GIS a look (and learn)!

Starting work yesterday my colleagues and I had a real surprise.

The boss greeted us as positive, jovial, forward thinking and smiling as ever. Something seemed strange, but as we got to our floor we were handed some note paper and briefed - very briefly - about a "local surprise for you hard-working, dedicated clinicians".

So it was off to the desk and on with the log-in. The surprise came with the provision of a series of maps and questions and exercises. The maps just like google maps, multimaps and other variants provided various views and choices of emphasis; street, satellite and several boundaries: our organization's borders the frontiers of partner PCTs, GP practices, social services. After all these decades GIS had arrived on the clinician's desktop.

There was more to follow though. My mug-shot was there in addition to my colleagues (ah... I'd wondered what that recent (online*) form was for). Drag and dropping this beautiful pic on the map the nursing homes pulsed (as if to confirm that I am alive at least clinically) and changed colour. I know something about drill down, aggregation and such like and there they were: caseload parameters: gender, referral source, diagnosis (if known), drug classes, MMSE. I was getting heady as it was possible to look at clients living at home AND/OR residential care. I nearly flipped when there was more available about the referrers and not just the frequency of referrals but the expected frequencies too. There was going to be quite a compare and contrast exercise there post-2011 Census.

On another map I suddenly thought of 'use the bus Ethel': a carer who when she could went everywhere and also used the trains. Active body : Active mind and there it was - the travel logistics and public transport routes across the patch. This was not just GIS on the clinician's desktop it was GIS for the caseload manager. What proportion of my caseload was within 2, 4, 6, 8 and 10 .... miles of base?

Individual insight aside there was team oversight too, a tool to engage in peer group supervision - with (and get this) tools for the 'integrated health and social care team' to investigate local commissioning and how that factors in geographically. Amazing! Yes there are tools to do all this now, but they are not in the hands of the people they should be. Reports are just for managers? What a waste!!

I was just really getting ready to do that piano-playing-finger-flexing thing that you do when you are about to be extraordinarily creative. I mean I had waited for this, public MENTAL health.... my mouth was dry and here it was - GIS nirvana...

Then it happened....

It was time to wake up and get to work.

I won't stop dreaming though....

*I should have recognised it was a dream at this point.

Additional links:

Welcome to the GIS Files

The 2011 Census: Office for National Statistics

Free Our Data

ESRI

Mapinfo

SCIENCES knowledge domain: GIS resources under 'Health & Social Informatics I, G.I.S., Classification, Coding, Data Sets & Grouping'

Image sources: Ordnance Survey

Crossroads http://www.photochart.com/photo_1189_Crossroads.html
Copyright Olga Dunaeva member of Photochart

Issue 2, 2009 of The Cochrane Library

Issue 2, 2009 of The Cochrane Library is now available. Among the new and updated Cochrane Reviews you will find :

• Homeopathic medicines for adverse effects of cancer treatments
• Music for stress and anxiety reduction in coronary heart disease patients
• Interventions for preventing falls in older people living in the community
• Extraction of primary (baby) teeth for unerupted palatally displaced permanent canine teeth in children
• Psychological therapies for the management of chronic pain
• Topical treatments for chronic plaque psoriasis
• Alcohol and drug screening of occupational drivers for preventing injury
• And many more … www.thecochranelibrary.com

Some of these reviews have been highlighted in Evidence Podcasts and are free to access.

Please see the Release Notes for a summary of the updates in this issue. Users can also access our Highlights PDF to learn more about the findings of new and updated Cochrane Reviews.
The Cochrane Library

The Cochrane Handbook for Systematic Reviews of Interventions is now available in print format. It is published by John Wiley for The Cochrane Collaboration.

Editors: Julian P. T. Higgins MRC Biostatistics Unit, Cambridge, UK Sally Green Australasian Cochrane Centre, Monash University, Melbourne, Australia

There is a 25% discount for Cochrane Review authors and an information page for the book where authors can also order, with a prompt to enter their discount code.

Wiley authors are entitled to a 25% discount not only on their own titles, but on all Wiley books, when ordering either via the site, by phoning customer services or filling in any printed order forms.

Sign up now for the Author Discount club by filling in the registration form. You will be sent a discount club card with a special promotion code printed on it. You will need this to order via on-line through the shopping cart (just type in the code in the discount information field) or through our customer services department.

Free Training and user guides:
Instructor-led virtual training sessions on The Cochrane Library. Self-paced online tutorials.

For User guides and Powerpoint presentations see the Help page on - Cochrane Library


Images and my source: John-Wiley mail-list

Cash Transactions : Care Continuity

In programming major applications such as finance there is a need to ensure within the transactions and the database operations that mistakes do not occur.

The classic example is a transfer between two accounts:

def transfer(from, to, amount)
  from.debit(amount)
  to.credit(amount)
end

It is vital that the above method (example provided by Tate and Hibbs) does not fail after the debit. In Rails the transaction method help to prevent 'digital accidents' as follows:

def transfer(from, to, amount)
  Account.transaction do
   from.debit(amount)
   to.credit(amount)
  end
end

transaction is itself a method built into Rail's Active Record that helps to maintain the integrity of transactions. Which brings me to 'care'. ...

