Most typical face in the world revealed (amid deep irony)

National Geographic Magazine has revealed what the most typical human on the planet looks like.…

There is a deep irony here (since we are talking about 'skin') in that as the global demographics flow across the decades to alter this typical face, there is a growing proportion of the population who hope that health and social care delivery is not typical and a 'composite'.

They hope that health, nursing and social care is truly personal and individual - taking in their preferences, needs and priorities.

Having said that though - would it be progress if everyone could expect at least to receive what is deemed a 'standard' level of basic nursing care that is in a way 'typical'?

more to follow - more will follow - are we ready?

NIH: Suggest social justice items for Electronic Health Records

My source: Spirit of 1848 list [The collaborative tool is very interesting]
Let's make suggestions for inclusion of social justice factors in Electronic Health Records by participating in the NIH activity described below.

Dear colleague,

Your input is requested to help make recommendations for a standardized set of patient-reported variables to be collected in primary care and public health electronic health records (EHRs), which will lead to unprecedented data harmonization and opportunities for health research. In order to participate in this process:

• Please visit the website for the collaborative tool: www.gem-beta.org
• Click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and then the associated EHR campaign title.
• Read the summary statements written by the expert panels
• Enter your comments on the recommended measures, and if needed, suggest alternative measures (see attachment for detailed instructions).
• Forward this request to your colleagues who may be interested in this initiative

Comments will be accepted through April 4, 2011.

Background about this Collaborative Effort

Several institutes within the National Institutes of Health in collaboration with the Society of Behavioral Medicine are coordinating an effort to identify a core set of brief, practical measures to recommend for use in adult primary care and public health electronic health records (EHRs), and we are inviting you and all members of your affiliated organizations to join this collaborative effort.

The HITECH Act and the Patient Protection and Affordable Care Act place new emphasis on the widespread and meaningful use of electronic health records (EHRs). This is an important advance, with one significant exception: Currently EHRs fail to capture data reflecting crucial health behaviors and psychosocial issues. Such patient-reported variables are both health outcomes themselves, and major determinants of other health outcomes.

To address the critical need for patient-reported data, we are organizing an effort to evaluate and recommend actionable, patient-reported measures of health behaviors and psychosocial factors for use in electronic health records (EHRs) within adult primary care and public health settings. In order to facilitate broad participation in the development of standard measures we are using a three-phase process of consensus building.

In the first phase panels of subject matter experts were convened for each of 13 behavioral domains to review available measures and to recommend up to 4 reliable, practical measures for each domain that would be appropriate to utilize in primary care and public health settings and to be reported in EHRs.

*Your input is being requested for the second and third phases of the project.*

For the second phase we are using the NCIs Grid-Enabled Measures (GEM) Database to gather feedback from all stakeholders. In order to participate in this process, please visit the GEM website, www.gem-beta.org, and click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and the associated header for the EHR campaign. Begin by reading the summary statements written by the expert panels, view the recommended measures, enter your comments on the recommended measures, and if needed, suggest alternative measures. Comments will be accepted through April 4, 2011.

The third phase will be a workshop/town hall meeting on May 2, 2011 at the NIH bringing together scientists, practitioners, policy makers, and patient/consumer representatives to review the results of this campaign and make recommendations on standard consensus measures for behavioral health and health behavior screening in primary care and public health settings. We encourage everyone interested in this effort to participate, and more information about this meeting will be forthcoming. Immediately following this workshop there will be a closed session meeting of key stakeholders to make final recommendations based on feedback obtained from the GEM tool and the open meeting.

Workshop participants will receive a summary of the meeting as well as information on final recommendations. Subsequent to the meeting, organizers and key stakeholders will discuss strategies to build support and implement plans to advance the adoption and incorporation of a core set of patient-reported behavioral and psychosocial measures in primary care and public health EHRs.

We truly thank you for your participation in this project to standardize the collection of behavioral data in EHRs because it will enable the collaborative group to put forth the best possible recommendations and ultimately improve patient outcomes.

Sincerely,

The EHR Measures Meeting Planning Committee
Maureen P Boyle, Ph.D.
AAAS Science and Technology Policy Fellow
Office of Behavioral and Social Sciences Research
Office of the Director, NIH
31 Center Drive, Building 31, Room B1-C19; MSC 2027
Bethesda, MD 20892-2027

Silver bullets & Magic wands: NHS shamed over callous treatment of elderly

There are none:

Silver bullets or magic wands - that is.

This ongoing news is very distressing for everyone.

I attended a sign-off mentors meeting yesterday afternoon and everyone takes this still relatively new role (outside midwifery) very seriously. It's a very parochial and a biased perspective, but I do believe that in teaching h2cm to the students that I come across they are better prepared to nurse, be a nurse and indeed question what nursing is to them and the public at large. This applies to all qualified nurses who try their collective utmost to instill positive values, safe practice and professional attitudes of the highest order.

Through h2cm I try to provide students with a reflective gravity assist.

As a student I recognised the gravity of what I was doing, or at least trying to do.

30+ years later I still need to do that.

If a student does not recognise the presence of gravity in the care environment, they cannot be effectively guided, navigate their way through it, warn of pending problems. They may not be able to work as an effective member of a team.

