial virus (RSV) is responsible for a massive health burden worldwide. Prophylactic antibodies were successfully developed against RSV. However, their use is restricted to a small group of infants considered at high risk of severe RSV disease. There is still no specific therapeutics or vaccines to combat RSV. As such, it remains a major unmet medical need for most individuals. The World Health Organisations International Clinical Trials Registry Platform (WHO ICTRP) and PubMed were used to identify and review all RSV vaccine, prophylactic and therapeutic candidates currently in clinical trials. This review presents an expert commentary on all RSV-specific prophylactic and therapeutic candidates that have entered clinical trials since 2008.