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Innovations in integrative healthcare education: mind-body faculty development at UCLA and the symposium for portland area research on complementary and alternative medicine.

Content on integrative healthcare and complementary and alternative medicine (CAM) is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr. Sierpina at or Dr. Kreitzer at . Submissions should be no more than 700-800 words. Please include any Web site or other resource that is relevant, as well as contact information.

California↗
PubMed2004

Conceptualising geographies of health knowledge: the emergence of new education spaces for public health.

In recent years both new knowledges and new experts have been introduced into public health as part of the development of multidisciplinary practice. This paper presents an analysis of these recent changes, which is informed by theoretical ideas around governmentality and geographies of knowledge. Although critical geographies of public health are starting to emerge the education of professionals, specifically the production and consumption of knowledges within education spaces, remains relatively unexplored. This research extends existing work by critically examining the academic instruction of professionals through the Masters in Public Health programmes. Specifically the paper argues that new spaces of education are emerging to meet the requirements of multidisciplinary practice, however there is no blueprint. Instead a geographically based diversity of practice can be observed which is characterised by enclosures of expertise wherein competing forms of public health knowledge and expert are held as ideal.

Education, Graduate↗
PubMed2004

Spaces and networks of genetic knowledge making: the 'geneticisation' of heart disease.

The 'geneticisation' of health, medicine and the body is extending from single-gene to multi-factorial conditions such as heart disease. Adopting 'Actor Network Theory', the paper argues that the making of genetic knowledge occurs in spaces and networks where contested knowledges necessarily produce a geneticisation that is neither certain nor complete. Drawing on empirical research in a coronary care unit in Glasgow, Scotland, the paper sets out the network of consultants, rehabilitation nurses and people with heart disease and others who collectively, through contestation and the marshalling of knowledges by prominent social actors, produce an understanding of the role of genes in heart disease.

Clinical Competence↗
PubMed2006

Learning to cross boundaries: the integration of a health network to deliver seamless care.

We analysed the development of an integrated network from a learning perspective to see how care givers from different organisations were able to cross the professional and organisational boundaries that existed between them to make sure patients receive the right care, at the right moment, in the right place. We show how through a process of collective learning social contacts between health professionals increased and improved. These professionals learned to speak each other's language, learned how other professionals and organisations work and learned to look at the care process from a network perspective instead of only from a professional or organisational perspective. Through this learning process, they also experienced the limitations of standardizing knowledge in criteria, protocols and rules, and the value of direct contact for sharing information and knowledge, to ensure continuity in care.

Continuity of Patient Care↗
PubMed2006

Critical diagnoses (critical values) in anatomic pathology.

Similar to critical values in clinical pathology, occasional diagnoses in surgical pathology and cytology may require urgent contact of the physician to facilitate rapid intervention or treatment. However, there are no established critical value (critical diagnosis) guidelines in anatomic pathology. As discussed herein, the Association of Directors of Anatomic and Surgical Pathology (ADASP) believes that establishing anatomic pathology critical diagnosis guidelines represents a practice improvement and patient safety initiative. The ADASP also recognizes that a generic anatomic pathology critical diagnosis guideline such as this should only be used as a template because the list needs to be customized at each individual hospital after consultation with relevant clinical services. Based on surveys of the membership of the ADASP, this document provides examples of possible critical diagnoses in anatomic pathology.

Diagnostic Errors↗
PubMed2004

Developing evidence-based interdisciplinary care standards and implications for improving patient safety.

AIM: Establish an organizational infrastructure to foster the delivery of quality clinical care through the development of interdisciplinary patient care standards that are evidenced-based and consistent throughout IHC. DESIGN: Develop a process for document development, review, and approval that includes best evidence from research and input from clinical experts. RESULTS: After six years of development, the electronic reference InfoBase (a searchable online reference manual which provides easy access to standards for clinical practice throughout the organization) contains over 700 interdisciplinary patient care standards (e.g., protocols, procedures, standards of care) and over 1000 "information chunks" (e.g., assessments, instructions, scales, tables, graphics) that support consistency in care delivery. All documents have been written, based on the best evidence available from research and reviewed by a group of clinicians at IHC facilities and approved for use throughout the company. An example of how standardization of interdisciplinary standards can improve patient safety in the area of falls is also included.