Collisions will happen. At the end (and start) of the day even if the student is sensitive to gravity waves and can snatch a Higgs boson out of the ether: mistakes do happen. Non-fatal though we pray, the public is very forgiving when the best efforts to deliver basic nursing care are made and that is the clear intent. This is why we are told if someone makes a complaint deal with it as quickly as possible.

The real deal isn't 'new'. It's the social and political contract called 'NHS'.

Without the necessary gravity assist students may not see, and may not hear what they should be sensitive to. Examples publicised in reports such as this (15 February 2011), by Health Service Ombudsman Ann Abraham shame us all.

Self awareness is a complex thing (rapport, reflection, empathy, emotional intelligence...). Self awareness is not a given. You have to check the switch is there, then be able to help them switch it on, and validate it - for the good of all. Failing that? Well - being prepared to fail a student too if you have to.

Nursing: magnetic Force 5

Back in 2009 I came across a post - Nurse magnets crucial for recruitment and retention about the 14 Forces of Magnetism:

In 1983, the American Academy of Nursing conducted a survey of 163 hospitals to learn why some hospitals attracted and retained well-qualified nurses who were devoted to quality patient care.

The 14 Forces are listed and described by the ANCC. The forces themselves include:

• Force 1 Quality of Nursing Leadership
• Force 2 Organizational Structure
• Force 3 Management Style
• Force 4 Personnel Policies and Programs
• Force 5 Professional Models of Care
• Force 6 Quality of Care
• Force 7 Quality Improvement
• Force 8 Consultation and Resources
• Force 9 Autonomy
• Force 10 Community and the Hospital
• Force 11 Nurses as Teachers
• Force 12 Image of Nursing
• Force 13 Interdisciplinary Relationships
• Force 14 Professional Development

The professional, organizational, and political (policy) emphasis of the 14 forces is obvious and becomes clear when each is weighed in terms of where it sits within the domains of h2cm.

Try it as an exercise. ...

Recruitment is ALL about magnetism.

If you are unsure, ask a magnet about the meaning of retention.

Demographics are already applying pressure upon these forces of magnetism. Not just when referred to explicitly in the USA within organizational media; but globally. Demographics is another magnet - it approaches with increasing force.

From here in the UK (and readers elsewhere) we have to exercise care when models are mentioned. While the theorists and philosopher's of nursing nail their definitions to the mast (h2cm?) there remains a models muddle, not just in the variety of models of care, but in the levels at which they operate. This is not a criticism, it's an observation - consider Force 5:

Force 5: Professional Models of Care
There are models of care that give nurses the responsibility and authority for the provision of direct patient care. Nurses are accountable for their own practice as well as the coordination of care. The models of care (i.e., primary nursing, case management, family-centered, district, and holistic) provide for the continuity of care across the continuum. The models take into consideration patients’ unique needs and provide skilled nurses and adequate resources to accomplish desired outcomes.

In the US in particular 'models of care' (moc) often refer to finance and accountability of costs (the market process), in the UK moc might refer to commissioning. In Force 5 the addition of 'Professional' (as the original author's no doubt recognized) is crucial. If you repeat the above exercise, plotting Force 5 on the Health Care Domains Model then you see how Force 5 works for nursing and remains to this day a great achievement as a yardstick for quality, assurance and retentive power.

In the almost 30 years since the research on the 14 Forces, I do wonder though if there is a need to imbue the following with magnetic properties:

• person-centred care;
• self-care;
• carers and public engagement;
• prevention;
• public (mental) health
• and informatics?

Yes, many of the above can be assumed to lie within the existing Forces 1-14. Health and social care are not static. Nursing has much to contend with from the level of the individual practitioner through to the group within an organization. The 14 Forces of Magnetism are well established in the USA and deservedly so, they clearly deliver.

In the political and economical heat of an economic recession, however; magnets may reach their particular^* Curie point. Then they cease to work.

The constant bangs and knocks of change, the incessant hammering of party politics and the 'market' on the door of "high quality nursing care" can also take its toll on magnetism.

Nursing needs to take care.

Related post on Healthcare IT News:

Top 10 trends for 2011 include IT, new care models

*OK it should be constant, but like our patients these magnets are not all the same - they have varying levels of vulnerability.

To follow some definitions from an olde book ...

h2cm and clinical equipoise

The past few weeks reading the Journal of Evaluation in Clinical Practice - I've encountered the concept of equipoise: specifically the clinical form.

The Health Career - Care Domains - Model is all about 'poise'.

The model's care domains provides the perfect workout.

Medicine, health and social care constantly exercises us. We are whether or not we recognize it on a balance board. In fact if you consider that image and then factor in the complexity of health care today you realise just how much stuff (technology), how many people (subjects, agents) need to be on that same board. Who does the board belong to though? Well of course it's -

Jo (off-balance, strengths depleted, sick (and tired), prone to relapse, bank poleaxed...) Public's !

The April 2010 issue of the above journal is a fascinating read. I noticed today that some of our placement students were not aware of the recent and current position regarding health policy: that is the 'long view' of decades such as: Health of the Nation, the National Service Frameworks, Darzi ... They need to address that and I'm sure they will.

