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Biomedical subjects

Siaw-Teng Liaw

Publications and source records attributed to Siaw-Teng Liaw.

8 recordsLinked to original sources
PubMed2006

Clinical, information and business process modeling to promote development of safe and flexible software.

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

Asthma↗
PubMed2005

A compulsory experiential and inter-professional rural health subject for undergraduate students.

CONTEXT: The Australian University Departments of Rural Health (UDRH) program aims to improve the rural workforce through improving rural experiences of undergraduates, graduates and health professionals. The 10 UDRHs vary in the way they implement the UDRH Program. This article describes the development of a compulsory, experiential and inter-professional rural health subject in a medical curriculum by the UDRH at the University of Melbourne, Victoria, Australia. The key concepts, underpinning theory, processes, logistics and resources required to develop and implement the subject among a network of small towns and Indigenous communities are examined. METHODS: METHODS used included formative evaluation using a participatory research approach, including the examination of internal discussion papers, minutes of meetings and planning workshops, financial records and feedback from students, staff and preceptors. ISSUES: Students, staff and preceptors generally accept the value of the rural health module in professional training. However, they stress the need for explicit learning objectives, relevant content and engaging delivery. Students expressed some concern about the compulsory nature of the subject. Significant issues are capacity, quality, sustainability and managing expectations of government and communities. Capacity includes the availability of appropriate placements and preceptors who have the capacity and capability to teach or to be supported to teach. The availability of appropriate and affordable accommodation is important, as are the cost and safety of travel to and from placements. Sustainability of 'placements' and 'placement fatigue' must be managed with a combination of resources and preceptor training and support. Quality of placements is important and highlights a paradox in that, while academically rigorous teaching, research and clinical programs for students and preceptors are important for quality, they are mostly perceived as additional burdens by health service providers. Finally, the expectations and commitment of stakeholders, in particular governments and communities, for student placements must be realistic and backed with resources. LESSONS LEARNED: A compulsory experiential inter-professional subject for undergraduate students is possible but requires significant resources and commitment over the long term. The resources must include funding for: preceptor time, training and support; recruitment and retention of appropriately qualified academic clinicians; intersectoral strategies like improved public transport and safe roads; community and other stakeholder engagement to develop and maintain educational facilities. Last but not least, funding is essential to support the long-term evaluation and monitoring of the outcomes in terms of the quality and quantity of the rural workforce over time.

Australia↗
PubMed2004

Developing a conceptual understanding of rural health practice.

OBJECTIVE: This study presents a set of concepts underpinning rural practice that could assist teaching health and medical students. OUTCOME: Five concepts, important in distinguishing rural health practice, are presented and discussed. These are rural-urban health differentials, access, confidentiality, cultural safety and team practice. Together these concepts impact the ways in which rural health professionals provide care, due to fewer services, greater distances, smaller populations, less choice of services and smaller workforce. CONCLUSION: These concepts introduce students to some of the positive and negative aspects of rural practice, as well as opportunities for rural practitioners to have a diverse practice, to become involved in all aspects of health and to initiate change. They provide an understanding of rurality from which health students can learn from their practical experiences during rural placements.

Attitude of Health Personnel↗
PubMed2004

RACGP training registrars' perceptions and practice of prostate cancer screening.

AIM: To examine the perceptions, knowledge and reported intended practice of prostate cancer screening by general practice registrars. METHOD: A descriptive study using a mail survey of all Victorian general practice registrars and supplementary interviews. RESULTS: The response rate to the questionnaire was 74% (n = 148). The reported correct answer for the sensitivity and specificity of digital rectal examination (DRE) and prostate specific antigen (PSA) test was 48% and 52%, and 30% and 35% respectively. Responses to questions about registrar's knowledge of screening guidelines indicated respondents believe that men aged 50 years and over should undergo annual screening. Over 50% of respondents were not familiar with any Australian guidelines for prostate cancer screening. However, reported intended practice was consistent with guidelines, with 73% of respondents indicating they would not perform a PSA test as part of a 55 year old man's check up. Qualitative interviews highlighted the importance of The Royal Australian College of General Practitioners supervisor, peer learning at release sessions, and study group preparation for college examination in their clinical decision making. Online learning and access were seen to be potential areas for further development. DISCUSSION: While knowledge about the characteristics of tests for prostate cancer and Australian prostate screening guidelines is poor, most registrars practice according to current guidelines. The potential of online learning and increased access to the internet needs further study.

Australia↗
PubMed2003

Falls prevention within the Australian general practice data model: methodology, information model, and terminology issues.

The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed.

Accidental Falls↗
PubMed2003

Doctors' perceptions and attitudes to prescribing within the Authority Prescribing System.

OBJECTIVE: To examine doctors' perceptions and attitudes to prescribing within the Authority Prescribing System (APS). DESIGN AND SETTING: Questionnaire survey of Australian doctors' responses to a number of statements and factorial vignettes, conducted between 1 May and 30 June 2001. PARTICIPANTS: A national random sample of 1200 doctors, stratified according to specialist/generalist, rural/urban and high/low prescriber: 669 (56%) responded. MAIN OUTCOME MEASURES: Self-reported perceptions of the APS and attitudes to prescribing within the APS. RESULTS: 72% of doctors agreed that the APS makes effective medications available to the socioeconomically disadvantaged members of the Australian public and 50% agreed that it compromises patient privacy. Fewer agreed that authority indicators were based on the highest quality of evidence quality (40%) or medication safety (12%). Doctors placed more emphasis on the doctor-patient relationship than on the criteria for authority prescribing in their decisions about prescribing APS medications. Doctors who used computers to prescribe were more likely to agree that computers can improve the authority prescribing process. CONCLUSIONS: This study suggests that authority-required prescribing is not achieving the stated aims of the National Medicines Policy in reducing variability in prescribing. Strategies to improve the quality of prescribing must consider the professional and ethical conundrum associated with prescribing outside of PBS/APS approved use for clinical and patient-centred reasons.

Adult↗
PubMed2002

General practice and computing standards.

BACKGROUND: 'Standards' refer to common standards for communication and exchange of information about goods and services. Embedded within these common standards are gold standards for quality, privacy, safety and performance. Technical and semantic standards are essential building blocks for the required information and communication infrastructure to support the secure management and sharing of high quality information across general practice and the health care system. OBJECTIVE: To describe the current developments and implications of terminology, architecture and messaging standards in general practice. CONCLUSION: The current Health Online framework and National Health Information Standards Plan, with nationally coordinated implementation strategies like HealthConnect and the Better Medication Management System, are encouraging, However, there is little common understanding of technical and semantic standards among clinicians, administrators and researchers in general practice and health care system. The state-Commonwealth and private-public dichotomies are other barriers. As part of their roles as gate-openers in an integrated health care system, GPs must explicitly promote the implementation of national communication and information exchange standards.

Australia↗