Accidental Falls↗
PubMed2007

Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?

The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.

Cooperative Behavior↗
PubMed2006

A method for determining information flow breakdown in clinical systems.

This paper presents Determining Information flow Breakdown (DIB), a method for analyzing adverse events in clinical environments from the perspective of breakdowns in information flow. The larger context for DIB is that it is the first stage in a process that promotes organizational learning in response to adverse events through the design of novel IT solutions. DIB is based on the theoretical view of distributed cognition and adopts a system-wide view of failures. DIB is both a reactive and a proactive method in that it aims to locate the causes of either actual or potential adverse events by investigating all elements of the system related to a chosen aspect of patient care. It was developed and evolved using a case study approach whereby data on actual and potential adverse events in clinical environments was collected, modeled and analyzed using successive versions of the method. We provide an explanation and overview of the DIB method, and discuss our experiences of applying it in practice via a detailed example.

Humans↗
PubMed2006

Categorizing the unintended sociotechnical consequences of computerized provider order entry.

OBJECTIVE: To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting. DESIGN: Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics. MEASUREMENTS: Instances of unintended consequences were categorized using an expanded Diffusion of Innovations theory framework. RESULTS: The framework was clarified and expanded. There are both desirable and undesirable unintended consequences, and they can be either direct or indirect, but there are also many consequences that are not clearly either desirable or undesirable or may even be both, depending on one's perspective. The undesirable consequences include error and security concerns and issues related to alerts, workflow, ergonomics, interpersonal relations, and reimplementations. CONCLUSION: Consequences of implementing and reimplementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences.

Ambulatory Care↗
PubMed2006

Individualization, globalization and health--about sustainable information technologies and the aim of medical informatics.

This paper discusses aspects of information technologies for health care, in particular on transinstitutional health information systems (HIS) and on health-enabling technologies, with some consequences for the aim of medical informatics. It is argued that with the extended range of health information systems and the perspective of having adequate transinstitutional HIS architectures, a substantial contribution can be made to better patient-centered care, with possibilities ranging from regional, national to even global care. It is also argued that in applying health-enabling technologies, using ubiquitous, pervasive computing environments and ambient intelligence approaches, we can expect that in addition care will become more specific and tailored for the individual, and that we can achieve better personalized care. In developing health care systems towards transinstitutional HIS and health-enabling technologies, the aim of medical informatics, to contribute to the progress of the sciences and to high-quality, efficient, and affordable health care that does justice to the individual and to society, may be extended to also contributing to self-determined and self-sufficient (autonomous) life. Reference is made and examples are given from the Yearbook of Medical Informatics of the International Medical Informatics Association (IMIA) and from the work of Professor Jochen Moehr.

Decision Trees↗
PubMed2004

A multidimensional analysis of the epistemic origins of nursing theories, models, and frameworks.

The purpose of this article is to introduce our notion of epistemic space and to demonstrate its utility for understanding the origins and trajectories of nursing theory in the 20th century using multidimensional scaling (MDS). A literature review was conducted on primary and secondary sources written by and about 20 nurse theorists to investigate whether or not they cited 129 different scholars in the fields of anthropology, biology, nursing, philosophy, psychology, and sociology. Seventy-four scholars were identified as having been cited by at least two nurse theorists (319 citations total). Proximity scores, quantifying the similarity among nurse theorists based on proportions of shared citations, were calculated and analyzed using MDS. The emergent model of epistemic space that accommodated these similarities among nurse theorists revealed the systematic influence of scholars from various fields, notably psychology, biology, and philosophy. We believe that this schema and resulting taxonomy will prove useful for furthering our understanding of the relationships among nursing theories and theories in other fields of science.

Anthropology, Cultural↗