This journal issue prompts me to consider evidence based medicine anew, especially:

• How long it's been around - some 20 years.
• Its occupying the SCIENCES domain, with its weight threatening to overbalance all (you could say it's a significant singularity).
• The realization that the Emperor is short on clothes.
• Given the above it can mature. Bogdan-Lovis and Holmes-Rovner (2010)

Back to that board: and stepping onto the health care domains - all four of them so spread your feet - you can see instantly (feel that feedback) how EBM, shared decision making and (person) patient-centered care are all related. As Bogdan-Lovis and Holmes-Rovner (2010) highlight:

Equipoise is the heart of the shared decision making movement, and it embodies the problems for which patient decision aids are most often developed to explain the risks and benefits of competing alternatives. p.377.

h2cm is well suited to this task on so many levels.

The past week or two I've also noticed several mentions of the need to nudge people - here and there - both in the media and in Bogdan-Lovis and Holmes-Rovner's paper and references.

More to follow - and as you step-off take care ....

Wilson, K. (2010) Evidence-based medicine. The good the bad and the ugly. A clinician's perspective. Journal of Evaluation in Clinical Practice, 16, 398-400.
Bogdan-Lovis, E., Holmes-Rovner, M. (2010) Prudent evidence-fettered shared decision making. Journal of Evaluation in Clinical Practice, 16, 376-381.

And for the week ahead:
One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?
http://hodges-model.blogspot.com/2009/02/one-mind-many-minds-one-planet-one-need.html

Care Logistics: have model will travel ...

From: NHS Logistics - supplies, v4m, corporate, orders, consultancy, catalogue, process, delivery, stock, just in time, service, quality, priority, efficiency, customers, finance, contracts ...
	To: Care Logistics - access, choice, attitude, empathy, communication, values, outcomes, human rights, dignity and respect, quality care, professionalism, purpose, roles, holistic competency, standards, personal, measures, equity ...

England: The future of the National Programme for IT

Department of Health - 09 Sep 2010 12:32
The future of the National Programme for IT
-----------------------------------------------------

A Department of Health review of the National Programme for IT has concluded that a centralised, national approach is no longer required, and that a more locally-led plural system of procurement should operate, whilst continuing with national applications already procured.

http://www.wired-gov.net/wg/wg-news-1.nsf/lfi/415392

My source: Wired-GOV

Ru! Ru! Ru! Ru! ..... alarmed by the noise? [ambient care]

Working in nursing home liaison I am a regular visitor to various homes in my patch.

As I respond to referrals inevitably I spend several minutes waiting to see residents, relatives and staff. At this point I can take in the ambience of the home and all too frequently what stands out is the home's call system.

Many are acutely effective.

Even though I am not there for long - 30-60 minutes, the volume, tone and the overall quality of some of these systems can be grossly irritating. Due to the care needs of the resident population the alarm calls are also a constant. This is not just my audiological experience, but one shared with students on placement with me.

Attracting the attention of staff is crucial. Caring staff do want to know who, where and when someone needs assistance. Ironically, sometimes that annoying, intrusive alarm call is supported with a plaintive shout for "someone!". As ever there are many ways to define person centred care. In response to the alarm's screech, scream and shrill the staff head to the panel and seek direction to Room 3 or 7.

If care is personalised then whatever happened to our signature tunes? Did this individual play a musical instrument? Gleaned from their life history record this might at least include Jo's musical favourites? It's true that existing alarms are anonymous, and so confidentiality is preserved. Meanwhile though peace, well-being and staff retention rates(?) are lined up against the walls and reverberated, rev erbe rat ed, re ve r be ra te d ... ...

Of course, at some remote future time I might embarrass myself as I press the red button and the Thunderbirds March rings out down the corridor, around a left, a right corner to light a panel.

Fellow residents and visitors might be given to say "Gee, there goes Alan Tracy needing help again!" Maybe by then the robots will have it sorted: the latest in-situ care units will save the day and people's ears.

Seriously though: designers, owners and managers of homes must consider the acoustic architecture of the care environment; or are they also anticipating a rise in the average age of employees with a consequent impact on the hearing acuity of employees? As to the quality of life of the residents go figure: 5, 4, 3, 2, 1!

New challenging behaviour charter launched

I noticed the item below (with links and images added here) on the Foundation for People with Learning Disabilities Forum. It makes a very important point:

"The label 'challenging behaviour', has become misused over time."

My worry is that this finding is not just relevant to individuals with learning disability and their families, but other groups.

People with dementia, especially in the latter stages can present with behaviour that is increasingly described as 'challenging'. Care facilities are being commissioned and designed with the requisite care, staffing and environment to provide care for people in an effort to provide the highest quality and standard of nursing care.

To some extent these are distinct groups with specific needs. So the use of 'challenging' in one context obviously has a different currency and meaning in another. Whilst the practise and care environments may be separate, is there no place where cross-over may occur? I remember a local RCN meeting presentation that highlighted the demographic trend of dementia within the learning disability population.

To start a painting we often start with a wash:
efficiency - puts a broad brush in the hand.

As we aspire to provide person-centred care
what type of brush do you hold?

We paint with the words we use - take care.

---

The Challenging Behaviour - National Strategy Group has launched a charter to promote the human rights of individuals with learning disabilities who are perceived as challenging.