There are several blog posts here since you reach a stage in your career when the hard fought lessons of yesteryear have to be faced again but this time like after dinner wind.
There are many possible care transactions that arise.

Many have a specific context and frequently these are conjoined:

• timing
• relationships - trust
• responsibility - transfer
• care environment
• record (paper, electronic)
  

As to care transaction consider these:

def transfer(from, to, care_plan)
 Care.transaction do
  from.hospital(care_plan)
  to.community(care_plan)
 end
end

def transfer(from, to, day_care)
 Care.transaction do
  from.home(day_care)
  to.day_center(day_care)
 end
end

Wherever, whenever, whatever and whoever your transactions involve, take care of them and remember in health and social care (esp.) outcomes add up.

Don't forget to look after the however: the information, the knowledge, the promises ....

def transfer(from, to, promise_plan_of_action)
 Care.transaction do
  from.nurse(promise_plan_of_action)
  to.carer(promise_plan_of_action)
 end
end

Reference: Bruce Tate, Curt Hibbs (2006) Ruby on Rails: Up and Running, O'Reilly, p.35.

Leadership Qualities Framework: individuals, teams, boards and systems

I've been catching up on some reading and according to Mike Cooke the (NHS) Leadership Qualities Framework includes vision, emotional intelligence and continued delivery of results. To which he adds:

'We need all three plus the marketing and political skills and some productive leadership skills thrown in. It is about balance in individuals, teams, boards and systems.'

So in Hodges' model then:

individual	systems
teams	boards

There is nothing special about this formulation whether as part of the Leadership Qualities Framework or Hodges' model. Individuals, teams, boards and systems are fundamental building blocks to any attempt to encapsulate and understand the world of local, regional and global health and much more besides.

Mike Cooke, Good Management: On Sizzling Leadership, HSJ, Jan 22, 2009, p.24.

Additional links:

http://www.nhsleadershipqualities.nhs.uk/

Nursing as reverse engineering...

At Scotland on Rails last month one of the sessions included an example of Ruby code outlining a 'morning routine'. It comprised a series of tasks and sub-tasks all of which led to getting to work.

Much of the vital essentials of the code I cannot understand beyond some tentative inklings, but in the hope of learning I've re-hashed the accessible bits and turned it into a NursingRoutine. The output looks like this....

Nursing....
"Non-judgmental attitude"
"Universal positive regard"
"Basic counselling skills"
"Open mind"
"Meet person"
"Receive referral"
"assess person utilizing Hodges model"
"Create care plan"
"Meet physical needs"
"Meet interpersonal needs"
"Meet political care needs"
"Meet social care needs"
"Holistic care"
"Evaluate physical needs"
"Evaluate interpersonal needs"
"Evaluate social care needs"
"Evaluate political care needs"
"Evaluate care"
"caring..."

Something like nursing is obviously a much more complex routine than that implied above - that is because:

• nursing is not [some - 'thing'];
• nursing can be represented as a routine BUT;
• nursing seeks to transcend the routine: emphasizing the personal, unique, the humanistic;
• nursing is parallel and sequential;

In addition now we are about collaborative, multidisciplinary care that must factor in agreement (the care plan...), and patient reported outcome measures (PROMS). ...

In the meantime I need to exercise care trying to understand the program that produced the output (that could also be easily printed as a list). While this is not an example there is such a thing as obfuscated code, but surely not obfuscated nursing care?

ERCIM News 77 - special theme "Future Internet Technology"

The latest edition of ERCIM News has just been published at: http://ercim-news.ercim.org/

Special Theme: "Future Internet Technology"

The Internet is undoubtedly permeating and transforming all aspects of our economies and societies. It is a remarkable catalyst for creativity, collaboration and innovation and more broadly, for the development of our economies and societies. A few examples: in 1998, Google indexed 26 million web-pages, today it indexes 1 trillion; Within only five years, Facebook and MySpace have attracted each more than 100 million users world wide; user-generated content such as YouTube produced more than 73 billion streams in 2008; with around four billion mobile users world wide, the Internet is becoming more and more mobile and capable to support a range of new applications and services that were not foreseen in its original design. Read more...


My source: ERCIM - the European Research Consortium for Informatics and Mathematics - mailing list.

Defining e-Health

E-Health is a compound and dynamic term for people, health (and social) care education and delivery, organisations, information and communications technologies (ICT), infrastructures, policies and means combined to facilitate, measure and improve the intentions, actions and outcomes of health (and social) care.

In a nursing context people refers to patients, carers, nurses and public; means refers to partnerships plus funding ranging from the macro level of the public sector to personal budgets; intentions, actions and outcomes covers education, the nursing process, records, quantitative and qualitative metrics.

To be holistic metrics must incorporate safety, access, personal outcomes, benefits, integrated informatics and economics.

1st draft: (c) Peter Jones