Up to 27,000 people with learning disabilities in the UK may have been given a label of challenging behavior, resulting in this group of people being - stigmatised and socially excluded denied the right to ordinary lives in the community, to education, recreation and employment placed in institutional settings a long way from home and families.

The label challenging behaviour, has become misused over time. Rather than being used as a term to encourage carers and professionals to understand the underlying reasons for a person's behaviour, 'challenging behaviour' has been used as a diagnostic label, viewed as being intrinsic to the person.

The Challenging Behaviour - National Strategy Group want people (and organisations) to sign up to the charter to register their support for the principles it contains and to commit to action to improve the lives of children and adults who are labelled as challenging. We need as many people as possible to support us, so please ask your friends and family to sign up too.

To read the charter, including an easy read version visit:

http://www.challengingbehaviour.org.uk/

ENDS

What is the Challenging Behaviour - National Strategy Group?

The Challenging Behaviour - National Strategy Group (CB-NSG) was launched on November 7th 2008. The CB-NSG is a key national group to address the needs of children, young people and adults with learning disabilities whose behaviour is perceived as challenging.

Members of the CB-NSG include family carers, representatives from the Department of Health, Royal College of Psychiatrists, British Psychological Society, Royal College of GP's, NHS Trusts, researchers, service providers and a range of practitioners, regulators, commissioners and third sector representatives. The group is action and outcome focused and comes together twice a year to monitor progress, share best practice and develop coordinated action plans.

What is challenging behaviour?

"Behaviour can be described as challenging when it is of such an intensity, frequency, or duration as to threaten the quality of life and/or the physical safety of the individual or others and it is likely to lead to responses that are restrictive, aversive or result in exclusion." (Challenging behaviour - a unified approach; RCPsych, BPS, RCSLT, 2007)

Challenging behaviour is things like hitting your own head against a wall, pulling curtains down or pulling someone's hair. Often people do this because they cannot communicate with words and they have little or no choice and control over what is happening to them. How do I find out more?

To find out more about the Challenging Behaviour National Strategy Group, please refer to 'All change' the Summer issue of 'Challenge' today. This issue focuses on the work of the National Strategy Group and includes articles from Dr Roger Banks (Consultant in the Psychiatry of Learning Disabilities), Jackie Edwards (Family carer) and Bob Tindall (United Response).


'Challenge' is the newsletter of the Challenging Behaviour Foundation and is available free of charge by emailing: info at thecbf.org.uk or downloading from www.challengingbehaviour.org.uk

Helen Marron
The Challenging Behaviour Foundation
Email: info at thecbf.org.uk

Seeing Standards: A Visualization of the Metadata Universe

The sheer number of metadata standards in the cultural heritage sector is overwhelming, and their inter-relationships further complicate the situation. This visual map of the metadata landscape is intended to assist planners with the selection and implementation of metadata standards.

Each of the 105 standards listed here is evaluated on its strength of application to defined categories in each of four axes: community, domain, function, and purpose. The strength of a standard in a given category is determined by a mixture of its adoption in that category, its design intent, and its overall appropriateness for use in that category.

The standards represented here are among those most heavily used or publicized in the cultural heritage community, though certainly not all standards that might be relevant are included. A small set of the metadata standards plotted on the main visualization also appear as highlights above the graphic. These represent the most commonly known or discussed standards for cultural heritage metadata.

Content: Jenn Riley
Design: Devin Becker
Work funded by the Indiana University Libraries White Professional Development Award
Copyright 2009-2010 Jenn Riley

My source:
Peter Kurilecz, RECORDS-MANAGEMENT-UK list and David Green, Archives & Archivists (A&A) list

A paper by Anzures-Cabrera & Higgins, Graphical displays for meta-analysis: An overview with suggestions for practice

The interesting paper below is currently available online:

Graphical displays for meta-analysis: An overview with suggestions for practice,
Judith Anzures-Cabrera, Julian P. T. Higgins

Keywords: meta-analysis • graphical displays • forest plot • funnel plot • Galbraith plot • L'Abbe plot

Abstract:

Meta-analyses are fundamental tools for collating and synthesizing large amounts of information, and graphical displays have become the principal tool for presenting the results of multiple studies of the same research question. We review standard and proposed graphical displays for presentation of meta-analytic data, and offer our recommendations on how they might be presented to provide the most useful and user-friendly illustrations. We concentrate on graphs that specifically aim to present similar sorts of univariate results from multiple studies. We start with forest plots and funnel plots, and proceed to Galbraith (or radial) plots, L'Abbé (and related) plots, further plots useful for investigating heterogeneity, plots useful for model diagnostics and plots for illustrating likelihoods and Bayesian meta-analyses.
Copyright © 2010 John Wiley & Sons, Ltd.

Judith Anzures-Cabrera, Julian P. T. Higgins (2010) Graphical displays for meta-analysis: An overview with suggestions for practice, Research Synthesis Methods, 1, 1, 66-80.
DOI: 10.1002/jrsm.6

<->

I will explore these plot / diagram forms and update the diagrams listing on Links II accordingly. I wonder if this journal will re-visit the question of visualization methods in the humanities - social sciences?

Prime Minister’s Commission on the Future of Nursing and Midwifery in England – 2010

Earlier in March The Prime Minister’s Commission on the Future of Nursing and Midwifery in England published its final report.

You can download the report in full.

Box 3.1.2 (on page 43) features key statistics on nursing and midwifery:

• In 2009 there were nearly 595,000 RNs on the register residing in England, 77% of them registered in the adult nursing branch.
• In 2009 there were over 31,000 RMs on the register residing in England.
• Nine out of 10 of RNs in England are female.
• There are disproportionate numbers of men in more senior nursing positions and certain specialties: a third of mental health nurses, for example, are male.
• Nearly all RMs in England are female. There are 131 male midwives.
• Well over half the RNs and RMs working in the NHS in England (57%) are aged between 35 and 54, with less than 3% under 25. Almost 70% of RNs and RMs on the NMC register in England are aged 40 and over.

Reporting on the Commission's report the RCN Bulletin (10 March) notes the need to encourage more men into the profession and people from black and ethnic minority groups. As the list above highlights, however - There are disproportionate numbers of men in more senior nursing positions and certain specialties: a third of mental health nurses, for example, are male.

From my early nurse education days (especially from mental health to general nursing) you had no choice, but be aware of gender and just w(h)ere you had landed. Upon my first encounter with Hodges' model, the model stood out in the list of theories and models of nursing.

It was not listed on the original nursing theory website.
(Hence, the initial website project)
The majority of models and theories were created by women and outside England.#

The future of nursing depends on successfully addressing* the numbers: totals, proportions, recruits, retirees*. ... We can use the numbers, quality, safety and I have to say - Hodges' model to help craft the creative and innovative messages needed. We really are in for a fascinating and exciting 20-30 years in nursing; here in the UK, EU and Internationally. There is much more in the Commission's report to reflect upon which will follow here. ...

http://cnm.independent.gov.uk/

* Note the use of 'addressing' not balancing - that's why this is also challenging.
# This is not a complaint, just an observation.

Additional link:

Sciences care domain: Nursing theory and models of care resources

Second IEEE Workshop on Interdisciplinary Research on E-health Services and Systems

Call for papers
Second IEEE Workshop on
Interdisciplinary Research on E-health Services and Systems

IREHSS 2010
June 14, 2010: Montreal, QC Canada

PAPER SUBMISSION EXTENDED DEADLINE: 6 March, 2010
************************************************************
(Edited for length please see website)

In the last few years advances in wearable computing, bioengineering, wireless sensors networks, mobile devices and wireless communications have paved the way to new definitions of e-health systems, moving from original telemedicine systems to the integration of existent specialized medical technologies with pervasive technologies. However, even more work on this area is needed to obtain significant results in improving the Quality of Life of patients and reducing medical errors and costs. First of all, a strict interaction and cooperation among medical specialists and ICT experts is necessary to define correct requirements fore-health systems. Then, in order to effectively design and deploy reliable E-health systems, a strong cooperation among several diverse research areas of ICT is necessary (i.e., bioengineering, wearable sensors, wireless communications, data fusion and processing, decision support systems and others). This is fundamental to make E-health systems a reality, satisfying main requirements of reliability and effectiveness both all the involved perspectives perspective.

IREHSS aims to provide a forum for the interaction of experts belonging to these different research areas, from wearable computing and ubiquitous connectivity to context-awareness, sensor data fusion, artificial
intelligence, expert systems, databases, security and privacy. The main objective is to provide a forum for the interaction of these multiple areas as an important chance to discuss and understand what aspects have to be considered to provide effective E-health systems.

Authors are invited to submit papers presenting new research related to E-health, not published or currently under review for another workshop, conference, or journal.

Areas of interest include, but are not limited to:

• Wearable and Implantable sensors for healthcare
• Wireless communications in healthcare
• Service and device discovery
• Data fusion and context elaboration
• Privacy and security issues in healthcare
• Middleware for e-health
• Energy Efficiency in health monitoring
• Artificial intelligence and expert systems
• User interface, usability and acceptability of e-health systems
• Healthcare applications for clinicians
• Home monitoring and ambient assisted applications for healthcare
• Power Management and energy-efficient design in Wireless Body Area Networks
• System architecture and networking protocols for e-health systems
• Medical data analysis, measurements and management
• Modeling and performance evaluation
• Semantic Web in Healthcare
• Standards and frameworks

Paper submission for regular papers must be limited to 6 pages including text, figures, references and appendices. They should be organized in IEEE proceedings format, with a font size of at least 10pt. Papers exceeding the maximum length of 6 pages will be automatically rejected. The IEEE LaTeX and Microsoft Word templates, as well as related information, can be found at the IEEE Computer Society website:
http://www.computer.org/portal/site/cscps/index.jsp .

The submission will be entirely managed through EDAS (http://edas.info/N8548).

Important Dates:

Papers registration EXTENDED : March 3, 2010
Papers submission EXTENDED deadline: March 6, 2010
Acceptance Notification: April 5, 2010
Camera Ready deadline: April 20, 2010.

See http://www.irehss.org/irehss2010/ for additional information or
contact the workshop organizers at irehss2010-chairs at iit.cnr.it .

Publicity Chair:
Eleonora Borgia, IIT-CNR, Italy

Additional links:

Journal of NeuroEngineering and Rehabilitation (JNER, http://jneuroengrehab.com )

IEEE Int. Symposium on a World of Wireless, Mobile and Multimedia Networks (WoWMoM 2010)

NT: Nurses urged to use checklists to reduce human error in practice

Last month Nursing Times included an item on checklists, highlighting work by the WHO in perioperative nursing and the Patient Safety First campaign. Following surgery's lead is the realisation that similar checklists have the potential to improve communication and team working in other areas such as nutrition, situational awareness and pressure ulcer care.

Checklists are ubiquitous in our day-to-day lives, the dividend for using them is fairly obvious. What is less obvious is the fact that checklists alone are dead bureaucratic adornments. Checklists are animated by situations and thinking, reflective individuals in those situations. As Lomas reports there is a need to stop at an agreed key point in the patient pathway and ask the critical - checklist - questions. In team work this co-ordinated acknowledgement to complexity is essential for comprehensive, consistent and safe care.

What is interesting here is the emphasis on human factors. While checklists undoubtedly have a demonstrated - proven - role to play in safety, situational awareness is not a product of checklists alone. There is a need for learning and for the cultivation of cognitive lists. While human memory is fallibility incarnate - hence the role for checklists - there is also the need for skilled, knowledgeable professionals with the required communication and observational skills. The need for nurses to further develop observational skills has also been highlighted over recent months.

So as checklists are checked and logged: prepare a space for the mental checklist that is Hodges' model. The model is situated, person-centered and one of the original purposes was to help bridge the theory - practice gap. Try doing that with a checklist: alone

Clare Lomas Safety checklists could cut 'human error' in clinical practice, Nursing Times, 106, 3, 26 January 2010, p.2.

HoNOS, checklists and semi-structured interviews

Mental health services not routinely (and formally) using HoNOS (Health of the Nation Outcome Scales) are gearing up with a push to implement the scale across services by April. HoNOS has been around for a long time almost 20 years so it is time it earned its keep. Perhaps high quality tools take time to emerge from the noise and chatter of the care marketplace? ;-)

Although they are available, I've been putting a presentation together to help get to grips with HoNOS in the role of a trainer. The evidence for the validity and benefits of using HoNOS is well established, with the HoNOS family of scales boasting global usage and development:

• HoNOS for working age adults
• HoNOS65+ for older people
• HoNOSCA for children and adolescents
• HoNOS-Secure for use in health and social care settings secure psychiatric, prison health care and related forensic services, including those based in the community)
• HoNOS-LD for learning disabilities
• HoNOS-ABI for acquired brain injury (ref.)
  

The number of assessment, intervention and evaluation tools available to clinicians AND managers begs the question (ironically): is there 'space' in the toolkit for yet another tool? If HoNOS can help establish a coherent currency for mental health commissioning beyond the block contract then this is most welcome. Mental health services need to move forward on several fronts. There is a timeline running with completion of this difficult task in its sights.

One set of guidance for HoNOS points out that:

The scales are not used as a checklist or semi-structured interview, but form a brief record of severity.

There is some succor there then, since Hodges' model is a checklist and a quad-structured interview there is still a role for a global conceptual framework.

There's nothing like a full and tidy set of tools!

Ref. http://www.gpsa.org.au/media/docs/mentalhealth/honos_information.pdf

DoH: Honos health of the nation outcome scales report on research and development July 1993 - December 1995

Additional links:

The UK Routine Clinical Outcomes in Mental Health Group

The NHS Information Centre: Mental Health Minimum Dataset

RCP references

Nursing & Midwifery Council consultation on standards for pre-registration nursing education

This NMC consultation seeks your views on new standards for pre-registration nursing education programmes. These standards set out what nursing students must demonstrate to be fit for practice at the point of registration.

They will be used by Approved Education Institutions (AEIs) and their partners within the UK to design and develop education programmes.

The new standards

The proposed standards have been developed following a review of the existing Standards of proficiency for pre-registration nursing education (NMC 2004) [PDF]. They set out the requirements that all pre-registration nursing education programmes must meet.

They also set out guidance, which should be followed by AEIs and their partners. Finally, they offer advice, providing extra information and context to those who design and develop nurse education programmes.

There are two parts to the standards:

• Standards for competence the knowledge, skills and attitudes that all graduate nurses need to demonstrate at the point of registration with NMC. Generic competencies need to be met by all nurses. Field competencies relate to the four fields of adult, mental health, learning disabilities and children’s nursing.

• Standards for education the requirements all pre-registration nursing programmes have to meet, including those relating to the teaching, learning and assessment of nursing students. The standards for education have been developed to ensure students’ competence can be rigorously assessed and demonstrated. The standards must be robust enough to meet public expectations for safe and effective practice.

The standards for pre-registration nursing education will be published in the autumn of 2010. They will replace the existing Standards of proficiency for pre-registration nursing education. New education programmes, designed to meet the new standards, will be introduced from September 2011.

The consultation

This consultation gives us the opportunity to receive your feedback on the proposed new standards. We want to know:

• how effective you think they will be in enabling programme providers to develop nursing education programmes
• how they can be enhanced or improved
• whether you can see any barriers to their successful introduction
• whether they are clear and easy to use
• whether we should include anything else and
• whether they support and promote equality and diversity.

Some of the requirements and guidance in the proposed standards for pre-registration have been carried over from the current Standards of proficiency for pre-registration nursing education (NMC 2004). [PDF]

Most of the questions in this consultation will ask you about information that is new, or where there have been major changes to the existing requirements.

Get involved
Our online survey will run from 29 January to 5pm on 23 April 2010.
Link to survey page.

Attend a question and answer event

During February and March we will host five question and answer events across the UK.

If you are considering taking part in the consultation, this is an opportunity for you to ask NMC professional advisors who have been leading this review any questions you have about particular aspects of the consultation document or the new standards.

The events are designed to support you in completing the online survey - their purpose is not to receive feedback on the new standards.
To find out more go here.

My source NMC mail list:
Leila Harris-Ryberg
Communications Officer
Press and Public Relations
Communications and Stakeholder Relations
Nursing & Midwifery Council
23 Portland Place
London W1B 1PZ
www.nmc-uk.org

Nursing and care homes: the new schools 4 basic nursing care?

I do not wish to denigrate the quality of care in nursing homes, as I've blogged previously there are others better placed to do that when needed. In some the nursing care is exemplary and this is evident not just in their inspection rating, but the morale of staff, the reports of relatives and local community plus other indicators - especially when you visit and use your senses. As a nurse you are duty bound to assess the quality of care wherever your practice takes you. In the homes where the care is very poor, there is no escape from that reality. The reality of poor care first hits visitors when they smell the home they have entered. If there is no escape for them - well what then of the residents and staff?

Now an extended and dedicated role for nursing home liaison within community mental health nursing has arrived* and taken root, this must say something about the quality of care in this sector (and not merely suggest a shortage of Consultant Psychiatrists)? Nurse, service managers and commissioners recognise that if they do not preempt the referral torrent (or trickle from some care homes!) then community teams will grind to a stand-still. Care homes need assistance even as private businesses in assuring their holistic competency.

If services do not stem that referral flow as a wave or otherwise, they will in turn become second rate first-aiders with no primary purpose. They will be forced to respond repeatedly to the same client RE-referrals, the same set of disjointed, fractured physical:mental:social health problems presenting in a series of unique individuals. And this is not person-centred care.

What the nursing home liaison role says is that here is one place we can locate the theory-practice gap, a skills gap and a lack of integrated, holistic person-centered care. Mash-ups may be desirable in the virtual world, but in care delivery - is that safe? Too frequently the mash-up of combined physical and mental health problems pass staff by. The problems go unrecognized, they are there: evident, but disguised; due to lack of comprehensive observation, life histories and despite the question and answer sessions at the gates (service interface). However it is described (e.g. single point), the specialisation of community mental health teams into memory assessment, intermediate, community mental health, ... depends on the vibrant management and quality of referrals.

Much is made of nursing homes registered as EMI (Elderly Mentally Ill) and their need for or access to a registered mental health nurse (RMN); but RMNs in turn rely on the ability of more junior staff to observe and accurately report the basic aspects of the resident's physical and mental state. If equity for older people in care is to be achieved, then although the care - nursing home sector is 'private' and a 'business' there must be an accommodation, a partnership when it comes to education and valuing time invested in these homes.

*Additional links:

http://www.careinfo.org/congress/pdf07/07par.1340q2-joannehirst.pdf

http://www.mentalhealthequalities.org.uk/our-work/later-life/communities-of-interest/care-homes-liaision-/hartlepool-care-home-liaison/

Image source: Neo - The Matrix http://www.dailygalaxy.com/my_weblog/psychology/

Comment on Paul Roemer's "EHR market is ripe for the taking by Google, Microsoft, Oracle"

I read with great interest Paul Roemer's post last month -

EHR market is ripe for the taking
by Google, Microsoft, Oracle

I've a lot of respect for the people working at that other sharp end of health. There are times when they are where I would like to be: not the bleeding edge, but the business edge:

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.

Mr Roemer is out there among the corporations, the deals, the the media frenzy and the stock market's take on health care AND health IT. He is addressing specific audiences and over here in the UK we can hear the debate raging. My problem is that working for the NHS all my career I have been and am cocooned. Even though I try to venture out and get involved, this is the very powerful criticism of long-term public sector employees. While far from totally sheltered from economical and political climate change, we are protected from the worst of the business elements. Despite this, seeing the title of Paul's post and his two rules:

Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.

Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

- two additional rules sprang instantly to mind. ...

Rule 3: Beware low hanging fruit

I posted in April 2009 Data sharing, privacy, health, citizenry.... "Database State" expressing concern that the sanctity of personal data is being eroded bit-by-bit in the mind of the general public by the media and the sheer ubiquity of information and technology. Peaches, plums, pears are delicious when ripe, but as such they need to be handled very carefully. So too does the Personalised health record amid a variety of threats - the worst of which are often internal. In health care the patient data that Paul identifies in his Rule 1 is central, and a key issue is the demarcation of individual and anonymised aggregated data. Hence, Paul quite rightly points to a regulated market. Personal data can be far more valuable in terms of direct marketing and so the temptations for misuse are profound.

In the UK an NHS consultation has addressed the additional uses of patient data. This concerned the research capability programme and provision of a health research support service; with events to present proposals and debate the various issues that include information governance. The report of that consultation is provided below (care of the NHS-HE Connectivity Project list):

http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_109310

Information governance is not fixed, nor should it ever be.

In Paul's rule 1 content is king and content=data - in this case:

• patient data;
• effectiveness data;
• disease data.

This list of data would surely qualify as being 'broad spectrum' in nature. If its circulation is not very tightly controlled it can damage the (care) environment. If not managed effectively across multifold 'borders' - national, regional/state, corporate, systems, organisations, users, testing, interfaces, legislative, public bodies - this data can mutate markedly despite the insistence upon standards. You see although Google, Microsoft and Oracle may take that ripe fruit, as they pick it they come across -

Rule 4: Whenever and wherever picked,
fruit can be tainted

This might include the odd bug, or one or two tainted fruit items perhaps? It could be problems in the form of parts of the EHR that are difficult to incorporate, with questions of shared access and ownership? (If the fruit is indeed pristine, no blemish, no chemicals, no truly-devoted-insect-kisses: what are the overheads - especially those in the form of corporate responsibility?)

Now don't mistake me: I'm also sick to the gums of flannel and people talking jargon. I've seen medics, nurses and nurse managers waving their arms around stressing the importance of their profession, this action followed by that and pointing to the shrouds (my right index finger twitches as I write). But if Google, Microsoft and Oracle believe they can do an Indiana Jones and just shoot to solve the problem because - as Paul suggests - they have the 'numerics' in the cable/telco model, then they need to take care (even if only improvising).

Microsoft, CSC and many other corporations already know of the complexity that reigns (pours in fact!) from their experience in health IT. Paul highlights Google as a new kid in town. Maybe acquisition does obviate the need to learn quickly (let others learn the lessons). But whatever the point of entry: health care remains a cussed business. And the future mix demands (begs!) the integrated addition of social care, but how and to what level?

It is not enough to counter "let's attack this complexity with simplicity." Health and social care are metronomic. They alternate between complex - simple descriptions (one of which is re-organisation). Plus, that metronome may as well be in a closed box:

Schrodinger's. Care to gamble?

Paul's choice of 'downstream' referring to the eventual valuation of PHR subscribers does lessen the mechanistic clang-clang as the subscription counter falls. There is a space for the person - for the humanistic aspects to shine through. Paul's post is also fascinating since such numbers do count and speak volumes (sorry - but they really do). They will not only reach shareholder's ears, but the general public's too helping erode the cherished sanctity of my personal data. So am I saying that some of the giants of corporative intelligence turn and run screaming, arms raised like surprised Martians in alien territory? No.

Maybe, as I have found -

the real low hanging fruit is the m+del.

Is it as ripe and appropriate in this market as it seems?

Or is it past its sell by date?

Time as ever will tell.

Additional links:

NHS data breaches: the 'cogeography' of who and where?

EHR market is ripe for the taking by Google, Microsoft, Oracle

Paul Roemer (twitter)

Image source:
LowHangFruit.com

=============== Paul's Post Follows ==============

December 17th, 2009

by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.

As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.

Why does this model make sense? Two ways, both of which come from the cable/telco business model.

Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.

Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

So, back to the example of me running Google's healthcare offering. (If you don't like Google as an example, insert your favorite firm.) If I'm Google, am I troubled by the fact that other firms are building their own solutions? No, because the difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some 'ownership' or right to use the data? That would certainly be the business goal.

One million users valued at $5,000 adds $5 billion in valuation. Ten million adds $50 billion. Ten billion is about 2.5 percent of the U.S. market. Do I stop at the border? Of course not.

By the way, while all this is going on, Google, Microsoft, or some other company will also be creating standards and building or buying up EHR firms.

memo FROM: Classroom health TO: Global health - PSHE education and model standards

Health care and educational professionals learn and adopt the key tools of the trade whilst training. Although for several decades experiential learning has also gained recognition and weight, it is the learning of theory and relation to practice in basic training that shapes the future career. We can describe this as formative professional education. We then hope that this learning and the tools in use are then updated according to research, evidence and best practice. There is much navel gazing at present as to how to measure, nurture, instill and strengthen the character trait of compassion. This applies not only to children, but within nursing.

This issue highlights of course what students bring with them to the lecture theatre, clinical arena and what they take from there to carry them through their professional career. My ideal would be that students have already learned and used Hodges' model as 14-16 year old's, as they negotiate their personal, social, health and economic (PSHE) education.

While Hodges' model is a world away from a de jure standard
- that is, defined and enforced by the ISO -
it might just :) become a de facto standard,
because of its widespread adoption in and beyond the classroom.

There is a great opportunity here for Hodges' model in the UK as PSHE education becomes compulsory in 2011. Perhaps you can help in or beyond the UK?

Reference:
Mooney, H. (2009). Can you measure compassion?, Nursing Times, 21 April 2009.

Blog post inspired by adamatronics groups.drupal.org Drupal in Education: Joint effort on a D6 SCORM API

tags: 'preventive medicine' + 'preventive medical sociology'?

Innovation and the 'middle' in NHS computing

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:

Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional links:

Computing, Letter of the week, UK is cursed with an anti-innovation culture, 5 November

BCS Sociotechnical Specialist Group

eHealthNews NHS Bury Primary Care Trust Goes Live with iSOFT Lorenzo RC 1.9